Citation Nr: 21027895 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 12-13 399 DATE: May 7, 2021 REMANDED Entitlement to service connection for impaired vision is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1965 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) from a July 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing at his local VA office. In February 2018, he waived his right to said hearing. Thus, the Board considers the request for a hearing withdrawn. 38 C.F.R. § 20.704 (e). The matter was thrice before the Board in December 2015, April 2018, and July 2020. The most recent remand of July 2020 mandated that the RO attempt to obtain any outstanding treatment records and associate them with the claims file and procure an addendum opinion to the January 2019 VA eye conditions examination. Outstanding VA treatment records have been associated with the claims file. In August 2020, the RO requested completed VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA). In October 2020, the RO received the execute document, listing no private treatment physician. In this regard, the Board finds that there has been substantial compliance. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The supplemental opinion of February 2021, however, is inadequate, and there has not been substantial compliance in this regard. Id. Entitlement to service connection for impaired vision is remanded. The Veteran asserts that his vision problems are secondary to his service-connected diabetes mellitus, type II. During the January 2019 VA examination, the examiner noted diagnoses of no ocular manifestations of his diabetes mellitus, type II, in either eye. However, he was diagnosed with a mild nuclear cataract, lagophthalmos, and right eye punctate keratitis, on the day of the examination. He noted a diagnosis of bilateral dry eye "a few years ago." Regarding a nexus to service, the examiner found that the diagnosed conditions were less likely than not caused by service. He explained that the Veteran's eye health was expected for his age, and his vision was not impaired. Furthermore, there was no retinopathy related to his diabetes. In February 2021, per the July 2020 Board remand, the examiner provided a supplemental medical opinion. The examiner again noted no signs of diabetic retinopathy on the exam. As for the diagnosed mild bilateral cataracts, the examiner noted that it was age-related, and thus "less likely than not that the [Veteran's] eyesight [was] at least as likely as not proximately due to or the result of diabetes mellitus type II." Regarding the aggravation prong, the examiner found that his eyesight was not also aggravated beyond its natural progression by his service-connected diabetes mellitus, type II, because he had no diabetic retinopathy and as cataracts were due to natural aging progression." The Board finds the supplemental medical examination, too, incomplete. The January 2019 VA examiner diagnosed a mild nuclear cataract, lagophthalmos, bilateral dry eye, and right eye punctate keratitis. The supplemental opinion, however, only provided an opinion as to the cataract diagnosis. An opinion is therefore needed for all diagnosed vision disabilities, including lagophthalmos, bilateral dry eye, and right eye punctate keratitis. Thus, a remand is warranted addressing all diagnosed vison disabilities and the secondary relationship to the Veteran's diabetes mellitus, type II, to include both aggravation and proximate causation. Accordingly, the matter is REMANDED for the following action: 1. Provide the Veteran's claim file to a qualified clinician so that a supplemental examination may be provided addressing the etiology of his vision disorders. The entire claims file and a copy of this remand must be made available to the examiner for review. A physical examination of the Veteran or telehealth examination is only required if deemed necessary by the clinician. The clinician is asked to address the following: a. Determine all vision disorders during the period on appeal. b. Determine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed vision disorder manifested during active service or is related to any incident therein. c. Determined whether it is at least as likely as not (50 percent or greater probability) that any diagnosed vision disorder is proximately caused by his service-connected diabetes mellitus, type II. d. Determine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed vision disorder is aggravated by his service-connected diabetes mellitus, type II. The clinician is reminded that for a secondary service connection claim, a VA medical opinion should not combine causation and aggravation; separate findings and rationales should be provided for each one. Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018). The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above-requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such a conclusion. DUSTIN L. WARE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Stevens, 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.