Citation Nr: 22018779 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 18-06 754 DATE: March 30, 2022 REMANDED Entitlement to an initial rating in excess of 10 percent for optic nerve drusen is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1980 to June 1984. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Augusta, Maine. Jurisdiction of this appeal is currently with the RO in Togus, Maine. This case was most recently before the Board in December 2020, 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. In addition, in a September 2021 rating decision, the AOJ granted entitlement to compensation under 38 U.S.C. § 1151 for bilateral upper and bilateral lower extremity nerve peripheral neuropathy (claimed as entitlement to compensation under 38 U.S.C. § 1151 for dysesthesias) and assigned initial ratings. To date, the Veteran has not submitted a notice of disagreement with this decision. As this decision represents a full grant of the benefits sought with respect to these claims for entitlement to compensation under 38 U.S.C. § 1151, such issues are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). 1. Increased Rating Optic Nerve Drusen The Veteran seeks entitlement to an increased initial rating in excess of 10 percent for her optic nerve drusen. Specifically, she asserted her visual acuity had worsened since her most recent VA examination and her eyes had progressively worsened. See e.g. VA Form 21-4138 Statement in Support of Claim, August 17, 2016. Accordingly, the Board previously remanded the claim for further VA examination in the December 2020 remand directives. The Veteran was afforded the directed VA examination in July 2021. At that time, in pertinent part, the VA examiner conducted visual field testing using the Goldmann equivalent III/4e target, and noted the Veteran had a contraction of a visual field. Then, the VA examiner noted that a repeat visual field testing was recommended to look for reproducibility. Further explanation nor elaboration was not provided at this time. Regrettably, the Veteran's claim must be remanded once again. The Board finds the July 2021 VA examination report incomplete to decide the claim. In this regard, the July 2021 VA examination opinion is internally inconsistent and did not provide supporting rationale for the conclusions reached. Namely, the VA examiner seems to indicate the visual field testing results at the July 2021 are unreliable or inaccurate, and that additional testing was recommended for reproducibility without any explanation. Moreover, the VA examiner did not reconcile the conflicting evidence of record, namely, that the Veteran was shown to have contraction of a visual field. Additionally, the examiner noted that the visual field loss was more likely than not due more to optic neuropathy that occurred after a neck injection in 2014 and not her optic nerve drusen because the optic nerve drusen had been present for many years without visual field loss. However, the VA examiner failed to provide supporting rationale for the conclusions reached. Rather, the VA examiner merely provided a conclusory statement without further elaboration that the documented visual field defect was more likely due to the Veteran's episode of "coding" following a neck injection, resulting in peripheral vision loss. Accordingly, the cause of the visual field impairment as shown in the Goldmann testing chart from July 2021 VA examination remains unexplained. Based on the above, the Board finds that there has not been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, further remand is required for compliance with the Board's December 2020 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 claim 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. Then, after the aforementioned development, schedule the Veteran for an additional VA examination to determine the current nature and severity of her service-connected optic nerve drusen. If it is determined that the Veteran's visual field testing results should be reconducted for reproducibility, conduct any such necessary testing. Then, obtain a VA addendum opinion from the VA examiner who previously examined the Veteran, and if unavailable, any licensed ophthalmologist or optometrist. Following a review of the record and interview and examination of the Veteran, the examiner must answer the following: What is the underlying cause of the visual field defect in each eye? If the underlying cause of the visual field defect is not her service-connected optic nerve drusen, then the examiner should provide an opinion as to whether it is at least as likely as not (50/50 probability or greater) that the visual field defect is due to the Veteran's service or a service-connected disability. The examiner must reconcile any conflicting evidence of record. Ask the Veteran to comment on any visual field symptoms/problems she has had from March 2015 to the present. For each diagnosed eye condition, the examiner should provide an opinion as to whether it is at least as likely as not (50/50 probability or greater) caused by or due to his military service or a service-connected 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. Christopher J. O'Donnell Acting 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.