Citation Nr: 21024654 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 14-16 258 DATE: April 23, 2021 REMANDED Entitlement to service connection for a bilateral eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1973 to March 1976. This appeal to the Board of Veterans’ Appeals (Board) is from a December 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this claim back to the RO in December 2015, January 2020, and most recently in May 2020. But, on review of the VA medical examination report from February 2021, so since, and with sincere apologies to the Veteran, the Board regrettably must again remand this claim to ensure compliance – or at least acceptable substantial compliance, with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a bilateral eye disability is remanded. The Board’s three previous remands all have requested that the RO acknowledge the various diagnoses for this Veteran’s bilateral eye condition – the last two specifying diagnoses since October 2010 – and comment specifically on continuing eye symptoms in the years since his service. The May 2020 remand directed that, for each diagnosed eye disorder, the examiner opine on whether the diagnosis is related to the Veteran’s documented May 1975 eye injury in service, comment on all competent reports of continuing eye symptoms in the years since his service, and explain how the photophobia from his cataracts is differentiated from the photophobia from his eye injury. The Veteran’s several diagnoses include a well-established one for age-related cataracts, diagnosed prior to November 2011, a refractive error in December 2017, bilateral temporal hemianopsia with pituitary adenoma in February 2018, identified as a macroadenoma in May 2019, and, finally, an incomplete retinal tear with homonymous inferior quadrantanopsia involving a presumed left superior parietal lobe stroke, diagnosed by the VA examiner in February 2021. The Board sees no evidence of a stroke, or treatment for a stroke, in the record on appeal. There is no other instance of a similar diagnosis in any of the Veteran’s treatment records. The February 2021 examination identified cataracts and the homonymous inferior quadrantanopsia, but no other diagnoses. The examiner’s medical opinion addressing any correlation (“nexus”) to the Veteran’s service and, supposedly, his reports of continuous symptoms since his service, only addressed cataracts and the symptom photophobia. The examiner did not address the difference between photophobia from cataracts versus from other diagnoses, as requested. Most notably, and inexplicably, the examiner also only discussed symptoms currently present and/or observations he could make based on the Veteran’s current diagnostic testing. The examiner made no attempt to account for the Veteran’s lay statements or symptoms since his service. The examiner’s failure to comply with the Board’s remand directives or consider the Veteran’s reports of symptoms since his service render the opinion inadequate. See Dalton v. Peake, 21 Vet. App. 23 (2007). 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, supra.   Accordingly, this claim is again REMANDED for the following still additional development and consideration: Obtain yet another addendum opinion regarding the nature and etiology of the Veteran’s bilateral eye disability. The opinion should be provided by someone competent to make the necessary determinations, such as an optometrist or ophthalmologist. If another physical examination of the Veteran is required (as opposed to file review), one should be scheduled. The claims file, including a complete copy of this remand, must be made available to and reviewed by the examiner – including to address the deficiencies in the prior opinions. The examiner is specifically asked to: a) For each diagnosed eye disorder, opine on whether it is at least as likely as not related or attributable to the Veteran’s service, including especially to his May 1975 eye injury and subsequent consultation and treatment for continued eye tearing, burning, blurring, and photophobia in June 1975. b) In formulating the opinion, specifically acknowledge and comment on i) all eye disabilities diagnosed since October 2010, ii) all instances of treatment for eye problems in the Veteran’s service treatment records (STRs), and iii) his competent reports of continuing eye symptoms in the years since his service. c) Also explain how the photophobia due to age-related cataracts diagnosed in 2011 is differentiated from the photophobia the Veteran experienced after his eye injury in service. Rationale for the opinion is essential, regardless of whether favorable or unfavorable to the claim, preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner must provide explanation of why this is so and note what, if any, additional evidence would permit a more definitive opinion. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Stearns, 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.