Citation Nr: 21021478 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 19-31 971 DATE: April 13, 2021 REMANDED Entitlement to service connection for vision impairment, to include as secondary to service-connected multiple sclerosis (MS) is remanded. REASONS FOR REMAND The Veteran served in the United States Airforce on active duty from July 1979 to July 1983. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Board previously remanded the above claim to provide a new VA eye conditions examination. Although the Board regrets further delay, another remand is necessary to provide the Veteran with every possible consideration. Further development is necessary prior to appellate review to provide the Veteran with an adequate VA medical opinion addressing his service connection claim. Entitlement to service connection for vision impairment, to include as secondary to service-connected multiple sclerosis (MS), is remanded. The Veteran contends that he suffers vision impairment associated with his service-connected MS. Following a review of the evidence of record, the Board finds remand is necessary to provide an adequate VA examination addressing the Veteran’s loss of vision as secondary to the Veteran’s MS. The August 2020 VA examination provided an internally inconsistent medical opinion as to the etiology of the Veteran’s cataracts. The VA examination provided a positive nexus opinion, stating the Veteran’s claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. However, the VA examiner’s rationale reported the Veteran’s current loss of visual acuity is highly likely due to mild progression of age-related cataracts. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 299-304 (2008). As the VA examination provides inconsistent opinions, the medical opinion is inadequate to adjudicate the Veteran’s claim. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Remand is required to provide an adequate medical opinion addressing the Veteran’s vision loss associated with MS. Additionally, the Board must consider all theories of entitlement either expressly raised by the claimant or which are reasonably raised by the record. Robinson v. Shinseki, 557 F.3d 1355, 1362 (Fed. Cir. 2009). The Veteran contends he suffers from vision loss as secondary to service-connected MS, to include long term treatment of MS with corticosteroid. Remand is required to provide the Veteran a VA medical opinion addressing the etiology of the Veteran’s cataracts related to the use of corticosteroid treatment for MS. The matters are REMANDED for the following action: Obtain an addendum medical opinion. Forward the claims folder to an appropriately qualified clinician to obtain an opinion regarding the nature and etiology of the Veteran’s current vision impairment associated with MS. If an examination is needed, then it may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. Provide the claims file, including a copy of this REMAND, to the examiner for review. Following a review of the evidence of record, the examiner must opine as to: a. Whether it is at least as likely as not (50 percent probability or more) the Veteran’s vision impairment, was proximately caused by, or the result of, the Veteran’s service-connected MS, including as a result of treatment or medication taken. b. Whether it is at least as likely as not (50 percent probability or more) the Veteran’s vision impairment, was aggravated by, the Veteran’s service-connected MS, including as a result of treatment or medication taken. c. Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s current vision impairment, had its onset during or is otherwise etiologically related to active duty service. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. M. Mills Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, 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.