Citation Nr: 21007624 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 20-22 051 DATE: February 10, 2021 ORDER Entitlement to service connection for bilateral meibomian gland dysfunction is granted. Entitlement to service connection for bilateral pinguecula is granted. REMANDED Entitlement to service connection for an eye disability, excluding diabetic retinopathy, diabetic cataracts, bilateral meibomian gland dysfunction, macular edema, and bilateral pinguecula, is remanded. FINDINGS OF FACT 1. The Veteran’s diagnosed bilateral meibomian gland dysfunction is associated with the service-connected diabetes mellitus type II. 2. The Veteran’s diagnosed bilateral pinguecula is associated with the service-connected diabetes mellitus type II. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral meibomian gland dysfunction have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for bilateral pinguecula have been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1962 to September 1965, with additional periods of reserves service thereafter. This matter comes before the Board of Veterans Appeals (Board) on appeal from a rating decision issued in May 2018 by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). This matter was previously before the Board in November 2020 when it was remanded for additional development. Following the Board’s remand, the RO granted service connection for macular edema. That disability was combined with the 20 percent rating that had been assigned for diabetes mellitus Type II. The matter has been returned to the Board for further appellate action. 1. Entitlement to Service Connection for Bilateral Meibomian Gland Dysfunction 2. Entitlement to Service Connection for Bilateral Pinguecula Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Service connection is also provided for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). The record establishes diagnoses of bilateral meibomian gland dysfunction and bilateral pinguecula. See November 2020 VA medical opinion. The examiner indicated the Veteran’s diagnosed disabilities underwent incremental increase in disability in the form of reduction in visual acuity due to diabetic cataracts and diabetic macular edema. Although the examiner did not specify which of the Veteran’s diagnosed disabilities of the eye underwent incremental increase in disability, the Board will resolve any doubt in favor of the Veteran and finds that service connection is warranted for bilateral meibomian gland dysfunction and bilateral pinguecula as secondary to service-connected diabetes mellitus type II. REASONS FOR REMAND Entitlement to Service Connection for an Eye Disability, Excluding Diabetic Retinopathy, Diabetic Cataracts, Bilateral Meibomian Gland Dysfunction, and Bilateral Pinguecula is Remanded. The continued denial of service connection for macular degeneration was based on the November 2020 VA medical opinion. The examiner noted there was no current diagnosis of bilateral macular degeneration nor was any such diagnosis observed upon record review. The examiner commented that “perhaps whoever is posing this question is confusing “diabetic macular edema” with macular degeneration.”” This negative finding is problematic for two reasons. First, there is no confusion by the Board posing its question as the record includes the report of a January 2020 VA examination that diagnosed bilateral macular degeneration as well as numerous VA treatment records that indicate that the Veteran has been prescribed a medication (vitamin regimen) for macular degeneration. Second, and of greater significance, the November 2020 VA examiner failed to reconcile her negative conclusion with the January 2020 examination of the internal eye, which indicated that the macula of right eye showed “RPE clumps, superior atrophy vs cystic changes, few dot hemes inferior to fovea, drusen” and the macula of the left eye showed “RPE clumps, temporal geographic atrophy, drusen.” An addendum opinion would be helpful in ascertaining whether a diagnosed bilateral macular degeneration disorder exists (or existed at any time during the appeal period) and, if so, whether it is related to the Veteran’s active service or service connected disability. The matter is REMANDED for the following action: Obtain an addendum opinion from the November 2020 VA examiner. As an initial matter, the examiner is asked to clarify whether the Veteran currently or at any point during the period on appeal had a diagnosis of bilateral macular degeneration. The examiner must discuss the diagnosis of bilateral macular degeneration found in the January 2020 VA examination report and the clinical significance of the examination findings that that the macula of right eye showed “RPE clumps, superior atrophy vs cystic changes, few dot hemes inferior to fovea, drusen” and the macula of the left eye showed “RPE clumps, temporal geographic atrophy, drusen.” If relevant, the examiner should also comment on whether bilateral macular degeneration had resolved during the appeal period. If bilateral macular degeneration is shown to have been diagnosed at any time during the appeal period, then the examiner should state: (a) whether it is at least likely as not that it was proximately due to a service-connected disability, to include diabetes mellitus type II, diabetic retinopathy, diabetic cataracts, bilateral meibomian gland dysfunction, or bilateral pinguecula. (b) underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability to include diabetes mellitus type II or any residuals thereof (diabetic retinopathy, diabetic cataracts, bilateral meibomian gland dysfunction, or bilateral pinguecula). The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there is any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith, 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.