Citation Nr: 21003909 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 16-53 245 DATE: January 25, 2021 REMANDED Entitlement to a compensable initial rating for primary biliary cirrhosis w/overlapping autoimmune hepatitis to include GERD w/hiatal hernia for the period prior to August 10, 2020, and in excess of 10 percent for the period from August 10, 2020 through the present is remanded. Entitlement to a compensable initial rating for osteoporosis is remanded. REASONS FOR REMAND The Veteran had active military service from October 1975 to July 1980 and from September 2000 to April 2015. These matters come before the Board of Veterans’ Appeals (Board) from the November 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board notes that jurisdiction currently rests with the St. Petersburg, Florida RO. In August of 2019, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Addressing the relevant procedural history, this case was previously before the Board in November of 2019 at which time it was remanded for additional development, to specifically include affording the Veteran new VA examinations. The case has now been returned to the Board for further appellate review. 1. Entitlement to an initial compensable rating for primary biliary cirrhosis w/overlapping autoimmune hepatitis to include GERD w/hiatal hernia for the period prior to August 10, 2020, and in excess of 10 percent for the period from August 10, 2020 through the present is remanded. Unfortunately, the Board still cannot make a fully-informed decision on this issue because the November 2019 Board directives were not complied with on remand. See 38 U.S.C. § 5103A (b); Stegall v. West, 11 Vet. App. 268, 271 (1998). In its remand, the Board instructed that the examiner who afforded the Veteran a VA examination to specifically address which of the two disorders is predominant between his cirrhosis and GERD, yet the examiner who provided examinations on remand did not do so. As separate disability ratings for the Veteran’s cirrhosis and asserted GERD may not be assigned, the issue must again be remanded for an addendum opinion to clarify this as previously instructed. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to an initial compensable rating for osteoporosis is denied. The Board regrets any further delay in adjudicating this appeal but finds that this matter must again be remanded for further development before a decision may be made on the merits. In its November 2019 remand, the Board instructed that the RO should schedule the Veteran for a VA examination before an appropriate medical professional to determine the current severity of the Veteran’s osteoporosis. While the RO complied with the instruction to afford a new examination in regard to the Veteran’s GERD claim, an addendum opinion was obtained in regard to the Veteran’s osteoporosis instead of the Veteran being afforded the chance to attend an examination. And while the VA clinician who provided an opinion in January of 2020 reviewed the Veteran’s claims file, there is no indication that this clinician interviewed the Veteran or otherwise had the opportunity to assess the current state of the Veteran’s condition. Notably, the most recent notation referred to by this clinician was from December of 2018, well over two years ago. Based on the foregoing, the actions undertaken on remand (and the lack thereof) do not complete the Board’s November 2019 remand directives. See 38 U.S.C. § 5103A (b); Stegall, 11 Vet. App. 268, 271. Therefore, the Board cannot make a fully-informed decision on the Veteran’s osteoporosis claim until this issue is remanded again for a new examination as well as the completion of the development that was previously instructed. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the record. 2. Following the completion of step one, schedule the Veteran for a VA examination before an appropriate medical professional to determine the current severity of the Veteran’s osteoporosis. All indicated tests and studies should be undertaken. The entire claims file, including a complete copy of this remand, should be made available to and be reviewed by the clinician, and it should be confirmed that such records were available for review. 3. Forward the Veteran’s claim’s file to a qualified medical professional for an addendum opinion which should, if possible, be authored by the same individual who provided the Veteran with examinations relevant to his cirrhosis and GERD on the previous remand. The entire claims file, including a complete copy of this remand, should be made available to and be reviewed by the clinician, and it should be confirmed that such records were available for review. The clinician specifically address which of the two disorders is predominant. Each examiner must provide rationale for all opinions provided. The examiner must 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), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Thereafter, readjudicate the claim. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and his representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Smith, 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.