Citation Nr: 21026871 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-26 666 DATE: May 4, 2021 REMANDED Entitlement to service connection for a bilateral eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to December 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Although the Veteran initially requested a personal hearing with a Veterans Law Judge, he withdrew his request in December 2018. 38 C.F.R. § 20.704(e). In June 2019 and July 2020, the Board remanded the Veteran's claim for additional development. The case is once again before the Board. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for a bilateral eye disability, to include as secondary to hypertension and coronary artery disease with ischemic cardiomyopathy, is remanded. In January 2021, the Veteran underwent an eye examination. There, the examiner diagnosed the Veteran with pseudophakia and rendered a negative direct and secondary service connection opinion. ("Pseudophakia" is "a condition in which the degenerated crystalline lens is replaced by mesodermal tissue." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1545 (32d. ed. 2012).) The examiner explained that the Veteran's pseudophakia was from his cataract surgery, not his service, hypertension, or coronary artery disease. The examiner's opinion raised the question whether the Veteran's cataracts are related to his service or service-connected disabilities. Recognizing this problem, the RO asked for an addendum medical opinion. Unfortunately, the resulting opinion is inadequate for decision-making purposes for the following reasons: the examiner did not opine on whether the Veteran's cataracts (1) were aggravated by his heart disability, (2) were related to his service, or (3) were caused or aggravated by his hypertension. Accordingly, remand is necessary for an addendum medical opinion. Finally, as the case is being remanded for additional development, any outstanding VA treatment records should be associated with the claims file. See Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (per curiam). The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's cataracts had their clinical onset during service or are due to an event or incident of the Veteran's active service. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion as whether it is at least as likely as not (50 percent probability or greater) that his cataracts were (A) caused or (B) aggravated beyond their normal progression by his service-connected hypertension. Aggravation means an increase in disabilityany additional impairment of earning capacityof the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability before aggravation by the service-connected disability. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. Arrange for an appropriate healthcare provider to review the Veteran's claims file and provide an opinion as whether it is at least as likely as not (50 percent probability or greater) that his cataracts were (A) caused or (B) aggravated beyond their normal progression by his service-connected coronary artery disease with ischemic cardiomyopathy. Aggravation means an increase in disabilityany additional impairment of earning capacityof the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability before aggravation by the service-connected disability. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran's pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Canedy, 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.