Citation Nr: 21063776 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 15-33 422 DATE: October 15, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1960 to November 1962 and from March 1964 to March 1982. He passed away in April 2007; the appellant is the Veteran's surviving spouse. In September 2017, the appellant testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. As for the matter of representation, the Board notes that on September 10, 2021 the appellant revoked her appointment of Texas Veterans Commission, and has appointed, effective September 9, 2021, attorney Falen M. LaPonzina as Power of Attorney to represent the appeal before the Board. By way of background, in an April 2020 decision, the Board denied the appellant's claim. In April 2021, the appellant appealed the decision to the United States Court of Appeals for Veterans Claims (Court) where the Court granted a Joint Motion for Remand (Joint Motion) and remanded the matter to the Board for consideration consistent with the terms of the joint motion. In August 2021, the Board remanded the matter for a medical opinion. However, as further explained below, an addendum opinion is needed to ensure compliance with the Joint Motion, the Board's prior August 2018 and recent August 2021 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the Board's August 2021 instructed that the examiner address the following: The examiner is also asked to review and specifically consider the appellate record, to include this remand; September 2017 hearing testimony, and statements in support of the appellant's claim, including an August 2007 letter (in which a nephrologist inferred that the Veteran's kidney disease and myeloma could have been caused by something injected by the Army during service); a February 2015 statement (in which a nephrologist inferred that the Veteran's kidney disease may have been in development for 8 to 10 years prior to a 1996 biopsy); and September 2015 statement (that the Veteran's kidney disease is related to service and due to drugs/vaccines administered during service). The record shows an August 2021 VA contract opinion where the examiner extensively discussed the Veteran's medical history and treatment records as well as medical data and research. Although otherwise adequate, the examiner did not properly address the lay evidence as specifically requested by the Board in the August 2021 remand. In fact, there is no indication that the examiner reviewed or acknowledged consideration of the letters such as the February 2015 letter where a nephrologist (Dr. Karim Nooruddin) inferred that Veteran's kidney disease may have been in development for 8 to 10 years before a 1996 biopsy. Indeed, the appellant stated in the February 2015 letter that she was merely paraphrasing Dr. Nooruddin's response. Notwithstanding, substantial compliance with the Board's remand is required. Stegall, 11 Vet. App. at 271. Thus, an addendum opinion reflecting consideration of the appellant's letters is needed. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, another remand is warranted, even though such will, regrettably, further delay an appellate decision on the matter. The matters are REMANDED for the following action: Arrange for the VA contract examiner who rendered the August 2021 VA contract opinion to provide an addendum opinion. If the examiner is not available, the request for an addendum opinion may be referred to another, equally qualified medical professional, who must independently review the electronic claims folder. The examiner should state whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's kidney disease, segmental glomerulosclerosis, and kidney failure, which led to his death, was etiologically related to service, to include inoculations, vaccines, consumption of and/or exposure to foreign material(s) including food and drink), or exposure to environmental toxins. The examiner is asked to acknowledge review and consideration of the following lay evidence: a) Letter dated August 2, 2007, received in May 2010, containing appellant's handwritten and typewritten notes of conversation with nephrologist (Dr. Karim Nooruddin) and oncologist (Dr. Michael Nash) that the Veteran's kidney disease and myeloma could have been caused by something injected by the Army during service. b) Letter dated May 10, 2010, received May 12, 2010, containing similar contentions. c) Letter dated February 9, 2015 containing typewritten notes from a discussion appellant had with Veteran's treating nephrologist, Dr. Karim Nooruddin, who inferred that the Veteran's kidney disease may have been in development for 8 to 10 years prior to a 1996 biopsy. d) Letter received September 9, 2015 containing appellant's contentions that the Veteran's kidney disease is related to service and due to drugs/vaccines administered during service. e) September 2017 hearing testimony The examiner is also asked to consider medical evidence (to include January 2020 VA opinion and August 2021 VA contract opinion). A complete rationale for all opinions is requested. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A., 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.