Citation Nr: 21065088 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-20 193 DATE: October 25, 2021 REMANDED Entitlement to service connection for residuals of frostbite to include tinea pedis, hallux valgus, and peripheral neuropathy of the bilateral extremities is remanded. REASONS FOR REMAND The Veteran had active service from May 1975 to May 1978. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston Salem, North Carolina. The Veteran testified at a Board videoconference hearing before the undersigned in February 2021. A transcript of that hearing is associated with the claims file. The Board previously remanded this case in June 2021 for further development and it is now before the Board. Unfortunately, a review of the most recent medical opinion regarding the Veteran's claimed cold injury residuals reveals that a remand is necessary before a decision can be reached on the merits of the matter. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary, and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Accordingly, remand is required to obtain an adequate medical opinion. Entitlement to service connection for residuals of frostbite to include tinea pedis, hallux valgus, and peripheral neuropathy of the bilateral extremities is remanded. In its June 2021 remand, the Board instructed the RO to obtain a medical opinion concerning the contended etiological relationship between the onset of the Veteran's feet disabilities and active service. The Board instructed that the examiner identify all bilateral foot disabilities and for each foot disability found, the examiner was asked to opine whether it at least as likely as not (50 percent or greater probability) that the disability had its onset in service or is otherwise the result of a disease or injury in service to include the incident of the blizzard in Hornsville, Germany in 1977. A review of the record since the June 2021 remand does not reflect any developmental actions consistent with the directives of that remand. Parenthetically, the Board notes that the most recent Disability Benefits Questionnaire Examination was provided in July 2021; however, the examiner simply stated that she concurred with and restated the prior January 4, 2017, medical opinion, without offering an independent assessment. Moreover, the examiner further indicated that if additional information is needed, the Veteran should be scheduled with an MD, as she as a nurse practitioner had exhausted the limits of current medical knowledge. The July 2021 examiner did indicate that she reviewed all of the records and accepted the Veteran's testimony of the in-service incident involving his foot injury; however, the Board finds it conflicting for her to restate the previous January 4, 2017 medical opinion verbatim if she reviewed review the record and accepted the Veteran's testimony, since the basis of the prior medical opinion was predicated on the fact that the incident causing the Veteran's foot injuries did not occur. As such, a new opinion is necessary to give the Veteran an opportunity to be evaluated by a medical doctor who can fully consider the testimony and the record in its entirety and provide a sound opinion that is supported by adequate rationale. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by a medical doctor (not a nurse practitioner) with appropriate expertise to determine the etiology of the Veteran's bilateral foot disabilities. The doctor must review this remand and the record to include all prior examinations in their entirety. The doctor should note review of all of the evidence of record in the report. A rationale for all opinions must be provided. The doctor should provide responses to the following directives: (a.) Identify all bilateral foot disabilities by either (a) diagnosis or (b) functional impairment that the Veteran had during the period on appeal. The examiner must accept the Veteran's testimony of the in-service incident in which he drove a military truck for 42 kilometers through blizzard-like conditions including snow and ice in Hornsville, Germany in 1977 which resulted in snow in the cab of his vehicle. The examiner must accept as fact that this incident occurred. The doctor must then consider and address the Veteran's statements that afterwards his feet were frozen and discolored (black and blue). The examiner must also consider the Veteran's testimony that the incident caused his toenail to come off and a feeling of heat in his feet and a sensation of pins and needles as credible. The examiner is reminded that the Board has found the Veteran competent and credible to report his symptoms. (b.) For each foot disability found, is it at least as likely as not (50 percent or greater probability) that the disability had its onset in service or is otherwise the result of a disease or injury in service to include the incident of the blizzard in Hornsville, Germany in 1977? The examiner is asked to consider and comment on the fact that the Veteran's separation examination dated April 1978, states that the Veteran had bilateral tinea pedis and whether this, to any extent, is related to the foot disabilities diagnosed. The Board would find it immensely helpful if the examiner clearly states if there is any medical reason to accept or reject the proposition that the in-service blizzard incident could have led to any of the Veteran's current foot disabilities. The examiner is advised that the absence of contemporaneous records showing complaints of or treatment for a foot disability, alone, is insufficient rationale for a medical nexus opinion. In providing this opinion, the examiner is reminded that the Veteran is competent to report continuous symptoms since service (even if such symptoms were not actually documented in the record until many years later), and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports regarding current or past symptoms, the examiner must provide a reason for doing so. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the doctor shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dorsey-Kwansa, 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.