Citation Nr: 21025232 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-23 712 DATE: April 27, 2021 REMANDED Entitlement to service connection for an eye disability, including as due to service-connected hypertension or service-connected coronary artery disease, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1953 to December 1979. This matter originally came before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In January 2017, the Board denied service connection for an eye disability, claimed as glaucoma, to include as secondary to service-connected hypertension and coronary artery disease. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In November 2017, the Court granted a Joint Motion for Partial Remand (JMR) filed by the parties to the appeal (the Veteran, through an attorney, and representatives from VA General Counsel), thereby vacating the Board’s decision insofar as it denied service connection for an eye disability and remanded that matter for readjudication. In June 2018 the Board remanded the Veteran’s claim pursuant to the JMR. The AOJ returned the Veteran’s claim to the Board and in September 2019 the Board again remanded the claim in order to obtain an addendum opinion. The claim is now once again before the Board. Entitlement to service connection for an eye disability, including as due to service-connected hypertension or service-connected coronary artery disease Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is an adequate opinion in the record upon which to decide the Veteran’s claim and to afford him every possible consideration. The Veteran was most afforded a VA examination, in connection with his claim, in November 2019. The examiner opined that the Veteran’s eye disability “was at least as likely as not … incurred in or caused by the claimed in-service injury, event, or illness”. It appears this may have been a scrivener’s error as the rationale contradicts this statement and in the rationale the examiner stated that the Veteran’s eye disability was “less likely than not … incurred in or caused while in service.” The examiner noted that the conditions occur with increased age and the only eye condition noted on the separation examination was arcus senilis which also occurred with increased age. The examiner noted that the October 1971 glaucoma check was normal. However, this opinion does not address all of the theories of entitlement raised by the Veteran. November 2011 Medical Treatment Records demonstrate the Veteran was concerned that the x-rays he received on the left side of his head during service affected his left eye in terms of glaucoma. In his October 2012 Statement in Support of Claim the Veteran questioned whether his in-service x-rays and operations to the left side of his head affected his left eye, in terms of glaucoma. In his February 2014 Notice of Disagreement, he expressed disappoint that an examiner had not mentioned the numerous x-rays of the left side of his head, and operations, and he suspected x-ray radiation damage resulting in glaucoma. To date no examiner has addressed the Veteran’s numerous contentions that his eye disabilities were related to his in-service x-rays and medical procedures. As such an addendum opinion is necessary to consider this theory of entitlement. Further the November 2019 examiner stated that the only condition noted on the separation examination was arcus senilis. On his August 1979 report of medical history, it was noted that the Veteran’s present health included “slight eye problems (preglaucoma)”. However, the examiner did not address this note of pre-glaucoma that was included on the Veteran’s report of medical history. A review of the Veteran’s service treatment record shows that in May 1972 his eyes hurt from sunlight. His September 1977 report of medical history noted he currently had, or had in the past, eye trouble. What appears to be an October 1979 ophthalmologic examination for a glaucoma check noted the fundus examination showed minimal cupping. A May 1980 examination of the fundus revealed small cups. The Veteran’s Service Treatment Record also contains a list of his medical history where it was noted he had pre-glaucoma in 1977 which was noted during a physical examination in the Philippines, and he was followed up by semi-annual eye examination. This evidence was not adequately discussed by the examiner. Although the examiner mentioned an October 1971 glaucoma check was normal the examiner did not discuss the other service records or the examination shortly after service. Notably the October examination notes minimal cupping and the examination shortly after the Veteran’s service noted small cups. The November 2019 examiner discussed how the literature reported that with glaucoma it is usually, but not always, in the presence of elevated intraocular pressure and the optic nerve or disc takes on a hollowed-out appearance on ophthalmoscopic examination , which is described as “cupping”. As noted above the Veteran’s service treatment record, and the examination that occurred shortly after his service, noted the presence of cupping. Because the examiner noted that cupping is associated with glaucoma, but did not discuss the records above wherein cupping was noted, an addendum opinion is necessary. The Board notes that there are multiple examinations in the current record. The November 2017 JMR found that the August 2013 and June 2015 examinations were not adequate. In September 2019 the Board found the April 2019 examination to be inadequate. The May 2020 VA medical opinion was limited to whether the Veteran’s eye disabilities were secondary to his service connected disabilities and whether the Veteran’s service connected disabilities aggravated his eye disabilities. Although the Board sincerely regrets the need for an addendum opinion, the current record is not sufficient to decide the Veteran’s claim. As discussed above no examiner has specifically addressed the Veteran’s contentions that his eye disabilities were related to his in-service x-rays and surgeries to his ear. As discussed above the November 2019 examiner’s opinion does not adequately discuss the in-service treatment records, and the other opinions have been found to be inadequate. As such a remand for an addendum opinion is necessary. The matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. To the extent possible, make arrangements to provide the record on appeal to the VA examiner who previously offered opinions with respect to the etiology of the Veteran’s eye disabilities in November 2019. The examiner should be asked to again review the expanded record and prepare a supplemental report as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran has a disability of the eye(s) that had its onset during, or is otherwise related to, the Veteran’s military service. In so doing, the examiner should discuss the medical significance, if any, of the Veteran’s contentions that his eye disabilities are related to his in-service left ear treatment including x-rays, the August 1979 report of medical history noting pre-glaucoma, the May 1972 report of eyes hurting, the September 1977 report of eye trouble, the May 1980 record with the note of small cups, and the medical history noting pre-glaucoma in 1977 with semi-annual follow. If it is the examiner’s opinion that it is unlikely that an identified eye disability had its onset in, or is otherwise attributable to, service, the examiner should offer a further opinion as to whether it is at least as likely as not that such disability has been caused or aggravated by the Veteran’s service-connected disabilities to include coronary artery disease and hypertension. If the November 2019 examiner is no longer employed by VA or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner(s) selected to offer the requested opinions. (Continued on the next page)   A complete rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. R. Costello Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, 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.