Citation Nr: 21031438 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 14-24 349A DATE: May 21, 2021 REMANDED Entitlement to service connection for a left eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1977 to January 1979. This matter was previously remanded by the Board in April 2018 and July 2020 for additional development. At a June 2017 Travel Board hearing, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. Here, the Veteran claim was previously remanded for an addendum opinion to a September 2019 VA eye examination. The 2019 examiner (one of the Veteran's treating optometrists) diagnosed bilateral narrow angle glaucoma. The Veteran's left eye corrected near and distant vision was 20/40. The examiner determined that the decrease in visual acuity was attributable to glaucoma. The Veteran denied diplopia. The examiner noted that no ophthalmological treatment was required for his insulin-dependent diabetes mellitus and that treatment for his glaucoma included eye drops. The examiner stated that bilateral narrow angle glaucoma was not caused by or a result of the reported in-service left eye injury or the documented left eye surgery. In support, he stated that the Veteran's glaucoma was a bilateral condition and did not only affect the left eye. Further, there was no evidence of glaucoma in the STRs. He also concluded that the Veteran's constricted visual field bilaterally was most likely caused by or a result of glaucoma. The examiner also addressed the March 2016 observation of a pigmented lesion in the left eye. He stated that he agreed with the May 27, 2016, retinal specialist that it was a visually insignificant pigment which was a congenital hypertrophy of the retinal pigment epithelium. Congenital hypertrophy of the retinal pigment epithelium was not caused by or a result of the left eye injury or left eye surgery since it is congenital in nature. Further, it was visually insignificant and did not progress beyond its normal expectation due to military service or any ocular events in military service. Regarding diplopia, the examiner stated that the Veteran did not report it at the current examination or at 14 other eye examinations with various doctors. The Board previously determined that, although the September 2019 examiner concluded that the current diagnosis of bilateral glaucoma was not caused by the in-service left eye injury or left eye surgery based on the bilateral nature of the condition, he did not address the Veteran's reports of blurriness and diplopia occurring since the left eye surgery. Although he correctly noted that the Veteran did not report diplopia to treating clinicians at numerous times, he stated that "no complaint" was made of diplopia throughout the record. However, the Veteran did report blurry vision and occasional diplopia to clinicians in May 2011, he described blurry vision in his left eye in June 2012, and he testified that he had occasional blurriness and double vision in his left eye at the June 2017 hearing. As it appeared that these reports of relevant symptoms were not considered, a new opinion was requested which addressed all lay statements of record. Additionally, the examiner determined that the left eye hypertrophy of the retinal pigment epithelium was a congenital condition that did not progress beyond normal expectation due to military service, but no rationale was provided for that conclusion. As such, a new opinion was sought upon remand. In January 2021, the Veteran was provided with an addendum opinion. However, it appears that the examiner merely recited the previous findings from the September 2019 VA examination, specifically prefacing the opinions with "As stated in original opinion." There did not appear to be any discussion of the Veteran's documented complaints of diplopia or complaints of blurred vision since his in-service left eye surgery. Rather, the examiner appears to have restated the Board's prior remand instructions as indication that this was considered, but provided no further elaboration or discussion. Furthermore, the examiner did not provide a rationale for why the Veteran's congenital eye disability did not progress beyond normal expectation due to military service as also requested. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Where the remand orders of the Board are not complied with, the Board itself errs in failing to ensure compliance. Id. at 271. Accordingly, the Veteran's claims file must once again be returned to the September 2019 VA examiner or other appropriate person for an addendum opinion in which the aforementioned issues are actually discussed and complete rationales provided. The matters are REMANDED for the following action: 1. Obtain an addendum VA opinion from a qualified clinician regarding the nature and etiology of any left eye disability. The need for an additional examination is left to the discretion of the clinician. Following a review of the entirety of the record, the clinician is asked to determine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any current disability, to include glaucoma, decreased visual acuity, and/or lay reports of blurriness and diplopia, are related to the Veteran's active service, specifically to include the reported left eye injury or the strabismus/exotropia surgery. The clinician should determine whether any of the reported symptomology is a residual of the injury or surgery or whether it is attributable to another condition, specifically to include glaucoma, decreased visual acuity, or hypertrophy of the retinal pigment epithelium. The reasons for any conclusion should be fully explained. (b.) Whether the left eye hypertrophy of the retinal pigment epithelium is a congenital or developmental disease or defect. (c.) If left eye hypertrophy of the retinal pigment epithelium is a congenital or developmental defect, whether the condition was subject to superimposed disease or injury in service, to include the reported left eye injury or documented left eye strabismus/exotropia surgery. The reasons for any conclusions should be fully explained. (d.) If left eye hypertrophy of the retinal pigment epithelium is a congenital or developmental disease, whether such disease clearly and unmistakably preexisted service, and if so, whether it was aggravated beyond natural progression during service. In this regard, the examiner is asked to identify the period of time (date) when any change occurred in the left eye hypertrophy of the retinal pigment epithelium, and if that change occurred after service, address whether any in-service experiences can be the cause of the post service changes. The reasons for the conclusions expressed should be fully explained. (e.) All opinions should be accompanied by a complete rationale. The examiner is asked to address all of the Veteran's relevant lay statements, specifically to include the May 2011 report of blurriness and diplopia, the June 2012 report of blurriness in the left eye, and the June 2017 hearing testimony describing occasional blurred vision and double vision following the in-service surgery. 2. Readjudicate the claim. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.