Citation Nr: 21061458 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-41 598 DATE: October 4, 2021 REMANDED Entitlement to service connection for pancreatitis is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to a disability rating in excess of 30 percent for hypertensive heart disease is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1987 to November 1998. The matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated July 2014 and October 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claim in April 2020 for further development by the RO. The case has been returned to the Board for further appellate action. 1. Entitlement to service connection for pancreatitis is remanded. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. Specifically, a remand is warranted in order to obtain an addendum medical opinion regarding the etiology of the Veteran's pancreatitis. Pursuant to the April 2020 Board remand directives, the RO obtained a June 2020 VA examination and medical opinion. The opinions regarding secondary service connection were adequate, and separate rationales were provided for both the causation and aggravation elements of a secondary service connection claim.38 C.F.R. § 3.310. The examiner opined against direct service connection, in part because no upper left quadrant pain was noted in service. However, the opinion does not address the Veteran's lay statement that he dealt with symptoms on his own for a time, as he was unaware that he needed medical attention. See August 2017 VA Form 9. The examiner also did not address a September 1996 service treatment record (STR) noting left rib pain. Further, there is a September 2012 VA treatment record effectively comparing left upper quadrant pain to rib pain and a contemporaneous pancreatitis diagnosis. These records, in combination with the Veteran's lay statement, raise the possibility that the in-service reports of rib pain may be related to the pancreas, which a medical examiner should address. Thus, the case must be returned for an addendum opinion regarding direct service connection. See Barr v. Nicholson, 21 Vet. App. 303 (2007). 2. Entitlement to service connection for an acquired psychiatric disorder is remanded. The April 2020 Board remand directives instructed the RO to obtain a VA examination. This was not done. There is no evidence in the file that the RO scheduled or attempted to schedule a VA examination for the Veteran's psychiatric disorder. The Board errs when it fails to ensure substantial compliance with a Board remand and in such cases, remand is appropriate. Stegall v. West, 11 Vet. App. 268, 271 (1998). 3. Entitlement to a disability rating in excess of 30 percent for hypertensive heart disease is remanded. The April 2020 Board remand directives instructed the RO to obtain a VA examination and required that the examiner explain any election not to conduct exercise based METs testing. The basis for this directive was the Veteran's statement that his heart disability had worsened and that he had not undergone a treadmill test in years. See February 2018 VA Form 21-4138 (statement in support of claim). The Board finds that the latter directive was not substantially fulfilled. The July 2020 VA examination report indicates that the examiner did not conduct contemporaneous exercise based METs testing, but instead conducted interview based METs testing and relied on an exercise stress test from 2007. The examiner did not explain why, in light of the Veteran's contentions regarding worsening, the 2007 results were reliable for rating purposes. The Board acknowledges the examiner's statement that an in-person examination was not undertaken due to the risks associated with the covid-19 pandemic. However, given the Veteran's contentions regarding worsening and the evolving circumstances regarding covid-19, the Veteran should be afforded an additional VA examination. Therefore, the case must be returned. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain an addendum opinion from the VA examiner who performed the June 2020 examination or an appropriate medical professional if the examiner is unavailable to determine the nature and etiology of the Veteran's pancreas condition. The claims file, as updated, must be made available to and reviewed by the examiner. The examiner is asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that the Veteran's pancreas condition is etiologically related to the Veteran's active service. The Board calls the examiner's attention to the following: (i) a September 1996 STR noting left rib pain and (ii) the Veteran's lay statements in the August 2017 VA Form 9 that he dealt with symptoms on his own for a time, as he was unaware that he needed medical attention. If, and only if, the examiner determines that another VA examination is necessary to provide an informed opinion, such an examination should be scheduled. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 3. Following completion of directive # 1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's claimed acquired psychiatric disability. The claims file, to include a copy of this remand, must be made available to and reviewed by the examiner in conjunction with the examination. The examiner must opine on whether any acquired psychiatric disability is at least as likely as not (a 50 percent probability or greater) etiologically related to an in-service injury, event, or disease. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 4. Following completion of directive # 1, schedule the Veteran for a VA examination by an appropriate medical professional to determine the current severity of the Veteran's hypertensive heart disease. The examiner must record all pertinent medical complaints, symptoms, and clinical findings in detail. 5. Readjudicate the claims. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.