Citation Nr: 21007177 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 11-14 389 DATE: February 8, 2021 REMANDED Entitlement to service connection for cataracts is remanded. Entitlement to service connection for detached retina is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Navy from October 1965 to August 1969, with ACDUTRA service from August to September 1964. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veteran Affairs (VA) Regional Office (RO) in Oakland, California. In December 2017, the Board remanded the issues on appeal for additional development, and the case has since been returned for further appellate review. Entitlement to service connection for cataracts and detached retina is remanded. The Veteran contends his eye conditions are due to his military service. Specifically, he has asserted since initiation of his claim that his cataracts and detached retina are due to his diabetes mellitus II. He also believes his eye conditions may be due to herbicide exposure while serving in the Vietnam War or his subsequent prostate cancer. The Veteran has current diagnoses of retinal scar from retinal detachment surgery in both eyes, cataract of the right eye, glaucoma of the left eye, and intraocular lens of the left eye. C&P, 3/25/2020, pg 2. He is service-connected for prostate cancer with an effective date of 2009 and diabetes mellitus II with an effective date of 2012. At the Veteran’s March 2020 VA examination, the examiner opined his cataracts are less likely than not due to diabetes mellitus II. He explained, “According to NIH, nuclear cataract is not associated with diabetes,” and further stated there is no evidence of premature cataract in the right eye. The examiner concluded the Veteran’s left eye cataract was likely caused by surgery for the retinal detachment. However, an opinion regarding the etiology of the retina detachment, cataracts, and glaucoma was not provided, and an assessment of any potential direct relationship to the Veteran’s service or aggravation by his service-connected disabilities is not discussed. In a September 2020 addendum opinion, the examiner concluded the Veteran’s glaucoma is less likely than not proximately due to or the result of his diabetes mellitus II. He concluded, “As per record review, the glaucoma is not defined as neovascular (the type associated with diabetes and there is no proliferative diabetic retinopathy that often results in neovascular glaucoma) and thus it is less likely than not that the claimants glaucoma is a result of his diabetes.” Of note, an October 2020 diabetes mellitus II examination includes an observation on the Veteran’s eye condition, indicating “Funduscopic examination of the right and left eye reveals pupils constricted, not due to diabetes mellitus II or hypertension.” However, the record does not contain an opinion on any potential relationship of the Veteran’s retinal detachment to his diabetes mellitus II or prostate cancer, and no assessment of a potential relationship between any eye condition and his presumed herbicide exposure is discussed. While the Board is appreciative of the examiner’s efforts, this opinions are incomplete as they do not address whether the Veteran’s eye conditions were aggravated by his service-connected disabilities or otherwise caused by his herbicide exposure. When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, remand is necessary to obtain a new VA opinion addressing the Veteran’s contentions. Accordingly, the matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s eye conditions, to include glaucoma, retinal detachment, and cataracts. 2. Following review of the claims file, the examiner is asked to opine on the following: (a.) Is it at least as likely as not (50 percent or greater probability) that any diagnosed eye condition was caused by the Veteran’s service-connected disabilities, including diabetes mellitus type II or prostate cancer? (b.) Is it at least as likely as not (50 percent or greater probability) that any diagnosed eye condition was aggravated by the Veteran’s service-connected disabilities, including diabetes mellitus type II or prostate cancer? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. (c) Is it at least as likely as not (50 percent or greater probability) that any diagnosed eye condition began in or was otherwise caused by the Veteran’s active service, to include the Veteran’s presumed exposure to herbicides. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. Likewise, the mere fact that a presumption has not been established for any particular disorder at issue is not dispositive of the issue of nexus. Consideration must still be given to the exposure. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.N. Chapman, 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.