Citation Nr: 25008294 Decision Date: 06/24/25 Archive Date: 06/24/25 DOCKET NO. 15-23 664 DATE: June 24, 2025 REMANDED Service connection for cataracts is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1989 to April 1993. This matter is on appeal to the Board of Veterans' Appeals (the Board) from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case has a long procedural history, which is fully laid out in the February 2025 Board Decision, which previously remanded this issue. The Board regrets the delay; nonetheless, prior to final adjudication, additional development is necessary. 1. Service connection for cataracts. Among the Board's February 2025 remand directives, the Board required an appropriate medical provider to opine whether the Veteran's service-connected disabilities aggravated his cataracts issue. Upon examination, in pertinent part, the medical provider stated, "[the] Veteran's condition has resolved post cataract surgery...an opinion was not rendered as there was no pathology to render a diagnosis." The examiner neglected to provide the opinion that the Board requested. Therefore, there has not been substantial compliance with the Board's remand directive; an additional remand is required in order to correct for error. Stegall v. West, 11 Vet. App. 268 (1998). Moreover, the examiner's implicit rationale for not providing the requested opinion is not congruent with VA regulations. Under the appropriate diagnostic code (DC), postoperative cataracts can still be rated. See 38 C.F.R. § 4.79 DC 6027. Accordingly, the Veteran's successful cataract surgery has not rendered the question of service connection for cataracts moot. Therefore, a remand to obtain substantial compliance with the February 2025 Board directives is needed. The matters are REMANDED for the following action: 1. The Regional Office (RO) should obtain an addendum medical opinion from the from the March 2025 cataracts examiner to address the Veteran's secondary service connection claim for cataracts. If the March 2025 cataracts examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical reexamination is needed, one should be scheduled. Upon review of the record, the examiner is asked to provide the following: Whether it is at least as likely as not (an approximate balance of evidence) that the Veteran's cataracts disability is 1) caused by or 2) aggravated (any incremental degree of worsening) by any of his service-connected disabilities, to include flat fee, chronic fatigue syndrome (CFS), posttraumatic stress syndrome (PTSD), bowel disturbance with abdominal distress, left ankle strain with achilles tendonitis, recurrent sinusitis, tinnitus, and/or bilateral hearing loss. The examiner is advised that secondary service connection does not require "permanent" worsening of the claimed condition 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. Further, the requirement of "proximate cause" was invalidated and instead "but for" causation or aggravation is enough to show entitlement to secondary service connection secondary service. See Spicer v. McDonough, No. 2022-1239 (Fed. Cir. March 8, 2023). The examiner is further advised that, for the purposes of service connection, the Veteran's postoperative state for cataracts is not determinative; as requested above, opinions on medical nexus and aggravation are required even if the Veteran's postoperative cataracts are asymptomatic. A complete written rationale must be provided for any opinion offered, and separate findings and rationales for causation and aggravation are required. 2. The RO should review the opinions for compliance with the Board's directives, and take corrective action if found deficient, to include obtaining an opinion from a more responsive provider if needed. After any additional development deemed necessary is accomplished, the RO should readjudicate the issue on appeal. If any benefit sought remains denied, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the opportunity to respond. Thereafter, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Drum, Ryan S. 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.