Citation Nr: 22011691 Decision Date: 03/01/22 Archive Date: 03/01/22 DOCKET NO. 14-34 830A DATE: March 1, 2022 REMANDED Entitlement to service connection for cataracts is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1977 to January 1981. He appeals a July 2017 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to reopen the Veteran's claim for service connection for visual depth perception loss. A Board of Veterans' Appeals (Board) hearing was held in May 2019 before a Veterans Law Judge (VLJ) who has since left the Board. A transcript is of record. In September 2019, the Board reopened the Veteran's claim and remanded for further development. A September 2020 letter notified the Veteran that the VLJ who conducted the May 2019 hearing was no longer employed at the Board and afforded him an opportunity for an additional hearing. As the Veteran did not respond to the letter, the Board proceeded with adjudication and remanded the claim in December 2020 for further development. In January 2022, prior to the appeal's certification to the Board, the Veteran's representative withdrew representation. As the Veteran has not appointed new representation since this withdrawal, the Board will proceed with the Veteran as self-represented. The Board apologizes for the additional delay, but a third remand is required. The December 2020 Board remand requested a clinician review the Veteran's record and provide an opinion addressing whether the Veteran's cataracts were caused by his conceded exposure to contaminated water while serving at Camp Lejeune. The December 2020 Board remand directives, among others, stated "the examiner must specifically address the prior opinion's comments that the Veteran's initial statements of visual/depth perception limitations precluding him from flight training may have represented contrast sensitivity loss." This Board remand directive was not addressed in the subsequent opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Instead, the July 2021 examiner stated there was no medical evidence that contaminated water caused cataracts, but that the Veteran's cataracts were as likely as not caused by his type II diabetes mellitus as "it is well documented that diabetes can hasten the development of cataracts." See July 2021 VA examination report. Indeed, the Veteran received an eye examination in October 2015 and was diagnosed with mild cataracts, but the ophthalmologist noted the Veteran had "no background diabetic retinopathy." See October 2015 VA treatment records. The Veteran's first abnormal diabetic retinopathy examination was noted in March 2017 VA treatment records, two years after his cataract diagnosis, and the Veteran underwent bilateral cataract surgery in August 2017. See August 2017 Cornea and Cataracts Consultants records. The July 2021 examiner incorrectly stated the Veteran's cataract surgery was in 2016, did not know when he was diagnosed with diabetic retinopathy, and, inexplicably, stated that the Veteran's claim was not filed prior to May 2018. See July 2021 VA examination report. Thus, as the VA examiner did not address a Board remand directive, provided inaccurate facts based on the record, and his rationale did not contain sufficient detail and explanation specific to the Veteran, the Board's evaluation of the Veteran's claim cannot be a fully informed one and a remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Additionally, the record appears incomplete. VA has a duty to obtain relevant records, including private treatment records that have been sufficiently identified. See 38 C.F.R. § 3.159(c). The record reflects the Veteran received a private eye examination in March 2017 by Dr. J.Y. in Maryland and the September 2019 Board remand requested the AOJ obtain these private records. See March 2017 VA treatment records. However, the AOJ's October 2019 subsequent development letter merely requests the Veteran submit treatment records from a private optometrist, to which the Veteran submitted other private optometrist treatment records. As the Board is remanding this appeal for an adequate medical opinion, the AOJ should attempt to obtain the Veteran's records from Dr. J.Y. The matters are REMANDED for the following action: 1. Obtain any outstanding and updated relevant VA and/or private treatment records including, but not necessarily limited to all treatment records and March 2017 eye examination by Dr. Jian Yang O.D. in Maryland. If any identified records are not obtainable, or none exist, the Veteran should be notified, and the record clearly documented. 2. After the development in #1 above is complete, obtain an opinion from a qualified clinician, other than the clinician who provided the July 2021 VA examination, to determine the nature and etiology of the Veteran's cataracts. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After a thorough review of the record to include all in-service and post-service treatment records, the reviewing clinician should answer the following: (a) Is it at least as likely as not that the Veteran's eye condition was incurred in or is otherwise related to his time in service, to include his conceded exposure to contaminated water at Camp Lejeune, North Carolina? (b) Discuss the July 2020 medical opinion and explain the relationship between cataracts and contrast sensitivity, specifically whether cataracts can be caused by contrast sensitivity? The reviewing clinician must address the Veteran's statement in the September 2011 VA examination report that he was "eliminated from flight training [in service] since he failed the depth perception screening examination." The reviewing clinician is also directed to consider (i) October 2015 VA treatment records noting the first diagnosis of cataracts with "no background diabetic retinopathy;" (ii) July 2017 VA treatment records and Cornea and Cataracts Consultants records reflecting mild nonproliferative retinopathy without macular edema; and (iii) August 2017 Cornea and Cataracts Consultants records noting the Veteran's cataract surgeries. A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. (Continued on the next page) 3. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.