Citation Nr: 21008254 Decision Date: 02/12/21 Archive Date: 02/12/21 DOCKET NO. 18-44 034 DATE: February 12, 2021 REMANDED Entitlement to service connection for glaucoma, to include as due to herbicide agent exposure and/or service-connected diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from July 1960 to July 1964. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which, inter alia, denied service connection for glaucoma. In April and October 2019, the Board remanded the Veteran’s claim for further evidentiary development. This matter was most recently before the Board in October 2020. At that time, the Board again remanded the Veteran’s claim for further evidentiary development, to include an addendum medical opinion. Entitlement to service connection for glaucoma, to include as due to herbicide agent exposure and/or service-connected diabetes mellitus, type II, is remanded. The Veteran contends that his glaucoma is due to Agent Orange exposure during service. See September 2017 Statement in Support of Claim; see also September 2018 VA Form 9. Service treatment records (STRs) are negative for complaints or findings of an eye disability. Post-service clinical records show a current diagnosis of glaucoma. See May 2015 correspondence from Dr. B.-A. The Veteran was most recently afforded a VA examination in November 2020. The examiner noted a diagnosis of bilateral glaucoma. The Veteran reported that he was told he had glaucoma and was going blind in 1966, a few years after discharge. He reported that he was treated with eye drops, which did not work, and that his condition required laser surgery. After examination of the Veteran and review of the claims file, the examiner determined that it was less likely as not that the Veteran’s glaucoma was causally related to or aggravated by his service-connected diabetes mellitus. The examiner opined in pertinent part, There was no evidence the Veteran was diagnosed or treated for glaucoma or any other eye diseases while in service. The Veteran was previously treated for narrow angle glaucoma with surgical evidence of LPI in both eyes. Risk factors for narrow angle glaucoma include age as well as hyperopia (refractive error). The Veteran does not have evidence of diabetic retinopathy or neovascular glaucoma (a known complication of diabetes). Although it is understood the Veteran was diagnosed with both glaucoma and diabetes mellitus during approximately the same time period the Veteran does not have evidence of diabetic complications such as diabetic retinopathy or neovascular glaucoma (a known complication of diabetes). The Board finds that the VA examination is inadequate. In that regard, the examiner’s rationale for her opinion is a near-verbatim recitation of the rationale for the prior December 2019 medical opinion which was found to be inadequate in the October 2020 Board remand. While the Board greatly regrets further delay, additional remand is required for full compliance with the Board’s previous remand instructions. Stegall v. West, 11 Vet. App. 268, 270-71 (1998); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, the Veteran indicated during the VA examination that he has received ongoing treatment for his eye condition for the past 40 years from Dr. Feitl. Treatment records from Dr. Feitl, however, have not been associated with the claims file. Since these private records are relevant to his claim, and they have not been associated with the claims file, the VA has a duty to undertake reasonable efforts to obtain those records. Thus, a remand is also warranted to enable the RO to obtain these potentially relevant records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Accordingly, the matter is REMANDED for the following action: 1. After obtaining the necessary information and authorization from the Veteran, undertake the necessary efforts to obtain records of the Veteran’s treatment from Dr. Feitl. If reasonable efforts prove unsuccessful, the Veteran should be notified and given an opportunity to obtain the records himself. All records and/or responses received should be associated with the claims file. 2. Obtain an addendum medical opinion from a different examiner addressing the nature and etiology of the Veteran’s current glaucoma. Access to the Veteran’s electronic VA claims file must be made available to the examiner for review in connection with the opinion. After reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: Is it at least as likely as not that the Veteran’s current glaucoma is causally related to an in-service disease or injury, to include legally presumed exposure to herbicide agents? (Continued on the next page)   If not, is it at least as likely as not that the Veteran’s current glaucoma is causally related to or aggravated by his service-connected diabetes mellitus? In providing the requested opinion, the examiner should consider and address the fact that the Veteran’s glaucoma and diabetes mellitus were diagnosed during approximately the same time period. If the Veteran’s diagnosed glaucoma is aggravated by the service-connected diabetes mellitus, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability. This may be ascertained by the medical evidence of record and by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. A complete explanation must be provided for any opinion offered. In providing the requested opinion, the examiner should reference any relevant evidence of record. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ruddy, 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.