Entitlement to service connection for an eye disorder is remanded.

Citation Nr: 26001387 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 17-17 216 DATE: January 30, 2026 REMANDED Entitlement to service connection for an eye disorder is remanded. Entitlement to service connection for osteoarthritis is remanded. Entitlement to service connection for a respiratory disorder is remanded. Entitlement to service connection for a skin disorder is remanded. Entitlement to an initial compensable rating for bilateral hearing loss prior to May 2, 2022. Entitlement to rating in excess of 10 percent from May 3, 2022, until May 2, 2023, and a compensable rating thereafter, for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from February 1984 to February 1998. This matter is before the Board of Veterans' Appeals (Board) on appeal from November 2014 (bilateral hearing loss, skin, osteoarthritis, respiratory) and September 2017 (eye) rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a virtual Board hearing in November 2021; a transcript is of record. Regarding the issue of service connection for an acquired psychiatric disorder, in April 2022, the Board remanded this issue for further development. Subsequently, a July 2023 rating decision granted service connection for generalized anxiety disorder with unspecified depressive disorder. As this grant represents a full grant of the benefits sought, this issue is no longer on appeal. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997). The remaining issues were remanded by the Board in April 2022 for additional development, to include obtaining updated examinations and medical opinions. For the reasons discussed below, they are again remanded. Obesity as an intermediate step In the April 2022 Board Remand, the Board remanded obesity as an intermediate step for some of the claims below. In April 2024, an opinion addressing obesity as an intermediate step was obtained. The examiner stated the Veteran's obesity was not due to his service-connected disorders as the leading causes were diet, lack of exercise, lifestyle, genetic, hormonal, and/or medication. The examiner stated there was no way to determine why the Veteran gained weight without speculation. See 5/7/2024, C&P Exam. In September 2024, additional obesity opinions were obtained. See 9/3/2024, C&P Exam. The examiner stated the Veteran's disorders did not preclude all forms of exercise. The examiner also reported that the Veteran's obesity caused or worsened his arthritis, respiratory disorders, and reported retinopathy. The Board acknowledges following the Board's remand, additional medical opinions were obtained. However, the opinions are either speculative or provide generalized medical knowledge that is not specific to the Veteran. As such, the Board finds that an addendum opinion is warranted ? 1. Entitlement to service connection for osteoarthritis is remanded. The Veteran asserts service connection for osteoarthritis, to include as due to obesity as an intermediate step as well as contaminated water at Camp Lejeune. The Veteran has degenerative disc disease in his cervical, thoracic, and lumbar spine, to include as reported in the April 2023 VA examination. See 4/19/2023, C&P Exam. As such, the first element of service connection is met. A private treatment record explained the Veteran's obesity caused his arthritis. See 8/27/2014, Medical Treatment Record - Government Facility. A November 2022 examiner stated the Veteran's arthritis was not due to contaminated drinking water at Camp Lejeune; rather, it was related to his obesity. See 11/22/2022, C&P Exam. The April 2023 VA examiner provided a negative nexus opinion. See 4/19/2023, C&P Exam. The examiner stated the Veteran's arthritis was not secondary to his service-connected disabilities as they were unrelated. Additionally, his back disorders were not due to service as there was a lack of chronicity during or after service. In this matter, the Board finds an additional opinion is necessary for the Board to fully address the Veteran's claim. As described above, the opinions regarding obesity are insufficient. For the Veteran's claim for arthritis, his arthritis has been attributed to his obesity. Additionally, the opinions for the Veteran's arthritis claim are conclusory and not specific to the Veteran. As such, an additional opinion is necessary. 2. Entitlement to service connection for a respiratory disorder is remanded. The Veteran asserts service connection for a respiratory disorder, to include obstructive sleep apnea (OSA) and asthma. The Veteran has current diagnoses of OSA and asthma, to include as reported in the April 2023 VA examinations. See 4/19/2023, C&P Exam. As such, the first element of service connection is met. A private treatment record explained the Veteran's obesity caused his OSA. See 8/27/2014, Medical Treatment Record - Government Facility. A November 2022 opinion determined that the Veteran's asthma was not due to contaminated water at Camp Lejeune as it was not presumptively associated with the chemical contaminants. See 11/22/2022, C&P Exam. The April 2023 examiner found the Veteran's OSA was not due to service as there was a lack of chronicity during service or after service. See 4/19/2023, C&P Exam. Additionally, it was not due to service at Camp Lejeune as it was not a presumptive condition. It was also not secondary to his service-connected disabilities as medical literature did not show a causal relationship. The examiner provided the same findings and rationale for the Veteran's asthma. In August 2024, an additional opinion was provided. See 8/26/2024, C&P Exam. The examiner stated that the Veteran's asthma was not due to contaminated water as there was no scientific evidence to suggest a causal relationship. In this matter, the Board finds an additional opinion is necessary for the Board to fully address the Veteran's claim. The above opinions largely rely on the absence of medical literature to support a negative conclusion or that the Veteran's disorders were not listed as presumptive to contaminated water at Camp Lejeune. As such, an additional opinion is necessary. 3. Entitlement to service connection for an eye disorder is remanded. The Veteran asserts entitlement to service connection for an eye disorder. In a May 2023 VA examination, pseudophakia was diagnosed. See 5/4/2023, C&P Exam. In a September 2024 VA examination, the Veteran was also diagnosed with epiretinal membrane (macular pucker). See 9/5/2024, C&P Exam. Background diabetic retinopathy was reported in a June 2017 VA examination. See 7/17/2017, C&P Exam. As such, the first element of service connection is met. The November 2022 examiner provided a negative nexus opinion. See 11/22/2022, C&P Exam. The examiner concluded that the Veteran's diabetic retinopathy was not due to contaminated water at Camp Lejeune as it was not presumptively associated with the chemical contaminants. See 11/22/2022, C&P Exam. Obesity was listed as a risk factor. The May 2024 examiner found the Veteran did not have a current diagnosis of diabetic retinopathy. See 5/7/2024, C&P Exam. The most recent opinion is from September 2024. See 9/5/2024, C&P Exam. The examiner stated the Veteran did not have diabetic retinopathy at present and that his other eye disorders were not due to Camp Lejeune as they were not presumptive. In this matter, the Board finds an additional opinion is necessary for the Board to fully address the Veteran's claim. The above opinions largely rely on the absence of medical literature to support a negative conclusion or that the Veteran's disorders were not listed as presumptive to contaminated water at Camp Lejeune. Additionally, the Veteran's diabetic retinopathy was not sufficiently addressed as he did not have such a diagnosis at the time of the examinations but the 2017 VA examination, during the period on appeal, listed diabetic retinopathy. As such, an additional opinion is necessary. 4. Entitlement to service connection for a skin disorder is remanded. The Veteran asserts service connection for a skin disorder. The Veteran had excision of squamous cell carcinoma and excision of atypical nevus as reported in a July 2022 VA examination. See 7/27/2022, C&P Exam. A history of scleroderma was noted in the August 2024 VA examination. See 8/26/204, C&P Exam. As such, the first element of service connection is met. The November 2022 examiner provided a negative nexus opinion. See 11/22/2022, C&P Exam. The examiner concluded that the Veteran's seborrheic keratosis was not due to contaminated water at Camp Lejeune as it was not presumptively associated with the chemical contaminants. See 11/22/2022, C&P Exam. Additional secondary opinions were provided in May 2023. See 5/21/2023, C&P Exam. The examiner determined the Veteran's skin disorders were not due to his service-connected disorders as medical literature did not support a relationship. The Veteran's disorder was likely caused by cumulative exposure of skin to UV light. The August 2024 examiner stated the Veteran did not have a current diagnosis of scleroderma. See 8/26/2024, C&P Exam. In this matter, the Board finds an additional opinion is necessary for the Board to fully address the Veteran's claim. The above opinions largely rely on the absence of medical literature to support a negative conclusion or that the Veteran's disorders were not listed as presumptive to contaminated water at Camp Lejeune. Additionally, not all of the Veteran's skin disorders were sufficiently addressed as he did not have varying diagnoses at some of the examinations but had previously had a diagnosis during the period on appeal. As such, an additional opinion is necessary. 5. Entitlement to an initial compensable rating for bilateral hearing loss prior to May 2, 2022. 6. Entitlement to rating in excess of 10 percent from May 3, 2022, until May 2, 2023, and a compensable rating thereafter, for bilateral hearing loss is remanded. In April 2022, the Board remanded the claim for an increased rating for bilateral hearing loss for additional development. The AOJ issued a September 2022 and July 2023 rating decision that increased the rating for service-connected bilateral hearing loss to 10 percent, effective May 2, 2022, and noncompensable effective May 2, 2023. As these rating decisions did not implement a full grant of the benefits sought on appeal, the appeal remained pending. However, the AOJ did not issue a supplemental statement of the case even though the appeal was not fully resolved and a supplemental statement of the case should have been issued. 38 C.F.R. § 19.31. As a supplemental statement of the case was not issued regarding the bilateral hearing loss issue, the Board must remand the claim for issuance of a supplemental statement of the case to ensure due process is met. ? These matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any records cannot be obtained, notify the Veteran and his representative of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. 2. After completing #1, obtain an addendum opinion or schedule the Veteran for an examination, if necessary, by an appropriate examiner to determine the nature and etiology of the Veteran's arthritis. Then, address whether: (a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disability is related to an in-service injury, event, or disease to include participation in toxic exposure risk activity or activities? In forming an opinion, the examiner must consider (1) the total potential exposure through all applicable military deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities. (b.) If no to question (a), whether the obesity/weight gain as a result of the service-connected disabilities was a substantial factor in causing his disorder; (c.) Whether his disorder would not have occurred but for the obesity/weight gain caused by the service-connected disabilities. (d.) If no to the above questions (b)-(c), is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder was either 1) caused by any service-connected disability OR 2) did the Veteran's disability get worse because of his service-connected disabilities, to include medications and/or treatment for his service-connected disorders? 3. After completing #1, obtain an addendum opinion or schedule the Veteran for an examination, if necessary, by an appropriate examiner to determine the nature and etiology of the Veteran's respiratory disorders diagnosed as asthma and OSA. Then, address whether: (a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disability is related to an in-service injury, event, or disease to include participation in toxic exposure risk activity or activities? In forming an opinion, the examiner must consider (1) the total potential exposure through all applicable military deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities. (b.) If no to question (a), whether the obesity/weight gain as a result of the service-connected disabilities was a substantial factor in causing his disorder; (c.) Whether his disorder would not have occurred but for the obesity/weight gain caused by the service-connected disabilities. (d.) If no to the above questions (b)-(c), is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder was either 1) caused by any service-connected disability OR 2) did the Veteran's disability get worse because of his service-connected disabilities, to include medications and/or treatment for his service-connected disorders? 4. After completing #1, obtain an addendum opinion or schedule the Veteran for an examination, if necessary, by an appropriate examiner to determine the nature and etiology of the Veteran's skin disorders. Please identify all skin disorders during the period on appeal (October 2013) onward. Then, address whether: (a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disability is related to an in-service injury, event, or disease to include participation in toxic exposure risk activity or activities? In forming an opinion, the examiner must consider (1) the total potential exposure through all applicable military deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities. (b.) If no to the above questions (b)-(c), is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder was either 1) caused by any service-connected disability OR 2) did the Veteran's disability get worse because of his service-connected disabilities, to include medications and/or treatment for his service-connected disorders? 5. After completing #1, obtain an addendum opinion or schedule the Veteran for an examination, if necessary, by an appropriate examiner to determine the nature and etiology of the Veteran's eye disorders. Please identify all eye disorders during the period on appeal (May 2017 onward). Then, address whether: (a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disability is related to an in-service injury, event, or disease to include participation in toxic exposure risk activity or activities? In forming an opinion, the examiner must consider (1) the total potential exposure through all applicable military deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities. (b.) If no to question (a), whether the obesity/weight gain as a result of the service-connected disabilities was a substantial factor in causing his disorder; (c.) Whether his disorder would not have occurred but for the obesity/weight gain caused by the service-connected disabilities. (d.) If no to the above questions (b)-(c), is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder was either 1) caused by any service-connected disability OR 2) did the Veteran's disability get worse because of his service-connected disabilities, to include medications and/or treatment for his service-connected disorders? 6. Issue a supplemental statement of the case as to the issue of entitlement to an increased rating for bilateral hearing loss. The case should then be returned to the Board for adjudication, if necessary. 7. Inform the examiner that a comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. Inform EACH appropriate examiner(s) that, in arriving at the opinion on the Veteran's disorder and weight gain/obesity, all lay evidence must be considered, including any articles submitted by the Veteran and his statements. To determine whether any weight gain or obesity is an "intermediate step" between either any or all of the Veteran's service-connected disabilities and coronary artery disease, the examiner is to fully answer the above questions to assist the Board with adjudication of these matters. (CONTINUED ON THE NEXT PAGE) ? If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G.M., 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.