Citation Nr: 21014123 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-10 962 DATE: March 11, 2021 REMANDED Entitlement to service connection for an eye surgery residual condition is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1997 to October 2008. He had additional service from October 29, 2008 to June 2012, which has been deemed to have been dishonorable for VA purposes, and therefore benefits cannot be awarded for disease or injuries incurred during that period. See July 2013 VA Administrative Decision. This matter was last before the Board in May 2020, whereupon it was remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record. Following the issuance of a September 2020 supplemental statement of the case continuing the denial of service connection, the case was returned to the Board for its adjudication. The eye surgery residual condition was remanded in order to afford the Veteran a VA examination to evaluate the nature and likely etiology of the Veteran’s claimed eye surgery residual condition. Specifically, the Board highlighted that the Veteran reported experiencing light sensitivity, blurring, and convergence issues ever since undergoing photorefractive keratectomy (PRK) surgery in service in 2004. The Board requested that the chosen VA examiner set forth a diagnosis to account for the Veteran’s symptomatology and then opine as to the likely etiology of the diagnosed eye condition, to include consideration of whether the condition was fully attributable to the in-service PRK surgery. In an August 2020 VA eye examination, the chosen VA examiner set forth a diagnosis of dry eye syndrome and noted that the symptoms began in 2007. However, in the medical history portion of the examination report the VA examiner also noted a history of punctate keratopathy beginning in 2004, with symptoms to include light sensitivity, eye irritation, and irregular visual acuity. The examiner ultimately opined that the Veteran’s dry eye syndrome was at least as likely as not attributable to the in-service PRK surgery as the condition was a common side effect of that type of surgery. The examiner did not further elaborate on the Veteran’s history of punctate keratopathy or set forth a separate opinion as to the likely etiology of the condition. The Board cannot rely on this opinion as the examiner did not fully account for all of the Veteran’s claimed symptomatology. As stated, and apparently acknowledged by the examiner in his evaluation, the Veteran has documented symptomatology, to include eye irritation, light sensitivity, and irregular visual acuity, that are not wholly encompassed within the dry eye syndrome diagnosis. Indeed, in a recent correspondence dated in October 2020, the Veteran himself noted that his dry eye syndrome diagnosis did not account for these symptoms, and that these symptoms were the main cause of his claimed functional impairment (as opposed to dry eyes as a singular symptom). While the Board accepts that the dry eye syndrome is a known and common side effect of PRK surgery, the August 2020 examiner did not set forth an etiology opinion that accounted for the additional symptomatology that does not fall under the umbrella of the diagnosed dry eye syndrome. On remand, the Veteran must be afforded a new examination in order to provide a diagnosis or diagnoses that account for all of his claimed eye symptomatology and then elicits an opinion as to the likely etiology of these diagnosed eye conditions. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Schedule the Veteran for a VA medical examination to determine a diagnosis or diagnoses which account for all of his documented eye symptomatology and then set forth an opinion as to the likely etiology of the diagnosed eye condition or conditions. The Veteran’s entire claims file, including a copy of this remand, must be made available to the examiner for review.  The VA examiner should confirm the claims file review.  All necessary diagnostic testing should be completed prior to setting forth any opinion as to the likely etiology of any diagnosed eye surgery residual condition. The chosen examiner is asked to determine whether the diagnosed dry eye syndrome accounts for all of the Veteran’s reported eye symptomatology, to include eye irritation, light sensitivity, convergence difficulties, and irregular vision acuity. If not, the examiner must provide a separate diagnosis or diagnoses that account for all of these symptoms. Regardless of what diagnosis or diagnoses are endorsed by the examiner, the examiner must then opine whether it is at least as likely as not (a 50 percent probability or greater) that any such diagnosed eye surgery residual condition is directly related to active military service. In setting forth this opinion, the examiner must clearly discuss whether all of the Veteran’s reported eye symptomatology is encompassed within a diagnosis or diagnoses that are attributable to the in-service PRK surgery or whether any symptomatology is not attributable to the PRK surgery. A complete rationale is required for all opinions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. To the extent that telehealth technology permits an alternative to an in-person examination, such opportunity is fully acceptable in lieu of an in-person examination. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Collins, 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.