Citation Nr: 21068789 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 04-13 902 DATE: November 12, 2021 REMANDED Entitlement to service connection for sickle cell thalassemia and associated residuals is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND Having reviewed the record, the Board finds remand is warranted. The October 2019 Board decision directed the agency of original jurisdiction (AOJ) to obtain an addendum opinion regarding whether there was a superimposed disease or injury in connection with the Veteran's sickle cell anemia, which has previously been identified as a defect. Remand directives expressly indicated that if an opinion could not be provided without resort to speculation, the examiner must state whether the need to speculate was due to additional facts required, as well as identification of any additional evidence that would permit the opinion to be made. In a May 2020 VA addendum opinion, the examiner stated that he could not provide an opinion without resorting to speculation as additional information is required regarding the specifics of the Veteran's complaints of in-service leg cramping. Here, the May 2020 VA examiner identified evidence that would permit an opinion. However, the AOJ failed to develop such evidence that would enable an opinion to be made. Accordingly, remand is warranted to obtain this evidence. A request should be made to the Veteran to provide a statement describing the circumstances of his in-service leg cramping. Thereafter, an addendum opinion should be obtained that considers any newly submitted statements as well as previously submitted lay statements describing in-service cramping, such as the September 2011 statement. Any outstanding VA treatment records from July 2020 to present should be obtained and associated with the claims file. The matters are REMANDED for the following actions: 1. Obtain the Veteran's VA treatment records for the period from July 2020 to present. 2. Ask the Veteran to submit a statement describing the circumstances of his in-service leg cramping. 3. After completion of directive 2, obtain an addendum opinion from an appropriate clinician regarding the Veteran's sickle cell trait. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled to include any necessary testing. After reviewing the claims file, the examiner is asked to answer the following questions: (a) Is it at least as likely as not that there was any superimposed disease or injury in connection with the sickle cell trait that has been identified as a defect? In rendering this opinion, the examiner must address the following: (i) Whether the Veteran's in-service leg cramping was a manifestation of a superimposed disease or injury, including symptoms of avascular necrosis (AVN) or anemia. The examiner must specifically address the circumstances of the in-service leg cramps, to include the time of day the cramping took place; and consideration of what activities, if any, would cause this Veteran to experience leg cramps during service, to include commenting on the degree of dehydration or exertion necessary for a person with the congenital defect of sickle cell trait to cause or aggravate in-service leg cramping or post-service AVN. Attention is invited to the Veteran's lay statements describing in-service leg cramping, to include the September 2011 statement and any newly submitted statements obtained as a result of remand directive 2. (ii) The examiner should comment on the medical article from Sickle Cell Information Center, received in the file on June 8, 2009, stating that carriers of the sickle cell trait should use caution during strenuous exercise in hot weather or at high altitudes, and that inadequate fluid intake and excessive perspiration can lead to dehydration. (b) If there was any in-service superimposed disease or injury in connection with the defects, is it at least as likely as not that it resulted in disability apart from the congenital or developmental defects. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise; or whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Vang, 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.