Citation Nr: 21070920 Decision Date: 11/27/21 Archive Date: 11/27/21 DOCKET NO. 17-40 446 DATE: November 27, 2021 REMANDED Entitlement to service connection for a bilateral eye condition, manifested as include retinal degenerative condition, is remanded. Entitlement to service connection for a bilateral eye condition, manifested as include depth perception defect, is remanded. Entitlement to service connection for an ear condition, to include cerumen impaction is remanded. Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. REASONS FOR REMAND The Veteran had active service from March 1981 to January 2003. In March 2019, the Board of Veterans' Affairs (Board) remanded these issues for additional development, to include VA medical examinations and etiology opinions. That development has been completed, and the case returns to the Board for adjudication. The March 2019 Board remand is incorporated herein by reference. Unfortunately, the Board finds an additional remand is necessary. 1. Entitlement to service connection for a bilateral eye condition, manifested as retinal degeneration 2. Entitlement to service connection for a bilateral eye condition, manifested as defective depth perception The Veteran contends she has a bilateral eye condition, involving both retinal degeneration and defective depth perception, related to active service. The Board finds that additional development is necessary before adjudication of this issue can be completed. The Veteran's entrance medical report did indicate defective visual acuity. Service medical records show that during active duty, the Veteran frequently sought treatment for blurred vision and perception distortion. For example, in January 1986 she complained of reduced vision at night, and in June 1991, she was assessed as having perception distortion. A May 2015 VA medical record shows a worsening of the Veteran's depth perception. On VA examination in November 2019, the Veteran reported that she worked long hours in front of a computer and has dry eyes, eyestrain, depth perception issues, headaches, and blurred vision. She used artificial tears for dry eyes a few times per week, for 15 years. The examiner found no visual field defect, excellent corrected vision, and only a diagnosis of dry eye syndrome. Internal eye testing was normal. The examiner remarked that additional testing was necessary to evaluate the Veteran's visual fields. The examiner also commented that the Veteran's vision conditions pre-existed service, and that it was less likely than not aggravated by in-service injury, event, or illness. In an addendum opinion, the examiner was unable to detect retinal degeneration on examination and the Veteran had 20/20 vision and full fields. Noting that medical records are silent for any eye examination notes of retinal degeneration, and records dated 1981, 1982, 1988, 1991, 1994, 2001, and 2015 show corrected vision in both eyes, it was less likely aggravated by in-service injury event, or illness. The Board notes that while the Veteran's entrance examination does show previous visual acuity defect upon enlistment, but does not indicate any other eye condition pre-existing active duty service. The VA medical opinions appear to contradict each other in that one of the piecemeal reports states that the Veteran's eye conditions exist, but preexisted service, and another from the same date states there was no currently diagnosed eye disability. Additionally, there was no discussion of the Veteran's in-service and post-service complaints and treatment for frequent eye complaints such as depth perception issues. As these reports are unclear and contradictory, they are inadequate, and a remand is necessary in order to obtain an addendum opinion. 3. Entitlement to service connection for an ear condition, to include cerumen impaction The Veteran contends that she has an ear condition which began during, and is related to, active service. The Board finds the evidence of record is inadequate, and a remand is necessary for further development. Service treatment records indication the Veteran reported experiencing dizziness in December 1992 and in September 1998. In February 1996, the Veteran complained ear symptoms and reported a prior similar episode. The medical provider assessed dizziness and possible vertigo. VA medical records from March 2015 indicate a diagnosis of impacted cerumen of the left ear. Private medical records from May 2015 confirmed a diagnosis of impacted cerumen of the right ear. An additional VA record from February 2016 shows 100% impacted cerumen bilaterally. On VA examination in November 2019, the Veteran reported pain in ears, and a feeling of fullness. The examiner found that there was no diagnosis, as there were no current signs or symptoms to support a diagnosis of impacted cerumen or other ear condition. In the accompanying opinion, the examiner stated that after reviewing all medical records and performing physical examination, there is no current pathology and/or diagnosis of cerumen impaction to render a medical opinion. Therefore the claimed condition is less likely than not incurred in and/or caused by active service. The Board finds this examination and opinion is not adequate. The examiner stated that all medical records were reviewed, but there was no discussion of the impacted cerumen diagnosed during the appeal period, or the complaints in service of ear problems and dizziness. Remand is required for an opinion that considers these complaints and findings. 4. Entitlement to service connection for a sleep disorder, to include sleep apnea The Veteran contends that she has sleep apnea related to active service. The Board finds that additional development is necessary before adjudication of this issue can be completed. In a June 2015 statement, the Veteran indicated that her sleep disturbance began in 1996 aboard the USS Harry S. Truman due to noise from the flight deck, and has worsened recently. Private medical records show the Veteran has been prescribed Ambien for sleep. VA medical records from April 2016 indicate that the Veteran had signs and symptoms consistent with sleep apnea. Additionally, the medical provider suspected here is an element of psychophysiologic insomnia precipitated by her time on an aircraft carrier and perpetuated over many years. As a result of a November 2019 sleep study, the Veteran was diagnosed with mild obstructive sleep apnea syndrome (OSA). In the accompanying medical opinion, the examiner opined that it was less likely as not that the Veteran's OSA was related to service as there are no medical records showing diagnosis, treatment, or complaints related to a sleep condition during active service. Records show unrelated complaints of dizzy spells, ear complaints, and positional vertigo during active duty however, there were no reports of sleep disturbance during service. The Board finds the November 2019 medical opinion inadequate. There was no discussion of the Veteran's lay statements of sleep disturbances beginning during service and continuing, and why those disturbances were or were not related to current sleep apnea. Further, the examiner failed to address the examination finding that the April 2016 report indicating a possible connection between the Veteran's current OSA as precipitated by her active service. For these reasons, an additional remand is necessary in order to obtain an adequate medical opinion. The matters are REMANDED for the following actions: 1. Obtain any outstanding relevant VA or private medical records. Obtain any necessary authorizations from the Veteran for outstanding relevant private records. All attempts to obtain this information shall be documented in the claims file. 2. Then, obtain addendum opinions regarding the Veteran's eye condition(s), ear condition(s), and OSA. In each case, the examiner is reminded to consider the Veteran's competent and credible history, as well as the in-service complaints of eye and ear issues, in addition to addressing any contradictory information. 3. In the case of the Veteran's eye conditions, the examiner must explain whether there is clear and unmistakable evidence that the Veteran's depth perception and any other condition pre-existed service, and if so whether there is evidence that it was clearly and unmistakably not aggravated during service. The examiner is also asked to discern between any visual acuity defect that would not be considered for service connection and other eye conditions. (Continued on the next page) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's claimed conditions began during, or are otherwise related to or caused by active duty. Adequate rationale is required for all opinions provided. If these opinions cannot be provided without an additional examination, the Veteran should be scheduled for an additional examination. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.E. Lee 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.