Citation Nr: 21027976 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 13-29 930 DATE: May 10, 2021 REMANDED Entitlement to service connection for bilateral eye disability, to include diabetic retinopathy, senile nuclear sclerosis, and vitreous floaters, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1969 to December 1973 in the United States Army with service in the Republic of Vietnam. His exposure to herbicide agents is presumed. 38 C.F.R. § 3.307(a)(6)(iii). These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issue in August 2018 and July 2020. See BVA Decision (August 2018); see also BVA Decision (July 2020). A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for bilateral eye disability is remanded. The Veteran contends that his bilateral eye disability developed as a result of his military service. The Board notes that the record indicates that the Veteran was presumed to have been exposed to herbicide agents during service. Alternatively, his representative argues that service connection for bilateral eye disability is warranted as secondary to service-connected disability. See Appellate Brief (April 2021). To ensure that VA has met its duty to assist, remand is necessary to obtain a new medical opinion in this matter. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Although a January 2021 VA examination and opinion was obtained as directed in the July 2020 Board remand, it is inadequate as explained below. An October 2019 VA examination reflects eye diagnoses for bilateral senile nuclear sclerosis and vitreous floaters. A January 2021 VA eye examination reflects diagnoses for dermatochalasis, corneal arcus, and senile nuclear sclerosis cataract, pinguecula, and dry eye syndrome bilaterally. Diabetic retinopathy was not found. A January 2021 VA medical opinion (VAMO) reflects that the eye conditions are less likely than not caused by in-service injury, event, or illness; or secondary to service-connected disability. The rationale was that dermatochalasis, cataract, dry eyes, and corneal arcus are age-related with no direct relationship with the Veteran's service-connected disabilities; and that pinguecula is a condition "produced by exposure to UV rays of the sun with conjunction of dry eyes." The VAMO indicated that eye disability had its onset was after service. Separate rationales were not provided for each conclusion reached. The Board finds the December 2020 VA medical opinion is inadequate. First, the record indicates that the Veteran has manifested with several different diagnoses involving his eyes. However, the January 2021 examiner did not address the eye the diagnosis of retinal degenerative drusen shown during the appeal period. Second, the conclusions reached are not supported by a complete rationale. It is also noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21Vet. App.102, 124-25. A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22Vet. App. 295, 301 (2008). In this case, the opinion does not include separate rationales for the causation and aggravation prongs of secondary service connection. See Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018) (an examiner must provide a rationale that deals with causation and aggravation as independent concepts). When VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, the matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from September 2020 to Present. 2. Obtain an addendum from an ophthalmologist addressing the nature and etiology of the Veteran's eye disorders to include (1) bilateral senile nuclear sclerosis and vitreous floaters (2) dermatochalasis, (3) corneal arcus, (4) senile nuclear sclerosis cataract, (4) pinguecula, and (5) dry eye syndrome. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with any eye disability. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. (a) For each eye disorder, opine on whether it at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease, to include herbicide agent exposure. Explain. (b) For each eye disorder, opine on whether it is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. Explain. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): An adequate medical opinion may not be predicated solely on the absence of literature supporting causation or aggravation without discussing those facts specific to this Veteran. NOTE (3): An adequate medical opinion on secondary service connection will include separate rationales for the conclusions reached on the causation and aggravation prongs of secondary service connection as these are independent concepts. 3. Ensure that the medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Macek, Mark 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.