Citation Nr: 21073154 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 15-22 903 DATE: December 7, 2021 REMANDED Entitlement to service connection for a bilateral eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July to September 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. This matter was previously before the Board in September 2019, at which time it was denied. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In an August 2020 Joint Motion for Remand (JMR), the parties agreed that the Board erroneously relied on an inadequate VA medical opinion that failed to discuss all of the evidence and improperly relied on a lack of records of any in service injury, event, or illness. The parties also agreed that the Board erred by not providing a complete finding of whether there is clear and unmistakable evidence that the Veteran's eye disabilities preexisted service to rebut the presumption of soundness. The Court then vacated the decision and remanded for further development. The appeal then returned to the Board in May 2021. At that time, the Board remanded the claim to obtain a medical opinion that addressed the issues raised in the August 2020 JMR. Bilateral Eye Disability is remanded In its August 2021 remand, the Board directed the AOJ to provide the Veteran a VA opinion whether the Veteran's eye condition is considered a congenital defect or congenital disease. The August 2021 remand explained for VA purposes, a defect is a structural or inherent abnormality or condition that is more or less stationary in nature and is generally incapable of improvement or deterioration. In contrast, a disease is capable of improvement or deterioration. The October 2021 VA addendum opinions stated the Veteran's bilateral eye condition was a congenital defect in one opinion and said it was a congenital disease in another opinion. The Board requires a clear explanation as to whether the Veteran's eye disability is a congenital defect or a congenital disease. The August 2021 Board remand also directed the examiner to consider and explain the significance of the difference in PULHES scores for eyes "E" from the Veteran's November 1966 preinduction evaluation and the July 6, 1967 induction evaluation (PULHES scores of "2") to his July 28, 1967 medical board examination (PULHES score of "4"). Whether the VA examiner finds the Veteran's bilateral eye condition is a congenital defect or a congenital disease, the examiner should address the significance of the difference in PULHES scores between November 1966 preinduction evaluation and the July 6, 1967 induction evaluation and July 28, 1967 examination. The examiner also failed to address the Veteran's description of his injury in his testimony at the February 2019 Board hearing. Accordingly, the October 2021 VA opinions are inadequate for decision making purposes and do not substantially comply with the Board's August 2021 remand directives. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Board remand). Therefore, the Board finds that another medical opinion is warranted. The matters are REMANDED for the following action: 1. Obtain an opinion addressing the Veteran's diagnosed eye conditions. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the opinion. Following review of the complete electronic file, the examiner is asked to address the following for each of the Veteran's eye conditions: (a.) Is the Veteran's eye condition a congenital defect or congenital disease? For VA purposes, a defect is a structural or inherent abnormality or condition that is more or less stationary in nature and is generally incapable of improvement or deterioration. In contrast, a disease is capable of improvement or deterioration. (b.) If the Veteran's eye condition is a congenital defect, is it at least as likely as not (i.e., a 50 percent or greater probability) subject to a superimposed disease or injury during military service that resulted in additional disability apart from the congenital or developmental defect? (c.) If the Veteran's eye condition is a congenital disease, does the evidence show it was aggravated (worsened) by the Veteran's military service? If there was worsening, was this due to the natural progress of the disease? The examiner should note the Veteran's description of his injury in his testimony at the February 2019 Board hearing, a transcript of which is attached to the file. The examiner is directed to consider and explain the significance of the difference in PULHES scores from the Veteran's November 7, 1966 preinduction evaluation and July 6, 1967 induction evaluation (PULHES score of "2") to his July 28, 1967 medical board examination (PULHES score of "4"). R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. St. Laurent, 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.