Citation Nr: 21010564 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-02 265 DATE: February 25, 2021 REMANDED Entitlement to service connection for an eye disability is remanded. REASONS FOR REMAND The Veteran had active service from August 1970 to March 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. The Appellant in this case is the Veteran’s spouse; she serves as the Veteran’s fiduciary due to a previous incompetency determination. This matter was most recently before the Board in July 2020, when it was remanded so the Agency of Original Jurisdiction (AOJ) could obtain a new opinion regarding the Veteran’s claim due to the conclusory nature of a previously obtained August 2019 opinion. Unfortunately, the post-remand, July 2020 opinion is also inadequate to make a fully informed decision on the issue of service connection for an eye disability. While the July 2020 VA examiner provided adequate direct service connection opinions regarding left eye nuclear sclerosis and pinguecula, conditions noted in the Veteran’s initial October 2016 VA examination report, the July 2020 VA examiner did not address the diagnoses of cataracts, dry eye syndrome, seborrheic blepharitis, and hypertensive retinopathy noted in the August 2019 VA examiner’s report. The Board acknowledges the diagnoses of cataracts, dry eye syndrome, seborrheic blepharitis, and hypertensive retinopathy appear to be bilateral eye disabilities, but they nevertheless encompass the left eye, which was explicitly referenced in the November 2016 rating decision, the December 2016 statement of the case, and the Board’s prior remand directives for this appeal, and must be addressed in the context of the present appeal in light of the paternalistic nature of the VA adjudication system. Further, the Board notes the Veteran’s initial April 2016 claim references the “eyes” plural rather than the left eye, a limitation which was apparently implemented by the AOJ based on the Veteran’s initial October 2016 VA examination. As such, the Board finds it necessary to recharacterize the scope of the issue on appeal as an “eye disability” without reference to the left or right eye. The Board further notes the Veteran was granted service connection for hypertension subsequent to the July 2020 VA examination, necessitating further consideration of service connection for hypertensive retinopathy, and possibly other diagnoses, on a secondary basis as the August 2019 VA examiner’s opinion appears to suggest a link between the Veteran’s now service-connected hypertension and his diagnosed hypertensive retinopathy, even though, as previously noted, this opinion lacks an adequate rationale to make a fully informed decision on the Veteran’s claim. The matter is REMANDED for the following action: Obtain an opinion regarding the etiology of the Veteran’s eye conditions. Schedule the Veteran for a new examination only if deemed necessary by the selected clinician. It must be noted that the scope of the Veteran’s claim includes a disability affecting either and/or both eyes, even though previous adjudicatory documents have only referenced the left eye. The selected examiner must provide an opinion addressing whether the Veteran has an eye disability that is at least as likely as not (50 percent probability or greater) the result of an in-service disease or injury, to include, but not limited to, herbicide agent exposure; or proximately due to, or aggravated by, service-connected hypertension. The he secondary service connection opinion must address both causation and aggravation to be deemed adequate. The examiner must be advised aggravation means an increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. The opinion must, at a minimum, address the diagnoses of cataracts, dry eye syndrome, seborrheic blepharitis, hypertensive retinopathy, nuclear sclerosis, and pinguecula noted in previous VA examination reports with a separate conclusion and supporting rationale being provided for each diagnosis. If a positive association is not found between the Veteran’s service-connected hypertension and hypertensive retinopathy, the examiner must explicitly address the August 2019 VA examiner’s conclusion in this regard and explain why it is erroneous. If a positive association is found between a diagnosed eye condition and an in-service disease or injury or a service-connected disability, the examiner must then also discuss how this eye condition with a positive association affects the other diagnosed eye conditions, to include a conclusion as to whether it is at least as likely as not (50 percent probability or greater) any of the other eye conditions are proximately due to, or aggravated by, the eye condition that has been linked to service and/or a service-connected disability. The examiner’s report must include a complete rationale for all conclusions contained therein. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. S. Kyle, 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.