Citation Nr: 21026920 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 15-33 761 DATE: May 4, 2021 REMANDED Entitlement to service connection for a bilateral eye disability as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to January 1971, to include service in Vietnam. This case comes to the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) rating decision dated in January 2013. This case was most recently before the Board in March 2019. It was remanded to the AOJ for additional development. Unfortunately, for the reasons below, another remand is required. Entitlement to service connection for a bilateral eye disability as secondary to service-connected disabilities is remanded. The Veteran was afforded a VA examination for his claim in December 2012. The examiner diagnosed nuclear sclerosis and hereditary retinal dystrophy. The examiner provided a negative opinion because the Veteran's macular dystrophy was hereditary. This opinion is inadequate because it does not address the correct legal standard for a hereditary defect or disease, nor does the opinion address the etiology of the Veteran's nuclear sclerosis. VA General Counsel has indicated that there is a distinction under the law between a congenital or developmental "disease" and a congenital or developmental "defect" for service connection purposes. A "disease" considered by medical authorities to be of congenital, familial (or hereditary) origin by its very nature pre-exists claimants' military service, but that service connection for such diseases could be granted only if manifestations of the disease in service constituted aggravation of the condition. See also Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); but see VAOPGCPREC 67-90 (July 18, 1990) (finding that "service connection may be granted for hereditary diseases which either first manifest themselves during service or which pre-exist service and progress at an abnormally high rate during service."). If the disorder is considered a congenital or hereditary "defect," service connection may be granted for disability resulting from any superimposed disease or injury. 38 C.F.R. §§ 3.303(c), 4.9. The Board finds the current medical evidence is unclear as to whether the Veteran has an acquired disorder, a hereditary defect, or a hereditary disease. Thus, a remand is required for a supplemental opinion. The Veteran underwent another VA examination in February 2020. The examiner diagnosed the Veteran with macular degeneration and pseudophakia. The examiner essentially opined that the Veteran's vision loss was due to macular degeneration, not diabetes mellitus, vascular disease, or herbicide agents. However, the examiner did not provide an opinion regarding the cause or etiology of the Veteran's macular degeneration. The examiner also did not address the other diagnoses in the Veteran's claims file, including nuclear sclerosis and retinal dystrophy. The VA examinations of record also do not directly address the Veteran's contention, making them incomplete. The Veteran has contended that his service-connected posttraumatic stress disorder, including his hypervigilance, impacted his blood pressure and cardiovascular system, which then caused his eye disabilities, or that his eye disabilities are secondary to his service-connected coronary artery disease. For these reasons, another remand is needed before a decision can made on the Veteran's claim. The matters are REMANDED for the following action: 1. Obtain a VA addendum opinion from an appropriate examiner to determine the etiology of the Veteran's eye disability, including nuclear sclerosis, retinal dystrophy, and macular degeneration. Following review of the record the examiner should respond to the inquiry below. If the examiner determines that he or she cannot respond to the Board's inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an in-person examination, or by other means if an in-person examination is not feasible. (a.) The examiner must clarify the Veteran's diagnoses, including nuclear sclerosis, retinal dystrophy, and macular degeneration. (b.) For each diagnosed eye disability or disorder, including nuclear sclerosis, retinal dystrophy, and macular degeneration, the examiner must indicate whether it is a hereditary defect, a hereditary disease, or an acquired disability or disorder. The examiner is advised that for purposes of VA compensation, a defect is defined as a condition that is more or less stationary in nature, whereas a disease is defined as a condition capable of improving or deteriorating. (c.) For any diagnosed hereditary defect of the eye, the examiner must opine whether it was at least as likely as not (50 percent likelihood or greater) subject to, or aggravated by, a superimposed disease or injury during service which resulted in an additional disability. If so, please identify the additional disability. (d.) For any identified disease or acquired disorder, the examiner must opine whether it at least as likely as not (50 percent likelihood or greater) clearly and unmistakably both (i) preexisted the Veteran's entry into active service, and (ii) was not aggravated beyond the normal progress of the disorder during or as a result of active service (i.e., that it clearly and unmistakably did not increase or that any increase was clearly and unmistakably due to the natural progress of the disease). (e.) If the disease or disability did not clearly and unmistakably preexist the Veteran's service, the examiner must opine as to whether it is at least as likely as not (50 percent likelihood or greater) that the diagnosed eye disability, including nuclear sclerosis, retinal dystrophy, and macular degeneration, is etiologically related to service, including exposure to herbicide agents. (f.) If it is determined that the eye disease or disability is less likely than not causally or etiologically related to service, the examiner must opine whether each diagnosed eye disability, including nuclear sclerosis, retinal dystrophy, and macular degeneration, is proximately due to, the result of, or aggravated beyond its natural progress by the Veteran's service-connected diabetes mellitus, heart disease, or PTSD. The examiner must specifically address the Veteran's contention that his service-connected posttraumatic stress disorder, including his hypervigilance, impacted his blood pressure and cardiovascular system, which then caused his eye disabilities, or that his eye disabilities are secondary to his service-connected coronary artery disease. A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. MARTHA R. LUBOCH Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. 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.