Citation Nr: 21007424 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-35 728 DATE: February 9, 2021 REMANDED Entitlement to service connection for glaucoma, including as secondary to service-connected diabetes mellitus type II, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from September 1965 to September 1968, including service in the Republic of Vietnam. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) rating decision dated August 2014 which denied service connection for glaucoma, bilateral upper extremity peripheral neuropathy, and bilateral lower extremity peripheral neuropathy, all claimed as secondary to the Veteran’s service-connected diabetes mellitus type II. Entitlement to service connection for glaucoma, including as secondary to service-connected diabetes mellitus type II Service connection may also be established for those “chronic diseases” listed in 38 C.F.R.§3.309(a)where the evidence shows a diagnosis manifest to a compensable degree within the presumptive period after service, or a continuity of symptomatology since service. See 38C.F.R.§§3.303(b), 3.307; Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013). In addition, if a veteran was exposed to an herbicide agent (such as Agent Orange) during active service, presumptive service connection is warranted for enumerated medical conditions. 38 U.S.C.§1116; 38C.F.R.§§3.307(a), 3.309(e). Secondary service connection may be established for a non-service-connected disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R.§3.310. To substantiate a secondary service connection claim, the Veteran must show: (1) a present disability (for which service connection is sought); (2) a service-connected disability; and (3) competent evidence that the service-connected disability caused or aggravated the disability for which service connection is sought. A review of the Veteran’s service treatment records indicates a brief reference on the Veteran’s induction examination of defective vision and 40/40 acuity on vision examination. In his separation Report of Medical History, the Veteran denied eye trouble and clinical evaluation revealed 20/20 visual acuity with normal intraocular tension. In January 2012 the Veteran was examined for suspected glaucoma with intraocular eye pressures of 18 on the right and 19 on the left respectively. The Veteran underwent VA examinations for his eyes in February 2012 in which he was diagnosed with diabetes without ocular manifestations, cataracts of both eyes, and suspected glaucoma in both eyes. Tonometry yielded eye pressures of 18 or the right and 19 on the left. The examiner designated the type of glaucoma as, other, as opposed to closed angle or open angle. The VA optometrist examiner concluded that the Veteran’s emerging glaucoma was less likely than not the result of his service-connected diabetes mellitus type II. As rationale, the examiner noted that glaucoma is a separate identifiable disease that occurs independent of diabetes. In March 2014 the Veteran filed a claim for “glaucoma secondary to diabetes that is already service connected.” In July 2014 the Veteran underwent a VA eye conditions disability examination. The Veteran advised the examiner that he had been diagnosed with suspected glaucoma. Tonometry reflected right and left eye pressures of 12. The examiner noted that the Veteran was prescribed Xalatan for prophylaxis of his suspected glaucoma. The examiner concluded that while the Veteran had suspected glaucoma, it was less likely than not that his suspected glaucoma was proximately due to the Veteran’s service-connected diabetes mellitus as there are no links between diabetes and glaucoma. During a July 2015 clinic visit, the Veteran’s wife advised the VA provider the Veteran’s eye pressures were higher. The Veteran was re-educated on the glaucoma medication protocol. In July 2016, the Veteran was seen in a VA clinic experiencing intermittent blurred vision and was prescribed Travoprost eye drops to control his glaucoma. Tonometry in both eyes yielded eye pressures of 21 in both eyes. A positive family history for glaucoma was noted and the Veteran was noted to be at higher risk for progression of glaucoma given his current intraocular pressures. In an August 2016 Visit, a VA nurse practitioner adviser the Veteran that glaucoma is not caused by diabetes mellitus. Although the Veteran’s VA treatment records do not contain a formal diagnosis of actual glaucoma, glaucoma is included in his list of active medical problems, with an onset of date of December 2015, and further show the Veteran continues to take a daily medication regimen for glaucoma. He also undergoes periodic follow up eye check-ups to monitor his condition. In May 2020 the Court of appeals for Veterans Claims granted the parties Joint Motion for Partial Remand (JMPR) citing the failure to obtain or document failed efforts to obtain potentially relevant private treatment records. In addition, the Remand was necessary to provide a nonconclusory opinion with a reasoned medical explanation for the conclusion that the Veteran’s glaucoma was unrelated to his service-connected diabetes mellitus. The JMPR noted that the VA’s adjudication manual lists glaucoma as a diabetic eye complication. Finally, the JMPR noted that the Board did not address the Veterans contention that the Veteran’s Agent Orange exposure directly contributed to his emerging glaucoma. While the Board finds that the record has been documented as to efforts to obtain potentially relevant private treatment records, the Board is still left with a conclusory rationale for the opinions of the VA examiner. Accordingly, remand is required for further development. The matter is REMANDED for the following actions: 1. Obtain any available service or military records that address the nature and extent of any exposure the Veteran had to Agent Orange including documentation in the possession of or known to the Veteran. 2. Request an addendum opinion from a qualified ophthalmologist or optometrist to address whether: a) It is more likely than not (50 % or greater probability) that the Veteran’s emerging glaucoma condition was caused by exposure to Agent Orange; b) It is more likely than not (50 % or greater probability) that the Veteran’s emerging glaucoma condition was caused by his service-connected diabetes mellitus, and if not, c) It is more likely than not (50 % or greater probability) that the Veteran’s emerging glaucoma condition was aggravated beyond its normal progression by his service-connected diabetes mellitus. The examiner must offer a complete nonconclusory rationale for any opinions expressed including citation to authoritative medical literature as appropriate. The examiner’s attention is requested to the Veteran’s normal intraocular tension on separation from service. A copy of this Remand must be included in the examiner’s review. 3. After accomplishing the development discussed above, readjudicate the Veteran’s claim. If the decision remains unfavorable to the Veteran provide him and his representative with a Supplementary Statement of the Case and after a period, return the matter to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Adams Hill, 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.