Citation Nr: 21007813 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 10-49 598 DATE: February 10, 2021 REMANDED Entitlement to service connection for a bilateral eye disorder, to include glaucoma and cataracts, and to include as secondary to service-connected diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran had active service from May 1968 to May 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2015, October 2017, and July 2020. Entitlement to service connection for a bilateral eye disorder, to include glaucoma, and to include as secondary to service-connected diabetes mellitus, is remanded. In August 2015, the Board reopened the Veteran’s claim for service connection for an eye disability and remanded the issue for an examination on the etiology of the Veteran’s eye disability, to include adequate consideration of whether the Veteran’s eye disability has been aggravated by his service-connected diabetes mellitus. This examination was provided in August 2016. In October 2017, the Board remanded the claim for records development and another VA examination addressing pieces of evidence highlighted by the Board therein. This examination was provided in July 2018. In July 2020, the Board remanded the claim due to the July 2018 VA examination’s noncompliance with the Board’s October 2017 directives. This examination was provided in November 2020. The Board regrets further delay, but finds a remand is again necessary to provide the Veteran with an adequate VA examination that complies with the Board’s prior remand directives. See Stefl v. Nicholson, 21 Vet.App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”); Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). In November 2020, the Veteran was provided his most recent VA eye examination, as requested by the Board’s July 2020 remand. The examiner diagnosed the Veteran with bilateral glaucoma and pseudophakia. Notably, the record also reflects a diagnosis of bilateral cataracts during the pendency of this claim. Regarding the Veteran’s glaucoma, the examiner explained that the condition is likely hereditary and that the Veteran does not have the type of glaucoma associated with diabetic retinopathy, and, therefore, a nexus could not be established. Regarding the Veteran’s cataracts, the examiner explained that there is no evidence directly relating herbicides to cataracts and that they are normally associated with aging, and, thus, a nexus could not be established. The Board finds these opinions inadequate. First, the examiner’s opinion regarding the Veteran’s cataracts is again conclusory and does not address whether they are secondary to the Veteran’s diabetes mellitus. For example, it appears the examiner related the Veteran’s cataracts to the natural aging process, but provides no explanation, simply stating, “cataracts are normally associated with aging.” Moreover, the examiner was asked to opine as to whether the Veteran’s service-connected diabetes mellitus has aggravated any diagnosed eye disorder other than glaucoma, including cataracts, but did not attempt such an opinion.   Second, and finally, the Board’s July 2020 remand indicated that the examiner must address eye trouble noted in the Veteran’s 1971 report of medical history in forming the requested etiological opinions. Unfortunately, the examiner did not address this fact in the examination report nor the subsequent opinions. For these reasons, the Board finds an addendum is necessary to ensure an adequate nexus opinion and rationale addressing the highlighted relevant evidence. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Stegall, 11 Vet. App. 268. The matter is REMANDED for the following actions: Obtain a supplemental medical opinion concerning the etiology of the Veteran’s eye disabilities. The claims file and a copy of this remand must be made available to the examiner. The need for an in-person examination is left to the examiner’s discretion. Following review of the claims file and this remand, the examiner is asked to opine and provide complete rationales on the following: (a.) Is it at least as likely as not that any currently diagnosed eye disorder, including glaucoma and cataracts, had its onset during or is otherwise etiologically related to the Veteran’s military service, to include exposure to herbicide agents? (b.) Is it at least as likely as not that any currently diagnosed eye disorder, including glaucoma and cataracts, is proximately due to or aggravated by the Veteran’s service-connected diabetes mellitus? To ensure compliance with Stegall, in rendering these opinions, the examiner is asked to address the following: The Veteran’s January 1971 separation report of medical history indicating eye trouble; the Veteran’s January 1987 claim that his glaucoma developed from photophobia; the Veteran’s May 2008 statement that he wears dark glasses for eye protection; the July 2009 VA examination diagnosing a refractive error; and November 2009 treatment records reflecting a diagnosis of cataracts. The examiner is reminded that causation and aggravation are independent concepts and should have separate findings and rationales.  See El-Amin v. Shinseki, 26 Vet. App. 136, 139-41 (2013); Atencio v. O’Rourke, 30 Vet. App. 74 (2018).  The examiner is advised that aggravation under 38 C.F.R. § 3.310 (b) does not require that there be “permanent” worsening of the nonservice connected disability.   A complete rationale is one that contains clear conclusions with supporting data and a reasoned medical explanation connecting the two. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante, 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.