Citation Nr: 23057760 Decision Date: 10/24/23 Archive Date: 10/24/23 DOCKET NO. 20-11 200 DATE: October 24, 2023 ORDER Entitlement to service connection for a neurological disorder of the right upper extremity is dismissed. Entitlement to service connection for a neurological disorder of the left upper extremity is dismissed. Entitlement to service connection for an acquired psychiatric disorder is dismissed. REMANDED Entitlement to service connection for a bilateral eye disability is remanded. Entitlement to service connection for a heart disability is remanded. FINDING OF FACT There is currently no justiciable case or controversy for active consideration by the Board on the issues of entitlement to service connection for a neurological disorder of the right and left upper extremities and an acquired psychiatric disorder as those matters were granted in January 2018 and May 2021 rating decisions, respectively. CONCLUSION OF LAW As the benefits sought on appeal have been granted in full, there remains no case or controversy as to the issues of entitlement to service connection for a neurological disorder of the right and left upper extremities and an acquired psychiatric disorder. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.104. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from June 1969 to February 1972 with an additional period of Illinois Army National Guard service. He died in March 2022. The appellant claims as his surviving spouse. These matters come to the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision by the agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). With respect to psychiatric disorders, a claim of service connection encompasses all pertinent symptomatology, regardless of how that symptomatology is diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5, 9 (2009). The Board has recharacterized the issue as a claim of entitlement to service connection for an acquired psychiatric disorder. It is a well-established judicial precedent that when there is no case or controversy, or when a once live case or controversy becomes moot, the Board lacks jurisdiction. Bond v. Derwinski, 2 Vet. App. 376, 377 (1992); Mokal v. Derwinski, 1 Vet. App. 12, 15 (1990). The current appeal arises from a July 2016 Fully Developed Claim (VA 21-526EZ) whereby the Veteran claimed service connection, in pertinent part, for neuropathy of the left and right upper extremities, and service connection for depression and anxiety. The respective claims were denied by the AOJ in a March 2017 rating decision. Following a timely April 2017 Notice of Disagreement, the Veteran submitted a claim of service connection for Parkinson's disease, manifested by tremors, stiffness, and difficulty walking and swallowing, in a January 2018 Fully Developed Claim. The AOJ, in a January 2018 rating decision, awarded service connection, in pertinent part, for Parkinson's disease, manifested by tremors and muscle rigidity of the right and left upper extremities, and merged such with already service-connected diabetic peripheral neuropathy disabilities of the upper extremities. While the Veteran did pursue claims for neurological impairments of the bilateral upper extremities after January 2018, he did not name any new conditions; he simply claimed the same impairments under different theories of entitlement, i.e., due to Parkinson's, due to diabetes, due to herbicide exposure, etc. In a November 2019 letter, the AOJ sought clarification regarding the disabilities that affected his claimed right and left upper extremities. The Veteran responded in December 2019 that the disability impacting the nerve dysfunction of the bilateral lower extremities was neuropathy (associated with his service-connected diabetes mellitus), while the disability that impacted the nerve dysfunction of the bilateral upper extremities was Parkinson's disease. In other words, he was addressing already service-connected conditions. Accordingly, the AOJ correctly interpreted and addressed the claims as ones for increased rating. The service-connected benefit sought had been granted. With respect to the appellant's claimed acquired psychiatric disorder, service connection for posttraumatic stress disorder (PTSD) with unspecified depressive disorder was granted by the AOJ in a May 2021 rating decision with an effective date of March 8, 2021. The Board questions the assigned effective date, as the claim of service connection for depression was pending since July 11, 2016; an earlier effective date claim is not before the Board, however. Thus, there is no "controversy" or "issue" currently before the Board as these claims currently before the Board have been fully resolved in the appellant's favor. Shoen v. Brown, 6 Vet. App. 456, 457 (1994). As there have been total grants of benefits sought in the March 2020 appeal, the issues of entitlement to service connection for a neurological disorder of the right and left upper extremities and service connection for an acquired psychiatric disorder are moot and are no longer before the Board. Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). In light of the above, there is no case or controversy currently before the Board as the claims of entitlement to service connection for a neurological disorder of the right and left upper extremities and service connection for an acquired psychiatric disorder have been resolved entirely in the appellant's favor. Consequently, the appeal with respect to these issues must be dismissed. REASONS FOR REMAND Further evidentiary development is required in connection with the claims of entitlement to service connection for a heart disability and service connection for a bilateral eye disability. The record reflects that the Veteran was afforded a VA heart examination in February 2017. If VA provides an examination that examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examination report referenced diagnoses of supraventricular arrhythmia, valvular heart disease, and atrial fibrillation. In rendering negative nexus opinions on a secondary basis, the VA examiner indicated that the supraventricular arrhythmia and valvular heart disease were less likely than not proximately due to or the result of the Veteran's service-connected diabetes mellitus. The VA examiner reported that the most common causes of atrial fibrillation are hypertensive heart disease and valvular heart disease. The VA examiner further opined that the findings of mild mitral and tricuspid insufficiency were less likely than not proximately due to or the result of the Veteran's diabetes mellitus. The VA examiner noted that such were incidental findings on echocardiogram and were the result of the disease process causing atrial fibrillation which was clearly hypertensive heart disease. The VA examiner further indicated that since the Veteran had normal renal function, hypertension was not the result of diabetic kidney disease. The VA examiner did not render a nexus opinion on a direct or presumptive basis as the AOJ has already conceded herbicide agent exposure. Further, only conclusory statements and no rationale were provided. To have probative value, a medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, the Veteran had been in receipt of service connection for hypertension associated with diabetes mellitus since February 2006. Therefore, no probative value is afforded to the opinion in light of the factual error underlying it. Reonal v. Brown, 5 Vet. App. 458, 460 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). Thus, the VA medical opinion is inadequate, and the Board must remand the claim for a new opinion. Additionally, the appellant asserts that the claimed eye disability (claimed as "vision loss") was caused by service-connected diabetes mellitus. A May 2021 diabetic eye consult referenced a suspected macular abnormality. While the Veteran was scheduled for a VA eye examination prior to his death, it was noted in March 2017 correspondence that the Veteran was unable to travel the significant distance required to attend the examination. The appellant has presented sufficient evidence to raise the possibility of a nexus for the claimed disability. Therefore, a VA medical opinion is warranted to determine the nature and etiology of the claimed eye disability. The matters are REMANDED for the following actions: 1. Associate with the claims file complete reports of retinal testing completed on May 21, 2021, to include any VISTA imaging. 2. Obtain a VA medical opinion to ascertain the nature and etiology of the claimed heart disability; the claims folder must be reviewed in conjunction with the examination. The examiner must opine as to whether such is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) caused or aggravated by service, to include as due to service-connected disabilities and conceded herbicide exposure. A full and complete rationale is required for all opinions expressed. 3. Obtain a VA medical opinion to ascertain the nature and etiology of the claimed eye disability; the claims folder must be reviewed in conjunction with the examination. The examiner must opine as to whether such is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) caused or aggravated by service, to include as due to service-connected disabilities and conceded herbicide exposure. A full and complete rationale is required for all opinions expressed. 4. Then, readjudicate the remanded issues. If the benefits sought remain denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G.A. Ong, 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.