Citation Nr: 21072588
Decision Date: 12/03/21	Archive Date: 12/03/21

DOCKET NO. 17-01 770
DATE: December 3, 2021

REMANDED

Service connection for left eye herpetic ulcer, to include as secondary to service-connected diabetes mellitus is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1965 to November 1972.  

This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision of a Regional Office of the Department of Veterans Affairs.

While the Board regrets further delay, remand is necessary to ensure proper development of the claim.  Specifically, the Board finds that the most recent VA medical opinion is not adequate.  The Board remanded the claim in June 2021 to obtain a VA opinion on secondary service connection which included an explanation.  An opinion was obtained in August 2021.  The examiner opined that the residuals of left eye ulcer were less likely than not "proximately aggravated" by diabetes and is most likely due to herpetic issues the Veteran developed in the 1990s.  The examiner stated that there was no nexus between the left eye ulcer and diabetes and that "this is not supported by the STR."  Further, the examiner stated that corneal ulcers are caused by bacterial or viral infections, not by diabetes.

The Board initially notes that the examiner did not provide the two specific opinions requested regarding secondary service connection.  Further, stating that a nexus is not supported by the STRs is not relevant to secondary service connection, therefore that explanation is not adequate.  Lastly, while the examiner found that diabetes did not cause corneal ulcers, the Veteran's representative has submitted evidence indicating a possible relationship between diabetes weakening the immune system, which can lead to the contraction of herpes.  The Board finds that a new opinion is needed which provides appropriate opinions with complete rationales, including addressing all evidence of record and theories of connection presented by the Veteran.

The matter is REMANDED for the following action:

1. Associate any pertinent VA or private medical records that are not already of record with the claims file.

2. Obtain a medical opinion from a medical doctor that has not previously provided an opinion to determine the nature and etiology of any left eye corneal or ulcer disability.  The examiner must review the claims file, including medical articles submitted by the Veteran, and should note that review in the report.  A complete rationale for all opinions should be provided. The examiner should explicitly provide the following opinions:

(a.) Is it at least as likely as not (50 percent or greater probability) that any left eye ulcer or corneal disability is due to or the result of service-connected disabilities, diabetes mellitus?  The examiner must specifically address the literature submitted by the Veteran indicating that diabetes mellitus results in a weakened immune system, which made the Veteran more susceptible to contracting herpes.

(b.) Is it at least as likely as not (50 percent or greater probability) that any left eye ulcer or corneal disability has been aggravated (permanently increased in severity beyond the natural progression of the disability) by service-connected disabilities, including diabetes mellitus?  The examiner must specifically address the literature submitted by the Veteran indicating that diabetes mellitus results in a weakened immune system, which made the Veteran more susceptible to contracting herpes.

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Ahmad

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.