Citation Nr: 21066312 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 18-03 396 DATE: October 29, 2021 REMANDED Entitlement to a rating in excess of 10 percent for painful left facial keloid scar and right inguinal hernia scar is remanded. Entitlement to a rating in excess of 10 percent for left facial keloid scar is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Air Force from October 1967 to October 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. 1. Entitlement to a rating in excess of 10 percent for painful left facial keloid scar and right inguinal hernia scar. 2. Entitlement to a rating in excess of 10 percent for left facial keloid scar. The Veteran contends that his symptomology is worse than the ratings currently assigned for his scar disabilities. The Board notes that this matter was remanded in May 2021 for a VA examination to determine the current severity of his service-connected left facial keloid and right inguinal hernia scars. The Board directed the examiner to consider and address the Veteran's testimony that his facial scar causes tightness and difficulty opening his mouth and that his right inguinal scar tissue has adhered to his bladder per recent MRI and CAT scan findings, causing urinary frequency and obstruction. A VA examination was conducted in July 2021. The examiner found one painful and stable scar of the trunk or extremities related to the Veteran's inguinal hernia. The scar measured 14 x 0.2 cm in length and width. The examiner also found one painful and stable scar of the head, face or neck related to the Veteran's left facial keloid. The scar on the left check measured 1 x 0.2 cm in length and width. The examiner also noted surface contour elevated on palpation. However, the examiner did not address or consider the Veteran's testimony when rendering these findings. The examiner did not address the MRI and CAT scan findings which the Veteran argues shows greater level of impairment. The examiner also did not address the Veteran's report that his facial scar affects his mouth. The examiner was directed to address this evidence and instructed as follows: If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to insure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Based on the failure of the VA examiner to address the Veteran's self-reported medical history in the examination report, the Board finds that there has not been substantial compliance with its remand directives. As such, the Board must remand this matter for a VA opinion that addresses the Veteran's testimony. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran's claims file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Request that the examiner who conducted the July 2021 VA scars examination to prepare an addendum examination report which address the following questions. If this examiner is not available, arrange to obtain the opinions from a suitably qualified health care professional. Another examination of the Veteran should only be scheduled if it is determined by the examiner that this is required to address the questions. a.) Is it at least as likely as not that the Veteran's left facial scar results in any impairment of the Veteran's mouth? b.) Is it at least as likely as not that the Veteran's abdominal scar has adhered to his bladder per recent MRI and CAT scan findings, causing urinary frequency and obstruction? If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional 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). 3. Upon completion of the above directives, complete any other necessary development after review of any additional received record, to include additional VA examination such as a urological examination if warranted. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.T. Massey, 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.