Citation Nr: 21070427 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 17-37 619 DATE: November 23, 2021 REMANDED Entitlement to a rating in excess of 10 percent for pulmonary tuberculosis prior to May 17, 2017, and a rating in excess of 30 percent since is remanded. Entitlement to service connection for a left eye disorder, claimed as retinal tear and detachment, is remanded. Entitlement to service connection for a right eye disorder, claimed as retinal tear and detachment, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1977 to September 1981. In January 2021, the Veteran and his wife testified before the undersigned Veterans Law Judge in a virtual tele-hearing. A copy of the transcript has been associated with the claims file. 1. Pulmonary tuberculosis The Veteran is seeking entitlement to a rating in excess of 10 percent prior to May 17, 2017, and 30 percent thereafter for his service-connected pulmonary tuberculosis disability. In support of his claim, the Veteran testified during his January 2021 Board hearing that he feels his breathing has gotten worse, and he has no energy level. The Veteran was last examined by VA in May 2017. Therefore, the Board finds that a new VA examination is needed to ascertain the current severity and manifestation of the service-connected disability. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). 2. Left and right eye disorders The Veteran is seeking entitlement to service connection for right and left eye disorders, claimed as retina tear and detachment. During his January 2021 hearing, the Veteran also stated that it was his belief the left and right eye disorders are due to the medications he was taking for his pulmonary tuberculosis. See January 2021 Board Hearing Transcript. The Veteran's VA treatment records show several currently diagnosed eye disorders, to include partial detachment in the left (OS), and corneal abrasion, lens replacement, horseshoe tear of the retina, nuclear sclerotic cataract, retinal detachment of the right eye (OD), and suspected glaucoma of both eyes. See January 2014 VA Treatment Record. However, the Board cannot make a fully-informed decision on this issue because no VA examiner has opined whether any impairment of the eye disorders are due to the Veteran's service, or are due to or aggravated by his service-connected pulmonary tuberculosis, to include the use of medications for that disability. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, a remand is required for a VA examination and opinion. The matters are REMANDED for the following action: 1. Obtain any available VA or private treatment records not currently associated with the claims folder dated from October 2018 to the present. 2. Schedule the Veteran for a VA examination to ascertain the severity and manifestations of his service-connected pulmonary tuberculosis. Any studies, tests (including a pulmonary function test (PFT)), and evaluations deemed necessary by the examiner should be performed. The examiner is instructed to review all pertinent records associated with the claims file. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology, such as decreased breathing ability and energy levels. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of the claimed left and right eye disorders. A complete rationale for all opinions offered must be provided. The examiner(s) is asked to provide an opinion on the following, with a full rationale: (a.) Identify any and all currently diagnosed eye disorders, to include partial detachment in the left (OS), and corneal abrasion, lens replacement, horseshoe tear of the retina, nuclear sclerotic cataract, retinal detachment of the right eye (OD), and suspected glaucoma of both eyes. See January 2014 VA Treatment Record. (b.) For each disorder, the examiner is asked to state the following: 1. whether each disorder is at least as likely as not (a 50 percent or greater probability) related to the Veteran's active service. 2. Whether it is at least as likely as not that each disorder was caused by the service-connected pulmonary tuberculosis disability, to include the use of medications for this disability, yes or no? 3. Is it at least as likely as not that the Veteran's disorders underwent any aggravation (incremental increase in disability, regardless of its permanence), due to the pulmonary tuberculosis, to include the use of medications for this disability, yes or no? The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. In answering these questions, the examiner is asked to consider the medical treatise information submitted by the Veteran in July 2017 showing a correlation between the Veteran's medication for his pulmonary tuberculosis and various eye disorders. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.