Citation Nr: 21070948 Decision Date: 11/27/21 Archive Date: 11/27/21 DOCKET NO. 16-14 730 DATE: November 27, 2021 REMANDED Entitlement to service connection for macular degeneration and cataracts, to include as due to exposure to herbicide agents or as secondary to service-connected ischemic heart disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1962 to May 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript is on record. In January 2020, the Board remanded the claim for further development, to include an opinion clarifying the current eye diagnoses and their etiologies. In June 2021, the Board again remanded the claim for development regarding etiologies of the eye conditions, to include separate findings and rationales on whether his eye conditions were caused or have been aggravated by his service-connected ischemic heart disease. When the appeal was last before the Board, it included a claim for service connection for hypertension, which was subsequently granted in a July 2021 rating decision. As the benefit sought on appeal was granted in full, the claim for service connection for hypertension is no longer before the Board. Entitlement to service connection for macular degeneration and cataracts, to include as due to exposure to herbicide agents or as secondary to service-connected ischemic heart disease, is remanded. The claim was last remanded for a VA opinion to address whether the Veteran's macular degeneration and cataracts were caused by his exposure to herbicides during service or caused or aggravated by his service-connected ischemic heart disease. The Veteran was provided this VA opinion in June 2021. However, the Board finds the examiner's opinion as to whether the Veteran's eye conditions were caused or have been aggravated by his service-connected ischemic heart disease to be inadequate. Similar to the October 2020 examiner, in addressing secondary service connection, the June 2021 examiner did not provide separate findings and rationales for causation and aggravation, as required by the United States Court of Appeals for Veterans Claims (Court) in Atencio v. O'Rourke, 30 Vet. App. 74 (2018). As such, a remand is warranted to provide the Veteran an adequate VA opinion. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an eye clinician on the nature and etiology of the Veteran's macular degeneration and cataracts. The examiner must be provided the claims file for review and indicate such a review was completed. Following a review of the claims file, the examiner must address the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's macular degeneration and/or cataracts were caused by his service-connected ischemic heart disease, and (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's macular degeneration and/or cataracts have been aggravated by his service-connected ischemic heart disease. **As indicated by the above, separated instructions and as required by the Court in Atencio v. O'Rourke, 30 Vet. App. 74 (2018), separate findings and rationales must be provided for causation and aggravation.** The examiner is also advised that aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice-connected disability. All opinions must contain clear conclusions, supporting data, and a reasoned medical explanation connecting the two. Stefl v. Nicholson, 21 Vet. App. 120 (2007). (Continued on the next page) 2. Then, readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, Associate 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.