BVA9504388 DOCKET NO. 89-21 915 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for a right eye disorder. 2. Entitlement to an increased rating for residuals of a laceration of the left eye, currently evaluated as 30 percent disabling. 3. Entitlement to special monthly compensation based on blindness in one eye. 4. Entitlement to specially adapted housing or a special home adaptation grant. 5. Entitlement to assistance in the purchase of an automobile or other conveyance and adaptive equipment. REPRESENTATION Appellant represented by: American Red Cross WITNESSES AT HEARING ON APPEAL The veteran and his wife ATTORNEY FOR THE BOARD R. L. Shaw, Counsel INTRODUCTION The veteran had active military service from February 1962 to March 1963. This matter is before the Board of Veterans' Appeals (the Board) on appeal from a July 13, 1988, rating decision by the Chicago, Illinois, Regional Office (RO) of the Department of Veterans Affairs (VA). The case was remanded to the RO on May 29, 1991, for additional development of the medical evidence. After the remand, the veteran was determined to be incompetent for VA purposes from March 25, 1993, and his wife was recognized as his fiduciary. On appeal the veteran has contended that, as a result of his service-connected left eye disability, he is no longer able to work. The issue of entitlement to a total rating for compensation purposes based on individual unemployability has not been developed or certified for review on appeal but is referred to the RO for appropriate action. REMAND Since the grant of service connection for eye pathology is presently limited to the left eye, the veteran can receive a rating higher than 30 percent only if he is found to be blind in both eyes, including the nonservice-connected right eye. 38 U.S.C.A. § 1160 (West 1991). In addition to service-connected residuals of a laceration of the left eye, which consists primarily of corneal scarring, the veteran has extensive nonservice-connected eye pathology, including bilateral glaucoma, cataracts, and chorioretinal scarring in the right eye. Examination of the veteran is difficult because of dementia of unknown etiology; the possibility of poor cooperation with test procedures or of malingering has not been ruled out by examiners. The cause of a visual deficit of the extent claimed by the veteran is also unknown. A CT scan and a May 1992 VA ophthalmology examination performed pursuant to the May 29, 1991, remand appear to rule out a cortical lesion to the brain as a cause of blindness. At the neurological evaluation, the veteran's blindness was characterized as "probably functional" in origin. While the weight of the evidence tends to establish that the veteran's overall loss of visual acuity in both eyes is tantamount to blindness, having light perception only, 38 C.F.R. § 4.84(a) (1993) (See also 38 C.F.R. § 3.350(a)(4) (1993) with respect to blindness and special monthly compensation), the extent to which blindness in the left eye is due to eye laceration residuals alone is not specifically shown in the file. (The cause of blindness in the right eye is irrelevant). The fact that blindness of functional origin may be present is not by itself significant since the possibility that the functional disorder may itself be the proximate result of service-connected eye injury residuals cannot be eliminated, based on the present record. See 38 C.F.R. § 3.310(a) (1993). Since the Board may not exercise its own independent medical judgment on medical issues, Colvin v. Derwinski, 1 Vet.App. 171 (1991), further clinical examination of the veteran must be performed. In view of the foregoing, the case is REMANDED to the RO for the following actions: 1. Any additional VA medical records pertaining to outpatient or inpatient treatment of the veteran since May 1991 should be obtained for the record. In addition, the veteran should be asked to identify any non-VA physicians and/or medical facilities (such as hospitals or clinics) from which he has received examination or treatment for his eyes or for dementia. Upon receipt of proper authorization, any available records should be obtained for the record. 2. The complete clinical record should be reviewed by a neurologist and an ophthalmologist to resolve the medical issues raised in this appeal. The examiners should state definite conclusions regarding the extent to which the service- connected left eye laceration residuals alone, without regard to any coexisting organic or functional disorder, cause or contribute to blindness in the left eye. In so doing, the examiners should feel free to discuss the effects of the nonservice- connected pathology, but their ultimate conclusions should be focused on the effect of the laceration residuals alone. In addition, the examiners should express an opinion as to whether any of the presently nonservice-connected disorders which contribute to blindness are related to trauma in service or to its residuals; in particular, it should be indicated whether glaucoma in the left eye is related to the service trauma. The complete clinical record showing the status of the left eye injury throughout the period since its incurrence in service should be reviewed and discussed. The conclusions of each examiner should be set forth in detail with complete reasoning. The examiners should correlate their findings and attempt to arrive at joint conclusions. The examiners should feel free to order any additional tests or studies deemed necessary to answer the above questions; any such examinations of the veteran should conform to the requirements of the VA Physician's Guide for Disability Evaluation Examinations (IB 11-56, March 1, 1985). 3. After completion of the foregoing, the RO should review the issues on appeal in light thereof. The review should include a determination as to whether any functional cause of blindness is proximately due to or the result of eye laceration residuals. 38 C.F.R. § 3.310(a) (1993). If the decision remains adverse to the veteran, in whole or in part, a supplemental statement of the case should be prepared and the veteran and his representative should be given a reasonable period of time for reply. Thereafter, the claim should be returned to the Board for further review, if in order. No action is required of the veteran until he receives further notice. The purpose of this REMAND is to obtain additional information. The Board does not intimate any factual or legal conclusions as to the outcome ultimately warranted in this appeal. EUGENE A. O'NEILL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).