Citation Nr: 20052937 Decision Date: 08/10/20 Archive Date: 08/10/20 DOCKET NO. 16-21 341 DATE: August 10, 2020 REMANDED Entitlement to service connection for inflammatory polyarthropathy/rheumatoid arthritis, to include as secondary to service-connected hypothyroidism, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1968 to August 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In November 2019, the Board remanded the claim for further evidentiary development. Included in this remand, was the issue of service connection for hypothyroidism. In June 2020, the RO granted service connection for hypothyroidism. As this represents a full grant of the benefit sought as to that issue, the issue is no longer in appellate status.   Entitlement to service connection for inflammatory polyarthropathy/rheumatoid arthritis, to include as secondary to hypothyroidism, is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran was afforded a VA examination in February 2020 and the examiner diagnosed the Veteran with rheumatoid arthritis. The examiner failed to offer an opinion on whether rheumatoid arthritis was caused or aggravated by hypothyroidism, as directed by the November 2019 Board remand. As such, the Board finds this VA examination to be inadequate. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that RO compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure substantial compliance). The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file VA treatment records from October 2019 to the present. 2. After completing the development above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any polyarthropathy/rheumatoid arthritis. The examiner is asked to provide opinions on the following questions: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s polyarthropathy/rheumatoid arthritis was caused by the Veteran’s service, including exposure to herbicide agents? (b.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s polyarthropathy/rheumatoid arthritis was caused by the Veteran’s service-connected hypothyroidism? (c.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s polyarthropathy/rheumatoid arthritis was aggravated (that is, any increase in severity beyond the natural progression of the condition including any incremental increase in disability) by the Veteran’s service-connected hypothyroidism? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not   be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Patel, Associate 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.