Citation Nr: 21010893 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 18-16 259 DATE: February 26, 2021 REMANDED Entitlement to service connection for a bilateral vision impairment, to include as due to ionizing radiation exposure and/or secondary to service-connected chronic myelogenous leukemia, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from January 1956 to October 1957. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded in May 2019 for a new eye examination and to obtain nexus opinions as to whether the Veteran's eye conditions were caused or aggravated by service or any service-connected disability. The examiner was explicitly directed to discuss the role of the Veteran's established in-service exposure to ionizing radiation and his chronic myelogenous leukemia with regard to his bilateral vision impairment. An examination was afforded the Veteran in November 2019, and addendum opinions were obtained in July and August 2020. Though the examiner opined that there was no nexus between the current vision problems and either radiation or myelogenous leukemia, she offered no adequate rationale for such. At most, she cited and quoted a medical article stating that the typical eye-related manifestations of myelogenous leukemia were mainly vascular in nature, though optic nerve and retinal damage (macular lesions) have also been noted. She did not explain how the article related to the current eye diagnoses, which is particularly deficient with regard to the cited history of “choroidal neovascular membrane” in the left eye. That condition on its face appears to involve the same system as those mentioned in the article. Additionally, she did not opine or explain regarding radiation. The examiner failed to comply with the Board’s directives. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 1 Vet. App. 268, 271 (1998). Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. As such, another remand is warranted. In addition, the record documents that the Veteran has received treatment for his chronic myelogenous leukemia and vision conditions from non-VA providers. Specifically, the Veteran has received treatment for his eyes from Nevada Retina and treatment for chronic myelogenous leukemia from Dr. AB, who has been associated with two different oncology practices. However, the record does not establish that treatment records from these providers has been requested.  VA’s duty to assist claimants to obtain evidence needed to substantiate a claim also includes making reasonable efforts to obtain relevant private medical records. 38 C.F.R. § 3.159 (c)(1). The matters are REMANDED for the following action: 1. Contact the Veteran and request properly executed releases for any private care providers who have treated him for his chronic myelogenous leukemia and vision conditions. Records from Dr. AB, RenOncology Consultants, Cancer Care Specialists and Nevada Retina should be specifically requested. Upon receipt of such, VA must take appropriate action to contact the identified providers and request complete treatment records, since at least November 2015. The Veteran should be informed that in the alternative he may obtain and submit the records himself. 2. After the above development is completed, obtain an addendum opinion regarding the current nature and etiology of the Veteran’s vision disabilities from an examiner other than the one who conducted the November 2019 VA examination. The entire claims folder must be reviewed in conjunction with the examination; provision of a new physical examination is at the discretion of the reviewer. a. The reviewer must opine as to whether it is as likely as not (50 percent probability or greater) that any current vision disability was caused or aggravated by the Veteran's service, including his established in-service exposure to ionizing radiation. The reviewer must consider and comment upon the Veteran's accounts of radiation exposure, including his April 2019 testimony, his statement that a doctor told him shortly after his exposure that his retinas had been burned, his May 2013 radiation Risk Activity Worksheet and the description of his exposure in the September 3, 2013 memorandum from the JSSRC. b. The reviewer must opine as to whether it is as likely as not (50 percent probability or greater) that any current vision disability was caused or aggravated by the Veteran's service-connected disabilities, to include his chronic myelogenous leukemia and leukemia treatment. A complete rationale is requested for all opinions provided. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. After the above has been completed, readjudicate the claim on appeal. If any benefit sought remains denied, issue an appropriate supplemental statement of the case and return the appeal to the Board. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Megan-Brady Viccellio 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.