Citation Nr: 21074763 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 16-31 304 DATE: December 16, 2021 ORDER Entitlement to service connection for blepharitis and dry eyes is granted. Entitlement to service connection for a disorder of the bladder and urinary tract is denied. Entitlement to service connection for a skin disorder is denied. Entitlement to special monthly compensation based on a need for aid and attendance is denied. REMANDED Entitlement to an eye disorder other than blepharitis and dry eyes, including retinopathy secondary to hypercholesterolemia, is remanded. Entitlement to service connection for a gastrointestinal disorder, to include irritable bowel syndrome (IBS), Crohn's disease, and ulcerative colitis, is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for a thyroid disorder is remanded. FINDINGS OF FACT 1. The Veteran has current diagnoses of blepharitis and dry eyes that were as likely as not incurred in or caused by service. 2. The preponderance of the probative medical evidence is against finding that the Veteran has a disorder of the bladder or urinary tract that was incurred in or is related to service. 3. The preponderance of the probative medical evidence is against finding that the Veteran has a chronic skin disorder that was incurred in or is related to service. 4. The Veteran does not require the aid and assistance of another person. CONCLUSIONS OF LAW 1. The criteria for service connection for blepharitis and dry eyes have been met. 38 U.S.C. §§ 1110, 1116(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309(e). 2. The criteria for service connection for a bladder or urinary tract disorder have not been met. 38 U.S.C. §§ 1110, 1116(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for a skin disorder have not been met. 38 U.S.C. §§ 1110, 1116(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for special monthly compensation based on the need for aid and attendance of another have not been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1966 to June 1969, with additional service in the Army National Guard. The Veteran served in the Republic of Vietnam and is the recipient of the Purple Heart Medal. This case comes to the Board of Veterans' Appeals (Board) from April 2014 and January 2019 rating decisions by the Department of Veterans Affairs (VA) Regional Office. These issues were remanded by the Board in August 2020 and May 2021 for further development. Bilateral Eye Disorder: Blepharitis and Dry Eyes The Veteran contends that he has a bilateral eye disorder that was incurred in service or that is related to either his exposure to Agent Orange, contaminated water at Camp Lejeune, or to the traumatic brain injury (TBI) he incurred in 1969. The Board notes that the Veteran's initial July 2012 claim was for "chronic itching and burning of eyes." Because the Veteran has been found to have multiple diagnoses relating to his eyes, including blepharitis, dry eyes, retinopathy secondary to hypercholesterolemia, posterior vitreous detachment, and cataracts, the issue has been expanded to include any relevant eye disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Because only two of the Veteran's current eye diagnoses have been related to his service, the Board is granting these disorders, and remanding the issue of entitlement to an eye disorder other than blepharitis and dry eyes, and it is discussed further below. Generally, service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires evidence satisfying three criteria: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain diseases may be presumed to have been incurred in service when a Veteran has been exposed, or may be presumed to have been exposed, to herbicide agents, such as Agent Orange, in service. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307(a)(6), 3.307(d)(1), 3.309(e). In this case, the Veteran has service in the Republic of Vietnam, and it is presumed that he was exposed to herbicide agents. The Veteran's eye disorders are not, however, diseases that have been found to be associated with herbicide agent exposure. Even though the claimed disorders do not qualify for the presumption of being caused by herbicide agent exposure, service connection may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). After reviewing the evidence of record, the Board finds that there is probative medical evidence which establishes that the Veteran has current diagnoses of blepharitis and dry eyes, and that these disorders were incurred in service. The Veteran attended a VA eye examination in July 2021. The examining optometrist found that the Veteran had diagnoses of bilateral blepharitis and dry eyes. She wrote that the Veteran's watery, itchy eyes had been a problem since the time of his service, and that he believed that it was directly related to contact with exposure to contaminants at Camp Lejeune and in Vietnam. She wrote that these symptoms were related to his chronic blepharitis and dry eye, and that they were directly related to exposure to herbicide agents that he suffered in service. The Board finds that this medical opinion constitutes adequate competent medical evidence which is based on an accurate understanding of the Veteran's medical history, and which provide probative medical evidence that supports the Veteran's claim. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). There are no other contradictory medical opinions which came to a different conclusion regarding the etiology of the Veteran's blepharitis and dry eyes. Because there is probative evidence that the Veteran has current diagnoses of blepharitis and dry eyes, and these disorders were related by competent medical evidence to his exposure to herbicide agents in service, the claim is granted. Bladder and Urinary Tract The Veteran has also requested service connection for a bladder and urinary tract disorder. At a May 2017 Decision Review Officer hearing, the Veteran testified that he has to wear Depends at times because he has urinary leakage, and that he also has problems with urinary urgency. He stated that this started when he was in his 40s and still in the National Guard. The Veteran had service in Vietnam, and therefore it is presumed that he had exposure to herbicide agents. 38 U.S.C. § 1116(a); 38 C.F.R. §§ 3.307(a)(6), 3.307(d)(1), 3.309(e). While urinary incontinence and benign prostatic hypertrophy are not diseases that qualify for the presumption of being caused by herbicide agent exposure, service connection may be established by showing that a disorder was in fact causally linked to such exposure. See Combee, 34 F.3d 1039. The Veteran has also been recognized as having had service at Camp Lejeune during the requisite period for the presumption of exposure to contaminated water. While the list of diseases that VA has recognized as being presumed to be the result of exposure to contaminated at Camp Lejeune includes bladder cancer, there is no evidence that the Veteran has ever been found to have bladder cancer, and this presumption therefore does not apply. See 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The list does not include benign prostatic hypertrophy or any other bladder disorder. The Board will nonetheless also consider whether service connection may be established by showing that the disorder was in fact causally linked to such exposure. While the Veteran has diagnosed disorders of benign prostatic hypertrophy and urinary incontinence, there is no probative medical evidence linking these disorders to the Veteran's service, including his exposure to herbicide agents in Vietnam and to contaminated water at Camp Lejeune. At a December 2015 VA examination, the Veteran was found to have a voiding dysfunction which caused daytime voiding interval between 1 and 2 hours, and nighttime awakening to void 3 to 4 times. It was found to be due to the natural aging process, and it did not require the wearing of absorbent material. At an August 2021 VA examination, the Veteran was found to have a voiding dysfunction that required absorbent material which must be changed less than 2 times a day. He also had urinary frequency, hesitancy, and slow stream. He did not have any bladder calculi, benign or malignant neoplasms, or other signs or symptoms. He was diagnosed with benign prostatic hypertrophy and urinary incontinence. The examiner found that it was less likely than not that the Veteran's disorder was incurred in or caused by service. He explained that the Veteran had a known history of benign prostatic hypertrophy, but there was no documentation of a diagnosis or treatment for this in service, and that there was no documentation of any bladder cancer. He wrote that there was no documentation in the medical literature of the development of benign prostatic hypertrophy connected to exposure to Agent Orange or to contaminated water from Camp Lejeune, and that his condition was more likely than not due to natural growth of the prostate gland in advanced years. The Board finds the VA examination reports to be highly probative evidence that weighs against the claim. The August 2021 VA opinion, which was based on review of the appellant's documented and asserted medical history and an in-person examination, constitutes probative evidence on the medical nexus question. See Prejean, 13 Vet. App. 444 (2000). The Board finds that this medical opinion is supported by the evidence of record, and the examiner provided adequate rationale for his findings. It is also consistent with the December 2015 VA examination, which found that the Veteran's urinary incontinence was due to the natural aging process. There are no contradictory medical opinions of record which came to a different conclusion regarding the Veteran's urinary dysfunction. The Veteran has not submitted any other medical evidence regarding the etiology of urinary dysfunction. While the Veteran may believe that his urinary disorder is related to exposure to herbicide agents or contaminated water, such lay assertions do not constitute probative medical evidence. The Veteran is competent to describe his symptoms as he perceives them, but as a lay person, he is not competent to opine on the etiology of his voiding dysfunction and benign prostatic hypertrophy, and his assertions are outweighed by the more probative VA medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). For the foregoing reasons, the Board finds that the evidence demonstrates that the Veteran's bladder/urinary disorder was not incurred in or related to service, and the claim for service connection is denied. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Skin Disorder The Veteran has also requested service connection for a skin disorder that he believes began in service or that is related to exposure to herbicide agents in Vietnam or to contaminated water at Camp Lejeune. The Veteran testified at a May 2017 Decision Review Officer hearing that he began having skin problems in 1969, once he got out of Vietnam. He stated that he itches all of the time, and that he gets hives. After reviewing all of the evidence of record, the Board finds that the preponderance of the evidence demonstrates that the Veteran does not have a current diagnosis of a chronic skin disorder, nor has he had such a disorder at any time during the pendency of the claim. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997). The Board acknowledges that the Veteran experienced some challenging skin problems in service. March 1967 Service Treatment Records demonstrate the Veteran had boils and a skin infection in Vietnam. In October 1967, it was noted he had infected sores on his right arm resembling cellulitis. In December 1967, he had sores on his left hand and elbow. In June 1968, he reported that he had, or had in the past, boils. In July 1968 and January 1969, he had boils on his neck, and in April 1969, he had an abcess on his buttocks. While the Veteran had skin problems in service, there is no evidence indicating that any of these skin problems have continued to the present day, or that he currently has any chronic skin disorder. At an October 2013 VA examination, the Veteran reported that he had itchy skin problems for 40 years, and that he believed it was related to Agent Orange. The examiner did not, however, find that the Veteran had, or had ever had, a skin condition. There were no visible skin conditions, and no functional impact of a skin condition. He wrote that no skin conditions were found on examination, and therefore no condition was related to his treatment in service. The Veteran next attended a VA skin examination in January 2019. The Veteran reported that his symptoms began in 1970 and that he had itching all over his body. He stated that he still has flare ups that require over-the-counter medication to relieve the itching. The examiner performed a physical examination, but he did not have any active findings of a chronic skin condition on examination, and no current skin diagnosis could be rendered. The examiner wrote that there was no diagnosis, because there was no pathology to render a diagnosis. The Veteran most recently attended a VA examination in August 2021. He reported that he had rashes, itchy skin, and hair loss with his skin disorder, and that he continued to use calamine lotion and Benadryl. The examiner performed a physical examination, but could not provide any diagnosis because there were no findings, signs, or symptoms to support a diagnosis. The Board acknowledges that the VA examiner who provided the January 2019 and August 2021 VA examinations and opinions provided an inaccurate statement in his rationale when he wrote that there was no documentation of evaluation or treatment for a skin condition in service. This is clearly incorrect, and does greatly diminish the probative value of any nexus opinion that he provided. However, in this case, the preponderance of the evidence indicates that the Veteran does not have a current disability, and in the absence of the first element required for establishing service connection, it is irrelevant whether an adequate nexus has been obtained, and therefore this error is harmless. See 38 C.F.R. § 3.303(a); Shedden, 381 F.3d at 1167. The Veteran's VA and private treatment records show intermittent reports of itching or rash, but no indication that he has received any diagnosis of a chronic skin disorder. The Veteran has been prescribed ammonium lactate lotion for dry skin on his feet, but he has not actually been found to have a diagnosis of any skin disorder on his feet, or for any other part of his body. He has also reported using Benadryl and anti-itch cream. The Veteran has had intermittent reports of itching, but nothing that is outside of ordinary, acute skin inflammations. In June 2016, he reported that he was walking through a wooded area and developed contact allergic dermatitis in the lower extremities, and he was going to use Benadryl cream. He was found to have skin urticaria (hives) on his lower extremities. In June 2017, the Veteran was noted to have a past medical history of rash medications. On an October 2019 medical history form, the Veteran just marked "itching." On many other separate occasions, the Veteran's skin has been found to be normal, and no other skin abnormalities have ever been indicated. The Board finds that the preponderance of the evidence indicates that the Veteran does not have a current chronic skin disorder. The Veteran has attended three VA skin examinations, none of which found any signs or symptoms of a current skin disorder. These examiners were aware of and discussed the Veteran's reports of often feeling itchy, but they found no clinical evidence to support a finding of any skin diagnosis. These examinations were based on in-person examination of the Veteran, and there is no indication that they are inaccurate in their findings. The Board has considered the Court of Appeals for Veterans Claims' holding in Saunders v. Wilkie, but does not find a basis for determining that there is functional impairment related to any skin symptoms, even in the absence of a formal diagnosis. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). None of the VA examinations found any skin symptoms at all, and while the Veteran's VA and private treatment records show that he has occasionally reported having itching skin, there is no indication that it has caused him any functional impairment. While the Veteran may believe that he has a chronic skin disorder, and he is competent to report that he uses over-the-counter medications such as calamine lotion, as a lay person, he is not competent to opine on a precise diagnosis or the etiology of a skin disorder. See Jandreau, 492 F.3d at 1377. In this case, while the Veteran is competent to report on his own symptoms as he experiences them, and these symptoms have been taken into consideration, he is not competent to diagnose himself with a chronic skin disorder, and his reports are outweighed by VA examination reports and medical treatment records. In sum, the evidence preponderates against finding entitlement to service connection for a skin disorder, and the claim is denied. The Board has again considered the doctrine of reasonable doubt, but the preponderance of the evidence is against the claim. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). SMC Based on a Need for Aid and Attendance The Veteran has also requested SMC based on a need for aid and attendance. The Veteran testified at a May 2017 Decision Review Officer hearing that he had difficulty walking and uses a walker. Special monthly compensation is payable under several circumstances, including when a veteran is permanently bedridden or so helpless as to be in need of the regular aid and attendance of another person. 38 U.S.C. § 1114; 38 C.F.R. § 3.350. A veteran shall be considered to be in need of regular aid and attendance if: he is blind or so nearly blind as to have corrected visual acuity of 5/200 or less, in both eyes, or concentric contraction of the visual field to 5 degrees or less; or is a patient in a nursing home because of mental or physical incapacity; or establishes a factual need for aid and attendance under the criteria set forth in 38 C.F.R. § 3.352. Determinations as to the need for aid and attendance are based on the actual requirements of personal assistance from others. In determining the need for regular aid and attendance, consideration will be given to the inability of the Veteran to dress or undress himself, or to keep himself clean; frequent need of adjustment of any prosthetic which by reason of the disability cannot be done without aid; inability of the Veteran to feed himself; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect himself from the hazards or dangers of his daily environment. Bedridden will be that condition which, through its essential character, actually requires that the Veteran remain in bed. 38 C.F.R. § 3.352. It is mandatory for VA to consider the enumerated factors within the regulation; at least one of the enumerated factors must be present. Turco v. Brown, 9 Vet. App. 222 (1996). The Veteran already has a 100 percent total schedular evaluation, and he has been granted entitlement to a total disability rating based on individual unemployability and SMC at the housebound rate under 38 U.S.C. § 1114(s). The preponderance of the evidence is, however, against a finding that he requires the aid and assistance of another person. The Board has considered all of the medical evidence of record, but finds that the preponderance of the evidence shows that the Veteran's disabilities are not so severe as to cause him to require regular aid and attendance or to be permanently bedridden. While the evidence indicates that the Veteran does have physical limitations that prevent him from doing moderately strenuous physical activities, the Veteran has not been found to be unable to perform activities of daily living on his own. He has never been found to need assistance in order to dress or undress himself, to keep himself clean, to feed himself, or to attend to the wants of nature, and he has not been found to require assistance on a regular basis to protect himself from the hazards or dangers of his daily environment. At a March 2013 VA examination, the Veteran discussed his typical day, which included getting cleaned up, going for a walk, working in the basement, and watching TV. He reported that he could not cook, and his wife made the meals. He was able to dress, feed, shower, and use the restroom by himself. He used a cane to ambulate and had limitations on how far he could walk, but he was able to perform his basic activities of daily living. He had difficulty with more difficult tasks, like shoveling snow or mowing the yard. At a December 2018 aid and attendance examination, the Veteran was noted to have some memory problems and a slow gait, and he was able to walk up to a few hundred yards. He used a walker. The examiner marked "No" for "Can Veteran travel beyond current domicile," but this is clearly in error, because he later wrote out that the Veteran was able to drive and leave the home without assistance. The Veteran reported that his brother had Alzheimer's disease and required his assistance, and the Veteran cared for him. The Veteran was able to handle his own finances. At an August 2021 VA examination, the Veteran had impairment with squatting, stooping, climbing, and kneeling. He was able to drive and leave the home as needed. The Veteran was found to be able to feed himself, prepare his own meals, and he did not need assistance with bathing or hygiene needs. He was able to manage his own medication and monetary payments. The preponderance of the evidence therefore shows that the Veteran's disabilities have not resulted in impairment to such an extent that he requires actual, regular personal assistance from others due to the inability to dress or undress himself; to keep himself clean; to feed himself; to attend to the wants of nature; to adjust a prosthetic device; or to protect himself from the hazards or dangers of his daily environment. He does not require medication management, and he is able to manage his financial affairs. There is no other probative medical evidence of record which contradicts the findings of these VA examinations or that indicates that he does need such assistance. The Board acknowledges that on the Veteran's January 2010 application for the Social Security Administration, he indicated that he had some difficulty putting on his socks, stepping over the tub edge, and wiping, but he did not indicate that he was unable to do these activities. He also wrote that his wife trimmed his toenails, but the Board does not find that this on its own indicates that he requires aid and attendance for all of his basic, daily needs. The Board recognizes that the Veteran does have many physical limitations and difficulties, and the 100 percent total rating that he has been assigned reflects that severity. The preponderance of the evidence demonstrates, however, that the Veteran is not in need of regular aid and attendance in performing activities of daily living due to any of his disabilities. Accordingly, he does not meet or more nearly approximate the criteria for special monthly compensation on that bases. Entitlement to special monthly compensation based on a need for aid and attendance is denied. The Board has again considered the doctrine of reasonable doubt, but the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b). REASONS FOR REMAND Bilateral Eye Disorder The Veteran contends that he has a bilateral eye disorder that was incurred in service or that is related to either his exposure to Agent Orange, contaminated water at Camp Lejeune, or to the traumatic brain injuries (TBIs) he incurred in service. At a May 2017 Decision Review Officer hearing, the Veteran reported that he started having trouble with his eyes in his 40s, and that he sometimes has blurry vision or double vision. He also reported having some distortion in the bottom of his field of vision. While the Veteran has now been granted service connection for blepharitis and dry eyes, these disorders do not appear to account for all of the Veteran's reported symptoms, such as double vision, and the Board finds that the issue of entitlement to an eye disorder other than blepharitis and dry eyes remains on appeal. The Veteran attended a VA eye examination in July 2021. The VA optometrist found that the Veteran many current eye diagnoses: blepharitis, dry eyes, retinopathy secondary to hypercholesterolemia, pinguecula, posterior vitreous detachment, and cataracts. She wrote that cataracts were age related and not associated with herbicides or water contamination, and that pinguecula were abnormal growths on the bulbar conjunctiva caused by environmental condition such as sun exposure, dust, and wind. She wrote that the Veteran had retinopathy secondary to hypercholesterolemia for several years, but studies had concluded that Vietnam veterans have not experienced major lipid or lipoprotein disease as a result of herbicide exposure. She then wrote that although several of the aforementioned disorders are related to environmental exposure, she could not conclude that they were caused by herbicide agents or contaminated water at Camp Lejeune. Unfortunately, the VA examiner has applied the wrong standard to her medical opinion. While she wrote that she "cannot conclude" that the Veteran's disorders were caused by exposure to herbicide agents or contaminated water at Camp Lejeune, VA regulations only require that it be "as likely as not" that the disorders are related to service, and does not necessarily require definitive proof of a medical link. The Veteran has also asserted that he believes that his symptoms such as double and blurred vision may be related to the TBIs the Veteran experienced in service, and his personnel and service treatment records do confirm that he served as a parachutist during both his active duty service and National Guard service, and has multiple documented orthopedic injuries related to parachute landings. A January 2019 VA medical examiner already found that the Veteran did incur TBIs during parachute jumps in service, and he is service connected for posttraumatic stress disorder (PTSD) and TBI. The relationship between the Veteran's eye disorders and his TBIs has not yet been addressed. This issue is therefore remanded in order to obtain a new VA examination and opinion to fully address whether it is as likely as not that the Veteran has any eye disorder that is related to service, including due to exposure to herbicide agents, contaminated water at Camp Lejeune, or a TBI. Gastrointestinal Disorder and GERD In May 2021, the Board remanded these issues in order to afford the Veteran with a new VA examination and to obtain a VA medical opinion about their etiology. The examiner was asked to provide any opinion on whether any gastrointestinal disorder was related to service, including as due to herbicide agents or to contaminated water at Camp Lejeune. The Veteran attended new VA examinations in August 2021. The VA examiner found that it was at least as likely as not that the Veteran's GERD, Crohn's disease, and ulcerative colitis began in service, because his records showed that he had a history of these disorders since the 1980s, and the Veteran had reported being diagnosed with these disorders in service. The examiner was then contacted by the Regional Office and informed that his rationale was not consistent with the facts of the case. He was informed that the Veteran only served from 1966 to 1969, and not in the 1980s. The examiner then provided an addendum opinion stating that there was a lack of evidence of any development of symptoms for these disorders until 11 years after separation from service, and therefore they were less likely than not incurred in service. Unfortunately, this opinion did not address the Board's question, which was whether the Veteran's disorders were related to exposure to herbicide agents or contaminated water at Camp Lejeune. These issues therefore must be remanded so that adequate medical opinions can be obtained prior to adjudication. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Board remand confers a right on a claimant to compliance with the remand order). Thyroid Disorder The Veteran has also requested service connection for a thyroid disorder. At a May 2017 Decision Review Officer hearing, the Veteran stated that he has had a thyroid problem since the 1980s. The Veteran attended a VA examination in August 2021. He was found to have a current diagnosis of hypothyroidism. The Veteran reported that the condition started in the late 1970s and was found on routine lab work. He stated that he took thyroid medication on a daily basis. The examiner found, however, that it was less likely than not that the condition was incurred in or caused by service. He explained that the Veteran's medical records showed that he was diagnosed with hypothyroidism in 2019, and there was no documentation or diagnosis of hypothyroidism during service, or even during his evaluation in 2015. The Veteran was clinically asymptomatic, and there was no documentation in the medical literature of the development of hypothyroidism due to exposure to Agent Orange or from contaminated water from Camp Lejeune. Unfortunately, the Board finds that the August 2021 VA medical opinion is inadequate, because it does not appear to be based on an accurate review of the medical evidence. The examiner wrote that the Veteran's hypothyroidism was diagnosed in 2019, but his medical records clearly show that he was already prescribed Synthroid for hypothyroidism in 2009. A November 2010 private evaluation also notes that he was taking thyroid medication. When VA undertakes to provide a medical examination or opinion, it must be adequate, and that includes actually reviewing the Veteran's medical records and accurately representing their contents. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board therefore finds that a new VA opinion should be obtained that accurate reflects the Veteran's medical history. Additionally, the Veteran's VA treatment records have only been obtained from July 2009, although they indicate that he was already receiving care through VA for some time at that point. Because the Veteran has argued that his thyroid is long-standing and was diagnosed while he was still in the National Guard, all of the Veteran's available, earlier VA treatment records should be requested. The matters are REMANDED for the following action: 1. Obtain all VA treatment records that are available for the Veteran prior to July 2009, as well as all new records since August 2021. 2. Schedule the Veteran for a VA examination to address the nature and etiology of any current eye disorder, other than blepharitis and dry eyes. If feasible, the examination may be held via telehealth during social distancing restrictions, and an opinion can be provided based on other medical evidence of record. The examiner must be provided access to the Veteran's entire claims file and must specify in the report that the claims file has been reviewed. The examiner should then address: a) What are the Veteran's current eye disorders? Please discuss the Veteran's past diagnoses of retinopathy secondary to hypercholesterolemia, pinguecula, posterior vitreous detachment, and cataracts. b) For each and every diagnosis found, the examiner must discuss whether it is as likely as not that the disorder had its onset during service or is related to any injury or incident in service, including i) exposure to herbicide agents in Vietnam, or ii) exposure to contaminated water at Camp Lejeune. c) Does the Veteran have any eye disorder that is a residual of his service-connected TBI, caused by head injuries during parachute jumps in service, or that as likely as not has been i) caused or ii) aggravated by his service-connected TBI? The examiner is reminded that the Veteran is competent to report on symptoms as he has observed them. A complete and fully explanatory rationale must be provided. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. 3. Obtain an addendum medical opinion to address the nature and etiology of the Veteran's gastrointestinal disorders, including ulcerative colitis, irritable bowel syndrome, Crohn's disease, and GERD. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. What are the Veteran's current gastrointestinal disorders? Please discuss his past diagnoses of ulcerative colitis, irritable bowel syndrome, Crohn's disease, and GERD. For each and every diagnosis found, discuss whether it is at least as likely as not (50 percent probability or more) that the disorder was incurred in or is related to any event or injury in service, including a) the Veteran's exposure to herbicide agents in Vietnam, and b) his exposure to contaminated water at Camp Lejeune. The examiner is advised that a medical opinion which concludes that a disability is not related to service solely because there is absence of medical records is inadequate. The examiner should also consider that the Veteran is competent to report symptoms as he experiences them, and if his reports are found not to be credible, the examiner must explain what evidence supports this finding. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. 4. Obtain an addendum medical opinion to address the nature and etiology of the Veteran's thyroid disorder, including hypothyroidism. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. Is it as likely as not (50 percent probability or more) that the Veteran's thyroid disorder was incurred in or is related to any event or injury in service, including a) the Veteran's exposure to herbicide agents in Vietnam, and b) his exposure to contaminated water at Camp Lejeune? Please discuss the Veteran's reports of having long-standing thyroid problems that were first diagnosed while he was either on active duty or was serving in the National Guard. The Board notes that the August 2021 VA examiner's finding that the Veteran's thyroid disorder was only diagnosed in 2019 has been found to be inaccurate, as the records clearly show that he was already taking thyroid medication in 2009. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mary E. Rude, 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.