Citation Nr: 21072865 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 12-03 227 DATE: December 6, 2021 REMANDED Entitlement to a disability rating in excess of 10 percent for left eye pterygium is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1961 to June 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2012, the Veteran testified at a travel Board hearing before the undersigned. In a November 2014 decision, the Board denied the Veteran's claim of entitlement to a compensable rating for left eye disability. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In September 2015, the Court granted a Joint Motion for Remand (JMR), remanding the matter for action consistent with the terms of the JMR. A November 2015 Board decision remanded the matter to schedule the Veteran for a VA examination. Following a February 2016 VA examination, a March 2017 Board decision granted a 10 percent rating, but no higher, for the Veteran's left eye disability. A May 2017 rating decision implemented the Board's March 2017 decision, granting a 10 percent rating for the Veteran's left eye disability effective April 1, 2011, the date of receipt of the Veteran's increased rating claim. The Veteran appealed the Board's March 2017 decision to the Court. In December 2017, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the portion of the March 2017 Board decision that denied a rating in excess of 10 percent for left eye disability. Following the Court's December 2017 JMPR, the Board remanded the left eye disability issue in June 2018, July 2020, and November 2020 to obtain addendum VA medical opinions. The Board's July 2021 remand directed the RO to send the Veteran's representative a copy of a May 2021 supplemental statement of the case to his new address. The Board finds that there has been substantial compliance with its July 2021 remand directives, and it will proceed with adjudication of the issue on appeal. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to a disability rating in excess of 10 percent for left eye pterygium is remanded. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). During a May 2021 VA examination, in addition to the Veteran's service-connected left eye pterygium, the examiner continued to find diagnoses of left eye cataract and left eye meibomian gland dysfunction, which were previously diagnosed during the 2016 VA examination. A new diagnosis of left eye vitreous detachment was also diagnosed. The examiner opined that the Veteran's left eye cataract and left eye vitreous detachment are inside the eye and are unrelated to the Veteran's left eye pterygium, without any further rationale. The VA examiner's opinion is conclusory in nature. The opinion does not adequately address whether the Veteran's left eye cataract and left eye vitreous detachment are symptoms of the Veteran's service-connected left eye pterygium or are separate diagnoses that may be proximately due to or aggravated beyond normal progression by his service-connected left eye pterygium. Such limits the Board's ability to make a fully-informed decision as to whether or not the Veteran's service-connected left eye pterygium warrants a higher disability rating and whether separate evaluations may be warranted for the diagnoses of left eye vitreous detachment and left eye cataract. A remand is necessary to obtain an addendum VA medical opinion. Regarding the Veteran's left eye meibomian gland dysfunction diagnosed during the May 2021 VA examination, the examiner stated that this disorder is a condition of the eye lid, while a pterygium is caused by exposure of the bulbar conjunctiva to wind, dust, and ultraviolet light. However, in support of his claim, the Veteran submitted two medical journal articles in July 2021 that discuss a correlation between a pterygium and meibomian gland dysfunction. While such medical literature does not reference the specific facts particular to the Veteran's claim, this medical evidence should be addressed by the VA examiner upon remand. See Wallin v. West, 11 Vet. App. 509 (1998); see also Sacks v. West, 11 Vet. App. 314, 317 (1998). The matter is REMANDED for the following action: Return the claims file to the optometrist who performed the May 2021 VA eye examination, if available, otherwise, to an appropriate medical professional, to obtain an addendum opinion regarding the etiology of the Veteran's left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment. The Veteran's electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. Following the review of the claims file, the medical opinion provider is then requested to respond to the following: a. Are the Veteran's left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment symptoms that are attributed to his service-connected left eye pterygium? b. If not, is it at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran's left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment are proximately due to or caused by the Veteran's service-connected left eye pterygium? c. If not, is it at least as likely as not that the Veteran's left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment underwent aggravation, i.e., any incremental increase in disability, regardless of its permanence, due to the service-connected left eye pterygium? 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. Moreover, any "incremental increase in disability" need not be permanent. If the Veteran's left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment are found to be wholly unrelated to the Veteran's service-connected left eye pterygium, the examiner must determine whether the symptoms from the left eye meibomian gland dysfunction, left eye cataract, and left eye vitreous detachment can be clearly delineated from the service-connected left eye pterygium. If so, the examiner must clearly identify which symptoms are due to each disability. If the symptoms from the four disorders cannot be clearly delineated, this must be expressly stated. In rendering the above opinions, the examiner must specifically consider the medical journal evidence submitted by the Veteran in July 2021 in support of his claim. If the requested opinions cannot be provided without a new examination, one should be scheduled. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Houle, 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.