Citation Nr: 22044745 Decision Date: 08/08/22 Archive Date: 08/08/22 DOCKET NO. 17-17 070 DATE: August 8, 2022 REMANDED Entitlement to service connection for a bilateral eye disability other than bilateral pseudophakia is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to November 1970. The Board previously remanded the matter in February 2019, September 2021, and December 2021. In December 2021, the Board remanded the matter for further development, to include obtaining an addendum opinion as to the Veteran's bilateral eye disability other than bilateral pseudophakia. The Board directed the examiner to address the various diagnoses related to the Veteran's eyes throughout the course of appeal. Specifically, the examiner was asked to address the following disorders: corneal pellucid marginal degeneration, vitreous floaters (vitreous degeneration), and mild ptosis that were identified at the Veteran's previous examinations and to determine whether each was directly related to service, to include his exposure to Agent Orange. Further, the Board directed the examiner to determine whether each disorder was either caused or aggravated by the Veteran's service-connected diabetes mellitus. In December 2021, the Veteran underwent a VA eye condition examination, and a medical opinion was provided. The December 2021 VA examiner diagnosed pseudophakia, pellucid marginal degenerative, and vitreous floaters affecting both eyes. The examiner found that the Veteran did not have a diagnosis of ptosis. However, the examiner did not consider or discuss the December 2014 VA examination report showing a diagnosis of mild ptosis. The examiner further provided negative nexus opinions as to the corneal pellucid marginal degeneration and vitreous floaters (vitreous degeneration) disorders. Regarding the Veteran's right and left eye corneal pellucid marginal degeneration, the examiner indicated that it was unrelated to diabetes mellitus and unrelated to any disease, trauma or event, or herbicide exposure experienced while in the military as it was a degenerative or dystrophic condition. As to aggravation, the examiner only stated that the Veteran's right and left eye corneal pellucid marginal degeneration presented in 2018 and was not aggravated while in the military in 1969-1970. Regarding the Veteran's right and left eye vitreous floaters (vitreous degeneration), the examiner indicated that the disorders were diagnosed in 2020 and unrelated to diabetes mellitus and unrelated to any disease, trauma, or event, or herbicide exposure experienced while in the military. As to aggravation, the examiner noted that there was no indication that the Veteran had right and left eye vitreous floaters (vitreous degeneration) in 1969-1970. The Board finds the December 2021 VA examination to be inadequate for adjudication purposes. First, the examiner failed to comply with the Board's December 2021 remand directives by failing to address the December 2014 VA examination report showing a diagnosis of mild ptosis. Second, the examiner's rationale as to their opinion that corneal pellucid marginal degeneration and vitreous floaters (vitreous degeneration) were not directly related to service and not aggravated by service-connected diabetes mellitus is conclusory, as it lacks further explanation to support the medical opinion. Accordingly, the Board finds that a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran's claimed eye disorders. See 38 U.S.C. §5103A(d); 38 C.F.R. §3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App.185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records up to the present. 2. Direct the claims file to a clinician to obtain an addendum opinion. (a.) As an initial matter, the examiner is asked to clarify whether the Veteran currently or at any point during the period on appeal had a diagnosis of mild ptosis. In providing such clarification, the examiner must discuss the diagnosis of mild ptosis found in the December 2014 VA examination report. If relevant, the examiner should also comment on whether mild ptosis had resolved during the appeal period. If mild ptosis is shown to have been diagnosed at any time during the appeal period, then the examiner should state: What is the medical probability that the diagnosis of mild ptosis in a December 2014 VA examination had its onset in service or was caused by or related to his active service, to include his exposure to Agent Orange? What is the medical probability that the diagnosis of mild ptosis in a December 2014 VA examination was caused by or aggravated by service-connected diabetes? The clinician is asked to address i) causation and ii) aggravation separately. (b.) With respect to corneal pellucid marginal degeneration, the clinician is asked to address the following: What is the medical probability that corneal pellucid marginal degeneration diagnosed in 2018 was due to or caused by service, to include his exposure to Agent Orange? What is the medical probability that corneal pellucid marginal degeneration was caused by or aggravated by service-connected diabetes? The clinician is asked to address i) causation and ii) aggravation separately. (c.) With respect to vitreous floaters (vitreous degeneration), the clinician is asked to address the following: What is the medical probability that vitreous floaters (vitreous degeneration) diagnosed in 2020 was due to or caused by service, to include his exposure to Agent Orange? What is the medical probability that vitreous floaters (vitreous degeneration) were caused by or aggravated by service-connected diabetes? The clinician is asked to address i) causation and ii) aggravation separately. A rationale for all opinions must be provided. If the clinician determines that an examination is necessary in order to provide the requested opinions, then one should be scheduled. T. SHERRARD Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Grzeczkowicz 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.