Citation Nr: 21023742 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 17-04 727 DATE: April 21, 2021 REMANDED Entitlement to service connection for an eye disorder other than diabetic retinopathy, to include retinal detachment and choroidal neovascular membranes (CNVM) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1965 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded in a December 2018 Board decision. For the reasons discussed below, remand is again warranted. Entitlement to service connection for an eye disorder other than diabetic retinopathy, to include retinal detachment and choroidal neovascular membranes (CNVM) is remanded. The December 2018 Board decision granted the Veteran’s claim for entitlement to service connection for diabetic retinopathy and remanded the issue of entitlement to service connection for an eye disorder other than diabetic retinopathy, to include retinal detachment and CNVM for an addendum opinion. The examiner was instructed to identify all eye disabilities the Veteran had during the period on appeal and to opine whether each eye disability was either at least as likely as not related to the Veteran’s military service, or secondary to the Veteran’s service connected disabilities to include diabetes. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In a November 2019 addendum opinion, the examiner identified the Veteran’s eye disabilities as diabetic retinopathy, macular degeneration and bilateral pseudophakia. Although the examiner offered an etiology opinion for each of these eye disabilities, the examiner did not address the Veteran’s choroidal neovascular membrane (CVNM). VA treatment records from October 2013 note a diagnosis of CVNM. As such, the examiner should have provided an etiology opinion for the Veteran’s CVNM. Because the Board’s remand directives were not complied with, remand is warranted for an addendum opinion regarding the Veteran’s CVNM. With respect to the Veteran’s retinal detachment, in the November 2019 addendum opinion, the examiner noted that the Veteran had a retinal detachment in 2012. The examiner further asserted that the retinal detachment was less likely than not the result of his diabetes and noted that diabetes may slow healing but is not the cause. The examiner offered no rationale for this opinion. Additionally, it’s unclear whether this statement is an indication of aggravation. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 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, 301 (2008). Here, because no rationale was offered, remand is warranted for an adequate addendum opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records relevant. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Obtain an addendum opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran’s choroidal neovascular membranes and retinal detachment. The evidentiary record, including a copy of this remand, must be made available to, and be reviewed by the clinician. After the record review, the reviewing clinician is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran’s choroidal neovascular membrane incurred in, or is otherwise related, to his time on active service? Is it at least as likely as not that the Veteran’s retinal detachment incurred in or is otherwise related to his time on active service? Is it at least as likely as not that the Veteran’s choroidal neovascular membrane was caused by a service-connected disability to include diabetes mellitus type II and or diabetic retinopathy? Is it at least as likely as not that the Veteran’s retinal detachment was caused by a service-connected disability to include diabetes mellitus type II and or diabetic retinopathy? Is it at least as likely as not that the Veteran’s choroidal neovascular membrane was aggravated beyond the normal course of the condition by his service-connected disabilities to include diabetes mellitus type II and or diabetic retinopathy? Is it at least as likely as not that the Veteran’s retinal detachment was aggravated beyond the normal course of the condition by his service-connected disabilities to include diabetes mellitus type II and or diabetic retinopathy? In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Wimbish, 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.