Citation Nr: 21065486 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 18-02 649 DATE: October 26, 2021 REMANDED Entitlement to service connection for tuberculosis is remanded. Entitlement to service connection for chronic cysts is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2002 to April 2013. He testified before the undersigned Veterans Law Judge at an August 2019 videoconference hearing. These matters were previously remanded by the Board in March 2020 for AOJ consideration of evidence not submitted by the Veteran after the most recent AOJ adjudication. The issues of service connection for left ankle and cervical spine disorders were also remanded. Compensation for relevant disabilities was granted in April 2021 and July 2021 rating decisions. As a result, those matters are no longer on appeal. 1. Entitlement to service connection for tuberculosis is remanded. At the August 2019 Board hearing and in statements submitted during the appeal, the Veteran reported that he had a positive skin (PPD) test for tuberculosis in 2008 and underwent treatment. This is supported by service treatment records. The Veteran was afforded a November 2020 VA tuberculosis examination. The examiner determined that the Veteran did not have tuberculosis upon examination and had never been diagnosed with either active or latent tuberculosis and had not had a positive skin test without active disease. The examiner notes the Veteran's reports of a positive PPD test in 2008 and subsequent treatment but indicates that "there are no available treatment records to confirm this claim." It is apparent that the examiner did not have access to service treatment records that are now available in the file or did not properly review them. The examiner notes that an x-ray was performed in March 2021 that revealed a normal chest. No further diagnostic testing is noted. Also of record is a July 2021 VA skin examination. The examiner notes that the Veteran presented with symptoms similar to Erythemous Nordosum "that can occur after having TB...." Remand is necessary for clarification. It is unclear to the Board to what degree the November 2020 examiner's determination that the Veteran did not have tuberculosis was based upon the examiner not reviewing relevant service treatment records. The examiner notes that he is "unable to provide a diagnosis of TB on the Veteran's recollection alone." In this case, the Veteran's recollection is supported by service treatment records and the examiner's opinion is based on an inaccurate factual premise (that there are not treatment records supporting the Veteran's assertion). It is also unclear if the diagnostic testing performed at the November 2020 VA examination definitively ruled out current tuberculosis. With consideration of the relevant provisions of sections 3.309(a), 3.370, 3.371, and 3.374, a clarifying medical opinion is necessary that properly reviews and addresses the in-service documentation of a positive PPD test and treatment for tuberculosis. 2. Entitlement to service connection for chronic cysts is remanded. The March 2020 Board Remand directed the RO to readjudicate the matter of entitlement to service connection for chronic cysts in light of evidence not submitted by the Veteran that was received after the issuance of a November 2017 statement of the case. Subsequent to the Remand, the Veteran was afforded a July 2021 VA examination to determine the etiology of his claimed cysts. However, the matter was not readjudicated, failing to comply with the Remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Return the claims file to an examiner of appropriate expertise to address the Veteran's service treatment records documenting treatment for tuberculosis and clarify whether the Veteran has a current diagnosis of tuberculosis. It is up to the discretion of the examiner if a new examination is necessary, or if a file review is sufficient to issue an opinion. In issuing the medical opinion as to whether the Veteran has tuberculosis, the examiner should address relevant service treatment records documenting a positive PPD test and subsequent treatment for tuberculosis, and what diagnostic testing is necessary to rule out a current tuberculosis infection, either active or latent. If the Veteran is determined to have tuberculosis, provide an opinion as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) causally or etiologically related to the in-service incurrence. A complete rationale for any opinion expressed should be provided in a report. The Veteran is competent to report symptoms and treatment, and his reports must be taken into account, along with the other evidence of record. 2. Readjudicate the matters on appeal. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. R. Stephens, 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.