Citation Nr: 21064784 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 14-12 120 DATE: October 21, 2021 REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for renal failure is remanded. REASONS FOR REMAND The Veteran, who is the appellant, served on active duty from August 1975 to July 1981. This matter was previously before the Board in March 2021, at which time it was remanded for further development. In its March 2021 remand, the Board requested a medical opinion. The Board requested that the Veteran's claims file be reviewed by a VA physician. The Board noted that while the reviewer was to review the claims folder, the reviewer was asked to note that the Veteran asserted that in 2008, the VA outpatient clinic in Harlingen, Texas failed to obtain sufficient laboratory test results to monitor his vancomycin levels during at home intravenous (IV) treatment. The Board observed that records of private treatment in 2008 noted acute renal failure and that subsequent private and VA treatment records noted kidney issues. The reviewer was asked to answer the following questions: (a) Did the acute renal failure noted in treatment in 2008 and subsequent kidney findings at least as likely as not constitute additional disability beyond the normal progression of the Veteran's kidney conditions in 2007? (b) Was there at least as likely as not carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault in VA's monitoring of the Veteran's vancomycin levels during at home IV vancomycin treatment in 2008? (c) Did any inadequacy in the monitoring of the Veteran's vancomycin levels at least as likely as not cause kidney problems? (d) Was it reasonably foreseeable, or was it not reasonably foreseeable, that the Veteran's IV vancomycin treatment in 2008 was followed by kidney problems? In July 2021, a medical opinion was provided. The examiner indicated that he had reviewed the conflicting medical evidence and was providing the following opinion: Records showed that Veteran developed acute renal failure, record dated May 23, 2008, nephrology consult done and stated acute renal failure, which may be related to antibiotics and infection and renal failure could be multifactorial and may have been contributed by antibiotics. The examiner indicated that the Veteran's increased vancomycin levels were due to renal condition that it was not properly eliminated by the kidneys. The examiner stated that the Veteran had other problems which had cumulatively contributed to the renal disease, particularly the uncontrolled diabetes, hypertension, and ongoing infection. Therefore, it was less likely than not that the inadequacy in the monitoring of the Veteran's vancomycin levels had caused the kidney problems. While the examiner provided the requested opinion, the opinion does not properly answer all the questions set forth in the March 2021 remand. The Board errs as a matter of law when it fails to ensure compliance with the instructions of its prior remand. See Stegall v. West, 11 Vet. App. 268 (1998). The matter must be remanded for compliance with the directives of the prior Board remand. The matters are REMANDED for the following action: If available, return the claims folder to the examiner who provided the July 2021 VA opinion. Following a review of the claims folder, the examiner must provide specific answers to the following questions: (a) Did the acute renal failure noted in treatment in 2008 and subsequent kidney findings at least as likely as not constitute additional disability beyond the normal progression of the Veteran's kidney conditions in 2007? (b) Was there at least as likely as not carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault in VA's monitoring of the Veteran's vancomycin levels during at home IV vancomycin treatment in 2008? (c) Did any inadequacy in the monitoring of the Veteran's vancomycin levels at least as likely as not cause additional kidney problems? (d) Was it reasonably foreseeable, or was it not reasonably foreseeable, that the Veteran's IV vancomycin treatment in 2008 was followed by kidney problems? Complete detailed rationale is requested for any opinion that is rendered. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. S. Kelly, 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.