Citation Nr: 22012872 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 17-54 089 DATE: March 7, 2022 REMANDED Entitlement to service connection for bilateral eye disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to March 1970. The Veteran has qualifying service in the Republic of Vietnam during the Vietnam Era. His exposure to herbicide agents is presumed. 38 C.F.R. § 3.307(a)(6)(iii). This appeal comes before the Board of Veterans' Appeals (Board) from a November 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In April 2021 and July 2021, the Board remanded the claim for further development. Entitlement to service connection for bilateral eye disability is remanded. The Veteran, and his representative, seeks service connection for a bilateral eye disability. In this regard, the Veteran argues that his current bilateral eye disability stems from in-service exposure to herbicide agents. In the alternative, the Veteran also argues that his disability is secondary to service-connected diabetes mellitus. To ensure that VA has met its duty to assist, the claim must be remanded for further development. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). VA examination report, dated in November 2021, reflects that the Veteran was diagnosed with horseshoe tears, bilateral; cataracts, bilateral; and dry eye syndrome, bilateral. VA medical opinion, dated in November 2021, reveals that the Veteran's bilateral eye disability is less likely than not proximately due to or the result of his service-connected diabetes mellitus. The Board finds the medical opinion inadequate for adjudicative purposes. Here, the opinion provides a rationale that does not reveal that the clinician considered the theories of causation and aggravation as "independent concepts." In this regard, the opinion appears to have mixed the theories of causation and aggravation. Indeed, the opinion, in this instance, copied the identical rationale in support of finding that the Veteran's diabetes mellitus did not cause or aggravate his bilateral eye disability. Although the same medical rationale may apply to both theories, the Board, on its own, is unable to make this unsubstantiated medical finding or conclusion. The Board, thus, can only consider independent medical evidence to support this finding or conclusion. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Further, the Board observes that aggravation of a nonservice-connected disability by a service-connected disability is independent of direct causation and must ensure that medical opinions are adequate on that question. See Allen v. Brown, 7 Vet. App. 439 (1995). Accordingly, the clinician's omission to adequately provide an opinion that dealt with causation and aggravation as "independent concepts," deprives the Board of the information it needs to decide this claim, thereby making the VA medical opinion inadequate for adjudicative purposes. Next, VA medical opinion, dated in June 2021, reveals that the Veteran's bilateral eye disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, to include in-service exposure herbicide agents. The Board finds the VA medical opinion is inadequate as the essential rationale for the opinion is not discernable. Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012). Here, the opinion does not reflect adequate rationale in support of the conclusion. For instance, the opinion notes several medical findings, such as exposure to herbicide agents is not a known risk for pinguecula or retinal tears; the opinion, however, does not reveal a medical explanation or discussion connecting the findings to the conclusion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (noting that "a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two"). Further, the opinion reveals that the clinician found nonservice-related etiologies, such as age and sunlight exposure, caused the Veteran's bilateral eye disability, the opinion, however, is absent a discussion of the relevant or significant medical history, clinical findings, medical knowledge or literature, etc., that support the nonservice-related etiologies. Although the clinician is not required to accept the Veteran's theory that his service caused his bilateral eye disability; however, the clinician is required to fully explain why he or she disagrees with the Veteran's theory of causation and provide a discussion of the relevant or significant medical history, clinical findings, medical knowledge or literature, etc., that support the negative medical opinion or conclusion(s). If another etiology is the more likely cause, the clinician must provide a complete explanation of his or her reasoning. Given the above, the Board finds that it may not rely upon the VA medical opinions in their present form and, therefore, finds the medical evidence is inadequate for adjudicative purposes. Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, as the Board has a duty to ensure compliance with the terms of its remand, remand is again required. Stegall v. West, 11 Vet. App. 268 (1998). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matter is REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for signs and symptoms for his bilateral eye disability, to include from Eye Health Services. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records for the period from March 2021 to the Present. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's bilateral eye disability. 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 symptom consistent with any eye disability. NOTE (1): The opinion should 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). NOTE (2): A negative medical opinion may not be predicated solely on the absence of in-service documented complaints, findings, or treatment. The clinician must opine on: Direct Service Connection (a) Whether any eye disability at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease. Consider and expressly address the Veteran's theory that his disability stems from in-service exposure to herbicide agents. Explain. Secondary Service Connection (b) Whether any eye disability is at least as likely as not (1) proximately due to service-connected diabetes mellitus, or (2) aggravated beyond its natural progression by service-connected diabetes mellitus. Provide a rationale that deals with causation and aggravation as independent concepts. Explain. 4. Ensure that the VA 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. (Continued on the next page) 5. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Griffey, 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.