Citation Nr: 21023017 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-19 238 DATE: April 19, 2021 REMANDED Entitlement to an initial compensable rating for retained metallic fragments in the right cornea (also diagnosed as right corneal scar) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1951 to November 1955, to include service in the reserves. This matter is on appeal to the Board of Veterans’ Appeals (Board) from a December 2017 rating decision. The Board granted service connection for the Veteran’s right eye disability in an August 2017 decision. A December 2017 rating decision effectuated the grant and rated the disability as noncompensable effective November 5, 2012, the date of claim. The Veteran appealed, and a December 2018 Board decision denied his claim for a compensable rating. The Veteran appealed to the Court of Appeals for Veterans’ Claims (Court); the parties entered into a Joint Motion for Remand (Motion) which was signed by the Court in August 2020. The Board remanded the claim for a new VA examination in November 2020. While the Board regrets the additional delay, remand is again required as the November 2020 remand directives have not been substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). According to the August 2020 Motion, the Board relied on two inadequate opinions by the same physician in May and December 2017, as well as failed to consider favorable evidence submitted by the Veteran, to include lay statements and medical articles regarding his eye disability. In a May 2017 Ophthalmology Telephone Encounter Note, Dr. W (with the title of Attending Physician) wrote that “[l]ooking at his eye examination notes, it appears that [the Veteran] has very subtle metal fragments embedded within his right cornea.” He noted that the service treatment records (STRs) were destroyed in a fire, and gave a brief overview of his “complicated ophthalmic history,” to include diagnoses of dysphotopsias, macular epiretinal membranes bilaterally, a macular hole in the right eye, vitreoretinal tag in the right eye, and dry eye syndrome. His opinion and rationale were as follows: Given the evidence I have available, I do believe that the metal fragments in his right cornea are more likely than not (greater 50% probability) caused by his military service exposure to metal fragments blown by a high-pressure hose. However, these metallic foreign bodies appear to be benign and are not causing any vision deficits or disfigurement. As far as eye pain, I believe that his eye pain has mainly been due to dry eyes and not the metal fragments. The May 2017 phone consultation did not include an in-person examination, nor did it specify what records were reviewed. However, an in-person examination with review of the VA e-folder and CPRS was conducted by Dr. W in December 2017. While this examination report is drafted in a Disability Benefits Questionnaire format, it contained an opinion in the exact same language from the May 2017 phone consultation. The only additional remarks are as follows: The Veteran has a history of a corneal foreign body from his military service as described above. However, it has not caused any disability or residual symptoms. The Veteran complains of eye pain, dizziness and headaches, but it is my opinion that these are all from problems that he has acquired since his military service. The metal fragments are not causing any of his symptoms or visual impairment. I believe that his eye pain is from acquired drying out of the eyes. I think his dizziness and headaches are from migraines. Due to the deficiencies in the above opinions, the November 2020 decision remanded for a new examination to consider all evidence of record, to include medical articles submitted by the Veteran and his contentions regarding symptoms and onset. Additionally, the examiner was directed to list any and all eye diagnoses and determine which symptoms are attributable to each diagnosis. If the examiner found the Veteran’s symptoms were not a result of the retained metal fragments in his right cornea, he or she must explain such a conclusion and identify which diagnosis is responsible for the symptoms. A VA examination was conducted in February 2021. The Veteran’s only listed diagnoses were foreign body and corneal scar in the right eye; however, the Board notes there are several other diagnoses listed in the treatment records. The Veteran’s best corrected visual acuity was 20/40 bilaterally. There was a documented visual field defect upon Goldmann chart testing which revealed that the right eye had a concentric contraction with remaining field of 34.375 degrees, and the left eye had a concentric contraction with remaining field of 25.75 degrees. However, the examiner indicated that there was no decrease in visual acuity or other visual impairment attributable to the corneal scar. He gave no further indication as to what, if not the corneal scar, caused the visual field defect. He did note the Veteran’s endorsement of dry eyes that causes discomfort but stated there were not enough physical findings to diagnose. In an accompanying medical opinion, the examiner explained that he has reviewed the case file and all articles, as well as the Veteran’s contentions. He concluded the foreign body and corneal scar have no symptoms. As the most recent examination reflects a compensable visual field defect, the claim must be remanded to identify the cause of such defects. Moreover, while the examiner indicated he reviewed all the evidence, he did not specifically address the medical significance, if any, of the Veteran’s submitted articles on acquired retinoschisis, membrane detachments, and dysphotopsia, nor did he address the Veteran’s lay statements in the claims file regarding his symptoms and onset. Additionally, at the time of the examination, VA treatment records in the claims file showed recent increased symptoms of blurry vision and pain in the right eye. The examiner failed to address this record and opine on the cause of these additional symptoms. The matter is REMANDED for the following action: Obtain a new VA opinion for the Veteran’s eye disability(ies) with a licensed optometrist or ophthalmologist. The examiner should review the entire claims file and indicate whether he or she has done so. The examiner must specifically consider and address the medical significance, if any, of the medical articles submitted by the Veteran, as well as his submitted lay statements of record regarding symptoms and onset. The examiner must list any and all eye diagnoses and determine which symptoms and/or visual impairment are attributable to each diagnosis. If the examiner finds that the Veteran’s symptoms (i.e., blurry vision and pain) and/or visual impairment (i.e., visual field defects in the February 2021 examination) are not a result of the corneal scar disability, he or she must explain such a conclusion and identify which diagnosis is responsible   for the symptoms. L.M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Carroll, 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.