Citation Nr: 22012106 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 14-09 177A DATE: March 2, 2022 REMANDED Entitlement to an initial rating in excess of 30 percent for the appeal period prior to March 23, 2020 for left eye pseudophakia is remanded. Entitlement to an initial compensable rating for the appeal period prior to March 23, 2020, and in excess of 20 percent thereafter for left eye maculopathy is remanded. Entitlement to an initial compensable rating for bilateral eye retinal scars for the appeal period prior to March 23, 2020 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United State Air Force from May 1984 to May 2010, to include service in Southwest Asia. These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Jurisdiction of this appeal was transferred and is currently with the RO in Roanoke, Virginia. This case was most recently before the Board in August 2021, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Increased Rating Left Eye As noted in August 2021, the Veteran asserts that he is entitled to higher ratings for his service-connected left eye pseudophakia, left eye maculopathy, and bilateral eye retinal scars as his symptoms are worse than contemplated by the current ratings assigned. Specifically, the Veteran stated he believed his rating for his left eye pseudophakia was incorrectly transferred into his claims file. See Notice of Disagreement, June 14, 2011. With regard to his left eye maculopathy, the Veteran asserts that he had corrected vision to 20/40 but that he had severe distortion with his left eye vision, and the macula hole is not completely gone and will not be regenerated back to 100 percent. Id. With regard to his bilateral eye retinal scars, the Veteran asserts he has significant scar tissue in his left eye with diminished visual acuity and distorted images. Id. The Veteran was afforded a VA examination in March 2020. At that time, the examiner diagnosed pseudophakia of the left eye; retinal detachment and retina tear, left eye, status post repair; maculopathy status post macula pucker surgery; and retinal scars bilateral. The Veteran reported current symptoms included reduced vision due to his maculopathy; he denied any current symptoms for his retinal detachment and retinal tear, pseudophakia, and retina scars. At his March 2020 VA examination, the Veteran was not shown to have a documented visual field defect; visual field testing was not performed. However, in his May 2010 VA examination, the VA examiner noted the Veteran had constricted visual field of the left eye that was more likely than not due to his retinal detachment and laser retinopexy. The August 2021 Board remand found that remand was necessary to obtain a clarification from the examiner regarding whether there is actually a visual defect, and if so, if that defect is related to the service-connected eye disability. The Veteran was afforded the directed VA examination in December 2021. At that time, the VA examiner opined the Veteran's retina detachment was less likely than not progressed based on visual acuities being stable; that there was no evidence of progression and his visual acuity was stable, and thus it was less likely than not aggravated beyond its natural progression by a service-connected condition; and that his visual field defect was due to retina detachment that occurred after he left service, and was not related to any condition in service or service-connected. The Board finds the December 2021 VA examination opinions incomplete to decide the claims because the examiner failed to adequately provide supporting rationale for the conclusions reached. Rather, the VA examiner merely provided conclusory statements that the Veteran's visual acuity was stable, and that his visual field defect is due to retina detachment that is not etiologically related to service, without any further elaboration. Thus, in order to avoid additional remands and avoid the possibility of issuing another inadequate opinion, the VA examiner is requested to comply with the Board's remand directives and only issue the medical opinion specifically requested for each issue and restate the opinion utilizing the exact language specified. See Stegall v. West, 11 Vet. App. at 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board regrets the additional delay, but an adequate VA examination is needed before the Board can render a decision on this issue. Given these deficiencies, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D'Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again required to obtain additional VA addendum opinions that comply with the Board's prior remand directives. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum from a qualified medical examiner regarding the Veteran's service-connected left eye disabilities. Specifically, the examiner should provide the results of visual field testing for the left eye, or if visual field testing cannot be performed on the left eye, explain why. If contraction of visual fields (or any other visual field defect) is found, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any visual defect found is attributable to any service-connected left eye disability. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 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 resorting 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. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.