Citation Nr: 18131196
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 07-35 158
DATE:	August 31, 2018
REMANDED
Entitlement to service connection for an eye disability, claimed as glaucoma, to include as due to herbicide exposure, and to include as secondary to service-connected diabetes mellitus, type II (diabetes) is remanded.
Entitlement to an initial rating in excess of 50 percent for post-traumatic stress disorder (PTSD) is remanded.
Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from November 1968 to June 1970, with service in the Republic of Vietnam.
Upon review of the record, the Board finds that the remaining issues must once again be remanded.  The Board sincerely regrets the additional delay caused by this remand, but wishes to assure the Veteran that it is necessary for a full and fair adjudication of these claims.

1. Entitlement to service connection for an eye disability, claimed as glaucoma, to include as due to herbicide exposure, and to include as secondary to service-connected diabetes.
The Board also finds an April 2016 VA examination to be inadequate.  With regard to glaucoma, the examiner determined it was unlike related to agent orange as medical literature does not support causation; the examiner concluded that the etiology of glaucoma is unknown.  With regard to another eye condition of proptosis, the examiner did not provide a nexus opinion and stated that “the exact etiology for unilateral proptosis in the right eye cannot be determined with evidence[] reviewed and examination findings without speculation at this time.”  The examiner’s speculative language renders the examination insufficient as to the question of nexus.  See Jones v. Shinseki, 23 Vet. App. 382 (2010).  Accordingly, the Board finds a remand is warranted for further evidentiary development.  See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate).
2. Entitlement to an initial rating in excess of 50 percent for PTSD is remanded.
A remand is necessary to obtain updated treatment records and to afford the Veteran a new examination so that the Board can gain a better understanding of the severity of the Veteran’s PTSD.  The Veteran’s last psychiatric examination was in November 2011.  The Veteran submitted a letter stating that things have changed with regard to his PTSD.  Furthermore, the Veteran’s file consists of only one psychiatric treatment record – the above state examination.  The Board finds that as the Veteran’s last psychiatric examination occurred approximately 7 years ago, and because the Veteran has indicated that his condition has worsened, a contemporaneous examination is required.    
3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
With regard to the TDIU claim, because the development and re-evaluation of the Veteran’s PTSD and eye condition claims may impact the TDIU claim, the Board finds those claims to be intertwined.  The Board will defer adjudication of the TDIU claim until the development deemed necessary for the claims have been completed.  See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Holland v. Brown, 6 Vet. App. 443 (1994); Henderson v. West, 12 Vet. App. 11 (1998).  
The matters are REMANDED for the following action:
1. Assist the Veteran with uploading updated treatment records.
2. Schedule the Veteran for a VA examination, WITH AN EXAMINER WHO HAS NOT PREVIOUSLY EXAMINED THE VETERAN, to determine the nature and etiology of the Veteran’s eye disability, to include proptosis, open angle glaucoma, and severe corneal scarring of the right eye with neovascularization, and to include as due to herbicide exposure and to include as due to service-connected diabetes.
The claims file should be made available to the examiner for review in connection with the examination.  Based on review of the record and examination of the Veteran, the examiner should respond to the following: 
a)	With regard to the eye disability, the examiner should state whether it is at least as likely as not (a 50 percent probability or more) that such a disability began in service, was caused by active service, or is otherwise related to active service, to include herbicide exposure.  
b)	The examiner should also opine as to whether it is at least as likely as not (a 50 percent probability or more) that such a disability is etiologically related to or aggravated by the Veteran’s service-connected diabetes.  
The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions.
The examiner is also asked to provide an opinion as to the occupation impact of the Veteran’s eye condition.
The examiner must provide the rationale for all proffered opinions.  If the examiner is unable to provide any required opinion, he or she should explain why.  If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so.  If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed.
3. Schedule an examination with the appropriate examiner to determine the current severity of the Veteran’s PTSD.  The examination should address all symptoms and occupational and social impairment. The electronic claims file must be available to the examiner, and the examiner must specify in the examination report that these records were reviewed.
The examiner is asked to discuss the symptoms of the Veteran’s PTSD throughout the entire appellate period, from February 18, 2005 onwards.
4. After any necessary development and readjudication of the increased-rating claim for and service-connection claim, readjudicate the TDIU issue remaining on appeal.

 
A. S. CARACCIOLO
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Gandhi, Associate Counsel

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