Citation Nr: 21009931 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 12-11 146 DATE: February 23, 2021 REMANDED Entitlement to service connection for a vision condition to include glaucoma, retinopathy and cataracts, as secondary to service-connected Diabetes Mellitus Type II, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include a nervous condition and depression, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from October 1963 to October 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2010 and July 2010 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded these claims for further development in February 2018. In the prior February 2018 Board decision, the Veteran’s vision claim was remanded as it was inextricably intertwined with the Veteran’s hypertension claim. The Board directed that if entitlement to service connection for hypertension is found to be warranted, readjudicate the vision disability claim to include as secondary to hypertension. In a September 2020 rating decision, the Veteran’s claim for diabetic nephropathy with noncompensable hypertension was granted effective from September 10, 2020. The Veteran contends that his vision disability is related to his service-connected diabetes and associated service-connected conditions. However, since the grant of for diabetic nephropathy with noncompensable hypertension, no opinion has been obtained regarding if the Veteran’s vision disability is caused or aggravated by this service-connected disability. Further, in the November 2020 written brief presentation, the Veteran’s representative submits argument that glaucoma is related to diabetes. Accordingly, the Veteran should be afforded an eye examination to determine the etiology of any diagnosed vision disability. In the prior February 2018 Board remand, the Veteran’s claim for entitlement to service connection for an acquired psychiatric condition was remanded to obtain a supplemental opinion regarding the etiology of any diagnosed acquired psychiatric condition with the examiner specifically directed to review SSA evaluations and a June 2014 statement by the Veteran. However, in an October 2018 addendum opinion, there was no indication the examiner reviewed the SSA evaluations or lay statements by the Veteran. The sole rationale provided was a PTSD examination in October 2015 did not find symptoms of a mental disorder meeting DSM-5 criteria. However, the examiner did not discuss treatment records reflecting the Veteran undergoing treatment for depression. Further, the examiner did not discuss the SSA records as directed by the Board in the February 2018 remand. The Veteran was granted disability benefits for disabilities including an affective disorder. SSA records reflect psychiatric findings revealing persistent depression manifested by motor tension, insomnia, psychomotor retardation, feelings of worthlessness and hopelessness, difficulty concentrating and auditory hallucinations. In addition, the November 2020 written brief presentation, the Veteran’s representative contended that the examiner failed to consider the effect of the Veteran’s chronic pain on his mental disorder. Accordingly, a new opinion must be obtained that considers the Veteran’s psychiatric history and discusses the etiology of any diagnosed psychiatric condition, to include if caused or aggravated by any service-connected disability or pain resulting from a service-connected disability. The Veteran’s TDIU claim is inextricably intertwined with the above claims, in that a grant as to any of the above claims could affect his entitlement to TDIU. As such, final adjudication of the TDIU claim is deferred pending the above development and readjudication of the service connection claims. The matters are REMANDED for the following action: 1. After performing any further development deemed appropriate, obtain an opinion regarding the etiology of any diagnosed vision disorder. The need for an examination, or telehealth appointment if an in-person examination is not feasible, is left to the discretion of the examiner. The electronic claims file must be made available to and reviewed by the examiner. The reviewer/examiner is asked to provide an opinion regarding whether it is as least as likely as not (50 percent probability or more) that any diagnosed vision disorder (to include glaucoma, retinopathy and cataracts) was (i) caused OR (ii) aggravated (i.e., worsened beyond the natural progress) by the Veteran’s service-connected disabilities, including diabetes and related conditions. Review of the entire file is required. A complete rationale for all opinions should be provided. 2. Obtain a supplemental opinion from a psychiatrist or psychologist regarding the etiology of any diagnosed acquired psychiatric disorder. The need for an examination, or telehealth appointment if an in-person examination is not feasible, is left to the discretion of the examiner. The electronic claims file must be made available to and reviewed by the examiner. The examiner is asked to provide an opinion regarding whether it is as least as likely as not (50 percent probability or more) that any diagnosed acquired psychiatric disorder (including major depressive disorder diagnosed in the 2011 examination) was (i) caused OR (ii) aggravated (i.e., worsened beyond the natural progress) by the Veteran’s service-connected disabilities. The examiner should also consider if pain caused by the Veteran’s service-connected disabilities (i) caused OR (ii) aggravated any acquired psychiatric disorder. Review of the entire file is required; however, attention is invited to the SSA evaluations and determination and the June 2014 statement of the Veteran. The medical professional is asked to explain the reasons behind any opinions expressed and conclusions reached. The medical professional is reminded that the term “as likely as not” does not mean “within the realm of medica possibility,” but rather that the evidence of record is so evenly divided that, in the medical professional’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. If the examiner does not diagnose any acquired psychiatric disorders, a full explanation is requested, and the discussion must include treatment records and other medical findings that have diagnosed the Veteran with an acquired psychiatric disability.   3. After the above is complete, readjudicate the claims (including the claims for entitlement to TDIU). If a complete grant of the benefits requested for each claim is not granted, issue a supplemental statement of the case (SSOC) to the Veteran and his representative. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Keogh, 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.