Citation Nr: 23014697 Decision Date: 03/10/23 Archive Date: 03/10/23 DOCKET NO. 12-14 398 DATE: March 10, 2023 REMANDED Entitlement to service connection for a right eye disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1965 to June 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a right eye disorder is remanded. The Veteran contends that his right eye disorder is due to service. The matter last appeared before the Board in November 2020, at which time the issue was remanded to obtain an adequate VA examination. The Board found that while the Veteran underwent an August 2020 VA eye conditions examination, the examiner provided an unfavorable opinion, but did not provide rationale. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A VA examination is adequate if it is thorough and contemporaneous, considers the Veteran's prior medical examinations and treatment, and describes the disability in sufficient detail so that the Board's evaluation is a fully informed one. Id. Most recently, the Veteran underwent an in-person VA eye conditions examination in August 2022, which resulted in diagnoses of left eye history of central retinal vein occlusion with macular edema, senile cataract right eye, and pseudophakia left eye. Addendum opinions were also obtained in August 2022. The examiner opined that the Veteran's right eye condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner rationalized that the Veteran does not have a right eye condition that was incurred in or caused by service, including, presumed exposure to herbicide agents. The examiner explained that the Veteran's loss of vision on the right eye is due to senile cataract and refractive error. The examiner described that senile cataract in the Veteran as an age expected changed on the lens of the eye, not caused by nor aggravated by military service, including presumed exposure to herbicide agents. The examiner further opined that the Veteran's right eye condition is less likely than not proximately due to or the result of the Veteran's service-connected diabetes mellitus, hypertension or the medications to treat the service-connected disabilities, nor to the left eye central retinal vein occlusion with macular edema. The examiner rationalized that the Veteran's loss of vision in the right eye is due to senile cataract and refractive error and that the Veteran has no diabetic retinopathy on the right eye. The examiner indicated that the Veteran's senile cataract is an age expected change in the lens of the Veteran. Finally, the examiner opined that the Veteran's right eye condition, senile cataract, was not aggravated beyond its natural progression by his service-connected conditions. The examiner rationalized that the senile cataract of the right eye is an age expected change in the lens of the eye, not aggravated beyond natural progression by diabetes mellitus nor hypertension. The examiner indicated that the Veteran's senile cataract did not start at an earlier age than expected, nor has it progressed more rapidly than expected. The examiner found that vision in the right eye is still 20/40 or better. The examiner further explained that the Veteran's left eye condition, left eye central retinal vein occlusion of the left eye with macular edema, is not a cause of any right eye condition, including senile cataract. The Board finds that, outside of the rationale explaining that the Veteran's senile cataract of the right eye did not start at an earlier age than expected, nor has it progressed more rapidly than expected, the examiner summarily concluded for all opinions, that the Veteran's condition is an age related expected change in the lens of the eye. Although the examiner noted that the rationale is based on review of the record, this rationale does not include medical analysis of the specific facts of the case. Here, the Board finds that the opinions are conclusory and inadequate. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Further, while the July 2017 and August 2020 VA eye conditions examinations also includes diagnoses of small recurrent nasal pterygium of the right eye, the August 2022 examiner did not provide an opinion for this condition. Barr, 21 Vet. App. at 311. Hence, remand is required to obtain adequate opinions. Id. The matter is REMANDED for the following action: 1. Obtain any outstanding treatment records and associate those records with the claims file. 2. Forward the claims file to an appropriately qualified VA clinician and request that the clinician determine the nature and etiology of the Veteran's right eye disorder. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician. The opinion must include a notation that this record review took place. The necessity of an in-person examination is left to the discretion of the examiner. After the record review, the reviewing clinician is asked to respond to the following: A. Is it at least as likely as not that the Veteran's right eye disorder, including senile cataract and small recurrent nasal pterygium of the right eye, is related to the Veteran's active-duty service? In so doing, the examiner asked to directly address the Veteran's service, including his presumed exposure to herbicide agents. B. Is it at least as likely as not that the Veteran's right eye disorder, including senile cataract and small recurrent nasal pterygium of the right eye, was proximately caused OR aggravated by his service-connected disabilities? A complete rationale for all opinions provided is required. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alli, Q. 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.