Citation Nr: 21077229 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 17-28 112 DATE: December 29, 2021 REMANDED Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. REASONS FOR REMAND The Veteran had active-duty service from March 1964 to April 1990. This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated January 2016 issued by the Department of Veterans Affairs (VA) Regional Office in Philadelphia, Pennsylvania. In October 2018, the Board denied entitlement to SMC based on the need for aid and attendance. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In August 2019, the Court issued a Memorandum Decision, vacating the part of the October 2018 Board decision that denied entitlement SMC based on the need for aid and attendance. In June 2020, November 2020 and August 2021, the Board remanded the issue on appeal; it has now been returned to the Board for adjudication. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 1. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. The Veteran contends that he is entitled to SMC based on the need for aid and attendance. See June 2015 Application for Disability Compensation and Related Compensation Benefits. Specifically, he asserts he is entitled to SMC based on the need for aid and attendance due to complications stemming from his service-connected diabetes mellitus, type 2. He asserts the primary complication stemming from his diabetes is his decline in vision, which has left him legally blind. See June 2015 Statement in Support of Claim. The June 2020 Board remand noted that a May 2015 Physician's Statement for Diabetes by Dr. S.O., opined that the Veteran's legal blindness was a complication of his diabetes. However, in a September 2015 VA examination, it was noted that the Veteran had no eye complications stemming from his diabetes. The November 2015 VA examination did not specifically note whether any of the identified eye conditions are complications from diabetes. The RO was instructed to obtain an opinion as to whether the Veteran's legal blindness and any of his eye conditions were caused or aggravated by his service-connected diabetes mellitus, type 2, or pterygium of the left eye. The August 2021 Board remand asked the examiner to determine whether the Veteran's blindness was caused or aggravated by the Veteran's service-connected diabetes mellitus and/or left eye pterygium. The examiner provided an opinion on secondary service connection for diabetes and pterygium and found as follows: Veteran's legal blindness right eye has been attributed to glaucoma. Pterygium is a condition of the surface of the eye and has no relationship to glaucoma. Further, pterygium is documented OS, and blindness is documented as OD. Therefore, it is less likely than not that legal blindness is secondary to pterygium. There was no evidence presented to connect blindness to diabetes. Blindness was attributed to glaucoma, which has no indication of diabetic/neovascular glaucoma, nor further connection to diabetes. Veteran left eye pterygium is the cause of left eye pterygium. The examiner provided an identical opinion for both causation and aggravation without providing a rationale to explain as to how this conclusion was reached. The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018). As such, the examiner must provide separate findings and rationales relating to causation and aggravation. A remand is warranted for the Veteran's claim as there has not been substantial compliance with the prior Board remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file all updated treatment records. The most recent VA records date to October 2021. 2. Obtain an addendum opinion from an appropriate examiner regarding the Veteran's claim. The examiner is asked to answer the following: (a.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran's diabetes mellitus caused the Veteran's legal blindness or any of his eye conditions? Comment on the generally likelihood of any possible increased risk of glaucoma in patients with diabetes and specifically in the Veteran's case. (b.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran's pterygium of the left eye caused the Veteran's legal blindness or any of his eye conditions? (c.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran's diabetes mellitus aggravated (worsened beyond the natural progression) the Veteran's legal blindness or any of his eye conditions? (d.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran's pterygium of the left eye aggravated (worsened beyond the natural progression) the Veteran's legal blindness or any of his eye conditions? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation (specifying the baseline level of disability and current level of severity, based on consideration of VA's rating schedule). *The examiner should consider and discuss the following: a) the May 2015 Physician's Statement for Diabetes by Dr. S.O., opining that the Veteran's legal blindness is a complication of his diabetes; b) September 2015 VA examination noting that the Veteran had no eye complications stemming from his diabetes; c) the November 2015 Eye Conditions VA Examination. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelsey Love, 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.