Citation Nr: 22036699 Decision Date: 06/27/22 Archive Date: 06/27/22 DOCKET NO. 18-53 102A DATE: June 27, 2022 REMANDED Entitlement to service connection for a vision condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1964 to December 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in September 2019, July 2021, and March 2022. Unfortunately, substantial compliance with the prior remand was not achieved and another remand is warranted. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a vision condition The March 2022 Board remand directed the RO to obtain an addendum opinion. The examiner was to opine as to whether it was at least as likely as not that any diagnosed eye condition is aggravated by service-connected hypertension. Thereafter, in an April 2022 VA opinion, a VA clinician checked the box for "no" in response to the question "regardless of an established baseline, was the Veteran's (claimed condition/diagnosis) at least as likely as not aggravated beyond its natural progression by (insert 'service connected condition')? As rationale, the clinician explained, the Veteran's dry syndrome and pseudophakia was less likely than not due to systemic service connected hypertension as there is no nexus between these conditions from medical record and literature review. Risk factors for dry eye syndrome include previous refractive eye surgery, poor environmental conditions, and systemic conditions. The pseudophakia is due to natural aging progression of cataract that then needed treatment with cataract surgery with lens implant. The rationale provided does not address the question of aggravation. Rather, it discusses causation. Remand is necessary for an addendum opinion that adequately addresses whether it is at least as likely as not that any diagnosed eye condition is aggravated by service-connected hypertension. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the file. 2. Obtain an addendum opinion from a qualified clinician regarding whether it is at least as likely as not (approximately 50 percent probability or greater) that any diagnosed eye condition is aggravated (defined as any increase in disability) by the Veteran's service-connected hypertension. The clinician is advised that secondary service connection does not require "permanent worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The clinician is reminded that causation and aggravation are independent concepts. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018). Provide a complete and thorough rationale for the opinion. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Vemulapalli, 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.