Citation Nr: 21068799 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 14-26 743 DATE: November 12, 2021 ORDER Entitlement to service connection for right deep peroneal nerve neuropathy, associated with service-connected right ankle tarsal tunnel syndrome (right ankle condition), is granted. REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected condition and medications used for the treatment thereof, is remanded. Entitlement to an initial rating in excess of 20 percent for service-connected right ankle condition is remanded. Entitlement to an initial rating in excess of 10 percent for service-connected hemorrhoids is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDING OF FACT The evidence preponderates in favor of a finding that the Veteran's right deep peroneal nerve neuropathy is secondary to his service-connected right ankle condition. CONCLUSION OF LAW The criteria for entitlement to service connection for right deep peroneal nerve neuropathy, associated with service-connected right ankle condition, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(b), 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from July 1973 to February 1975. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions, dated September 2012, January 2013, and May 2014, issued by a Department of Veterans Affairs (VA) regional office. These matters were previously remanded by the Board in September 2018 and September 2020. Additionally, the issues of entitlement to service connection for hypertension and entitlement to a TDIU were remanded by the Board in October 2016. In the October 2016 decision, the Board denied the Veteran's claims of higher initial ratings for his service-connected hemorrhoids and right ankle condition. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court). In a January 2018 Memorandum Decision, the Court found that a remand of the Veteran's claims was warranted. With respect to the Veteran's hemorrhoids, the Court found that the Board did not provide an adequate statement of reasons or bases for its decision as the Board incorrectly framed the issue as whether an initial compensable rating was warranted, and as the Board did not address whether separate ratings were warranted for impairment of sphincter control. With respect to the Veteran's right ankle condition, the Court found that the Board did not provide an adequate statement of reasons or bases for its decision as the Board did not provide an analysis in its discussion assigning a 20 percent rating, and as the Board did not discuss whether the Veteran's right ankle condition would be more appropriately rated under a different diagnostic code or whether an additional rating under a different diagnostic code was warranted. As an initial matter, the Board notes that VA is required to develop and adjudicate related claims for secondary service connection for disabilities that are reasonably raised during the adjudication of an increased rating claim for the primary disability. See 38 C.F.R. § 3.160; Bailey v. Wilkie, 33 Vet. App. 188 (2021); Kisor v. Wilkie, 139 S. Ct. 2400, 2415 (2019). Here, the evidence indicates that the Veteran has a diagnosis of right deep peroneal nerve neuropathy that is associated with his right ankle condition. See November 2020 VA Ankle Conditions Disability Benefits Questionnaire (DBQ). As such, the issue of entitlement to service connection for right deep peroneal nerve neuropathy, associated with service-connected right ankle condition, is before the Board on appeal and is properly included in the list of issues before the Board. Additionally, the Board notes that, in a March 2020 rating decision, a separate rating for fecal incontinence associated with hemorrhoids was granted, and a rating of 30 percent from September 30, 2010 through September 24, 2019, and 10 percent thereafter was assigned. The Board also notes that, in an October 2021 Memorandum Decision, the Court remanded the issue of whether the Veteran submitted a notice of disagreement (NOD) as to the initial rating assigned for the Veteran's service-connected fecal incontinence. As the rating decision from which this issue arises was issued after February 19, 2019, the issue of whether the Veteran submitted a timely NOD as to the initial rating assigned for his service-connected fecal incontinence will be addressed in another Board decision, under the framework of the Veterans Appeals Improvement Modernization Act of 2017 (AMA), in the normal course of business. Entitlement to a separate rating deep peroneal nerve neuropathy, associated with service-connected right ankle tarsal tunnel syndrome, is granted. Factual Background. The Veteran's medical treatment records indicate a notation of decrease in pinprick sensation of deep peroneal nerve distribution in November 2007 and right deep peroneal nerve injury in October 2011, but are otherwise silent with respect to treatment for or complaints indicative of deep peroneal nerve neuropathy. See Atlanta VA Medical Center (VAMC) records, received April 2018, September 2019, September 2020, November 2020, and May 2021 in CAPRI; Northside Hospital records, received June 2019; Dr. R. Vanapalli records, received December 2013 and December 2014; Peachtree Orthopaedic Clinic records, received January 2014; Mercy Medical Center records, received July 2013; Dr. S. Hasan Neurology Practice records, received October 2012. In November 2020, the Veteran underwent a VA examination regarding his service-connected right ankle condition in which the examiner noted a diagnosis of right ankle tarsal tunnel syndrome with residual post-operative deep peroneal nerve neuropathy. The examiner noted that the Veteran's established diagnosis of tarsal tunnel syndrome had changed and that the new diagnosis was a progression of such diagnosis. See November 2020 VA Ankle Conditions Disability Benefits Questionnaire (DBQ). Analysis. As discussed above, the issue of entitlement to service connection for right deep peroneal nerve neuropathy, secondary to service-connected right ankle condition, has been raised by the record. See Bailey v. Wilkie, supra; Kisor v. Wilkie, supra. Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a medical nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra. Here, the Veteran has a diagnosis of right deep peroneal nerve neuropathy and is service-connected for a right ankle condition. As such, the first two elements of service connection on a secondary basis are met. See Wallin v. West, supra. The remaining question is whether there is a nexus between the Veteran's service-connected right ankle disability and his right deep peroneal nerve neuropathy. As noted above, the Veteran underwent a VA examination in November 2020 in which the examiner noted the diagnosis of deep peroneal nerve neuropathy. Additionally, the examiner noted that this diagnosis was a progression of his established diagnosis of tarsal tunnel syndrome. See November 2020 VA Ankle Conditions DBQ. Considering the foregoing, the Board finds that the evidence of record overall supports the finding that the Veteran's diagnosed right deep peroneal nerve neuropathy is secondary to his service-connected right ankle condition. As such, entitlement to service connection for right deep peroneal nerve neuropathy, associated with service-connected right ankle condition, is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as secondary to service-connected condition and medications used for the treatment thereof, is remanded. The Board regrets the delay associated with this remand, particularly as this matter is the subject of three prior remands. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the Agency of Original Jurisdiction to obtain an adequate opinion regarding the etiology of the Veteran's hypertension. In November 2020, a VA opinion was obtained in which the examiner opined that the Veteran's hypertension was less likely than not related to or aggravated by his service-connected conditions. In support of this opinion, the examiner stated that hypertension is essential in more than 95 percent of cases and therefore more likely than not essential in the absence of renovascular disease or structural abnormality of the heart. See November 2020 VA Medical Opinion Disability Benefits Questionnaire (DBQ). However, the examiner did not cite any medical literature or otherwise elaborate in support of their conclusion that the Veteran's hypertension was not aggravated by his service-connected conditions. As such, the Board finds the November 2020 opinion to be conclusory and, therefore, inadequate. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). In December 2020, an addendum opinion was obtained from the examiner that provided the November 2020 opinion, in which the examiner opined that the Veteran's hypertension was less likely than not aggravated by his service-connected disabilities, to include pain symptoms and/or side effects of medication. In support of this opinion, the examiner stated that there was no evidence or documentation of pain symptoms having long term effects on hypertension, nor any scientific documentation of the Veteran's medication causing elevation of blood pressure. See December 2020 VA Addendum Opinion DBQ. In February 2021 and March 2021 addendums, the examiner elaborated by stating that there was no pathophysiology of pain symptoms causing hypertension nor between medication usage and hypertension. See February 2021 VA Addendum Opinion DBQ; March 2021 VA Addendum Opinion DBQ, received May 2021. In other words, the examiner opined that the Veteran's hypertension was not aggravated by his service-connected conditions, or medications used for the treatment thereof, because there was no scientific documentation that such conditions or medications are related to hypertension. However, the examiner did not cite any medical literature or otherwise elaborate in support of this conclusion. As such, the Board finds the December 2020 opinion, as well as the February 2021 and March 2021 addendums thereto, to be conclusory and, therefore, inadequate. See Stefl v. Nicholson, supra; Nieves-Rodriguez v. Peake, supra. Moreover, as discussed above, in finding that the Veteran's hypertension was not aggravated by a service-connected condition, the examiner stated that there was no documentation of pain symptoms having long term effects on hypertension. See December 2020 VA Addendum Opinion DBQ. In other words, in support of the negative nexus, the examiner stated that pain would not permanently aggravate the Veteran's hypertension. However, the question is not whether the Veteran's hypertension was permanently aggravated by his service-connected conditions, but whether his hypertension underwent an incremental increase, regardless of permanence, due to his service-connected conditions. See Ward v. Wilkie, 31 Vet. App. 233, 240-41 (2019). As the examiner applied the wrong standard with respect to service connection on a secondary basis due to aggravation, the December 2020 opinion is inadequate with respect to such. For these reasons, the Board finds the November 2020 and December 2020 opinions, as well as the February 2021 and March 2021 addenda thereto, to be inadequate for adjudication purposes. As such, a remand is necessary to obtain an adequate opinion regarding the etiology of the Veteran's hypertension. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Additionally, the Board finds that this issue poses a medical problem of such obscurity or complexity that an advisory opinion from an independent medical expert (IME) is required. See 38 U.S.C. § 5109; 38 C.F.R. § 3.328. Specifically, multiple VA opinions have been unable to adequately answer the question of the etiology of the Veteran's hypertension. The AOJ must follow its established procedures for requesting an advisory opinion furnished by a medical school, university, or clinic on remand. Lastly, the Board notes that the evidence indicates that there may be pertinent private medical records that are not associated with the claims file. See Northside Hospital records; Dr. R. Vanapalli records; Peachtree Orthopaedic Clinic records; Mercy Medical Center records; and Dr. S. Hasan Neurology Practice records. The Board also notes that, in September 2020, the AOJ requested that the Veteran provide a list of medications related to his hemorrhoids, right ankle disability, and hypertension. The AOJ also requested that the Veteran provide the names, addresses, and approximate dates of treatment of all medical care providers that provided him with treatment pertinent to his claimed condition. The AOJ also provided the Veteran with a VA Form 21-4142, Authorization to Disclose Information, and VA Form 21-4142a, General Release for Medical Provider Information, to allow the AOJ to obtain his medical records on his behalf. See September 2020 VA Correspondence. In an October 2020 correspondence, the Veteran reported that he had taken Percocet, oxycodone, and hydrocodone. The Veteran also referenced an October 2018 statement, in which the Veteran reported using various over the counter medications. See October 2020 VA Form 21-4138; October 2018 Correspondence. However, the Veteran did not elaborate as what over-the-counter medications were utilized, nor did the Veteran respond with respect to private medical records. VA's duty to assist is not a "one-way street", and a veteran seeking help cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining pertinent evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Nonetheless, as a remand of this matter is otherwise warranted, the Board finds that the AOJ should make one more attempt to identify and obtain any pertinent medical records, and obtain a list of medications the Veteran has used to treat his service-connected conditions. The Veteran is cautioned that failure to cooperate with any requested development may result in the denial of his claim. 38 C.F.R. § 3.655. 2. Entitlement to an initial rating in excess of 20 percent for service-connected right ankle tarsal tunnel syndrome (right ankle condition) is remanded. The Board regrets the delay associated with this remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary as the AOJ has not substantially complied with the September 2020 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, in September 2020, the Board instructed the AOJ to schedule the Veteran for a VA examination to determine the current severity of his service-connected right ankle condition. As part of this examination, the examiner was instructed to address the previous VA examinations regarding os calcis or astragalus. Importantly, the Veteran's right ankle condition is rated under Diagnostic Code 5273, which addresses malunion of the os calcis or astragalus. In November 2020, the Veteran underwent a VA examination regarding his right ankle condition; the examiner did not address the findings of prior VA examinations regarding os calcis or astragalus. See November 2020 VA Ankle Conditions DBQ. In May 2021, an addendum opinion was obtained from the November 2020 examiner, in which the examiner stated that there was no os calcis or astragalus noted on examination. See May 2021 VA Addendum DBQ. The examiner did not address the December 2012 VA examination report, which found malunion of the os calcis or astragalus with marked deformity, or the October 2019 VA examination, which indicates that the Veteran did not have malunion of the os calcis or astragalus. See id; December 2012 VA Ankle Conditions DBQ; October 2019 VA Ankle Conditions DBQ. As the Board cannot find substantial compliance with the September 2020 remand directives, a remand is necessary to allow the AOJ to afford the Veteran with an examination regarding the severity of his service-connected right ankle condition. See Stegall v. West, supra. Even if the Board could find substantial compliance with the September 2020 remand directives, a remand would nonetheless be necessary to allow the AOJ to obtain an adequate opinion regarding the severity of the Veteran's right ankle condition. As noted above, in a May 2021 addendum, the November 2020 examiner stated that there was no os calcis or astragalus noted on examination. See May 2021 VA Addendum DBQ. However, the Veteran's treatment records document a chronic healed fracture deformity of the calcaneus (os calcis) as recently as June 2019. See Northside Hospital records. As such, the November 2020 examination report and May 2021 addendum thereto appears to be based, in part, on an inaccurate factual premise and, therefore, is inadequate. See Reonal v. Brown, 4 Vet. App. 458 (1993). Further, an examination is inadequate when, as indicated here, the examiner does not consider the Veteran's prior medical history. See Stefl v. Nicholson, supra. As such, a remand is necessary to afford the Veteran with a new examination regarding the nature and severity of his right ankle condition. See Barr v. Nicholson, supra. Lastly, as discussed above, the Board notes that the evidence indicates that there may be pertinent private medical records that are not associated with the claims file. See Northside Hospital records; Dr. R. Vanapalli records; Peachtree Orthopaedic Clinic records; Mercy Medical Center records; and Dr. S. Hasan Neurology Practice records. The Board also notes that, in September 2020, the AOJ requested that the Veteran provide the names, addresses, and approximate dates of treatment of all medical care providers that provided him with treatment pertinent to his claimed condition. The AOJ also provided the Veteran with a VA Form 21-4142, Authorization to Disclose Information, and VA Form 21-4142a, General Release for Medical Provider Information, to allow the AOJ to obtain his medical records on his behalf. See September 2020 VA Correspondence. To date, the Veteran has not responded. VA's duty to assist is not a "one-way street", and a veteran seeking help cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining pertinent evidence. See Wood v. Derwinski, supra. Nonetheless, as a remand of this matter is otherwise warranted, the Board finds that the AOJ should make one more attempt to identify and obtain any outstanding pertinent private medical records. The Veteran is cautioned that failure to cooperate with any requested development may result in the denial of his claim. 38 C.F.R. § 3.655. 3. Entitlement to an initial rating in excess of 10 percent for service-connected hemorrhoids is remanded. The Board regrets the delay associated with this remand. However, based on a review of the evidence of record, the Board finds that another remand is necessary to allow the AOJ to afford the Veteran with an adequate examination regarding the severity of his service-connected hemorrhoids. In November 2020, the Veteran underwent a VA examination in which the examiner noted that the Veteran's symptoms included bowel incontinence, bleeding, and large hemorrhoids, and that the condition resulted in an inability to complete occupational duties and a frequent need to go to the restroom. However, the Board finds this to be internally consistent with the examiner's findings that the Veteran had small or moderate hemorrhoids that were mild or moderate in severity, and that his hemorrhoids did not impact his ability to work. See November 2020 VA Rectum and Anus Conditions DBQ. As such, the Board finds the November 2020 examination to be inadequate for ratings purposes and, therefore, a remand is necessary to afford the Veteran with an adequate examination regarding the severity of his service-connected hemorrhoids. See Barr v. Nicholson, supra. Lastly, as discussed above, the Board notes that the evidence indicates that there may be pertinent private medical records that are not associated with the claims file. See Northside Hospital records; Dr. R. Vanapalli records; Peachtree Orthopaedic Clinic records; Mercy Medical Center records; and Dr. S. Hasan Neurology Practice records. The Board also notes that, in September 2020, the AOJ requested that the Veteran provide the names, addresses, and approximate dates of treatment of all medical care providers that provided him with treatment pertinent to his claimed condition. The AOJ also provided the Veteran with a VA Form 21-4142, Authorization to Disclose Information, and VA Form 21-4142a, General Release for Medical Provider Information, to allow the AOJ to obtain his medical records on his behalf. See September 2020 VA Correspondence. To date, the Veteran has not responded. VA's duty to assist is not a "one-way street", and a veteran seeking help cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining pertinent evidence. See Wood v. Derwinski, supra. Nonetheless, as a remand of this matter is otherwise warranted, the Board finds that the AOJ should make one more attempt to identify and obtain any outstanding pertinent private medical records. The Veteran is cautioned that failure to cooperate with any requested development may result in the denial of his claim. 38 C.F.R. § 3.655. 4. Entitlement to a TDIU due to service-connected disabilities is remanded. The Board regrets the delay associated with this remand. However, the Board finds the issue of TDIU to be inextricably intertwined with the claims remanded herein. As such, a remand is required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, the matters are REMANDED for the following action: 1. With the Veteran's assistance as appropriate, obtain and associate with the electronic claims file any outstanding pertinent medical records, whether VA or private, to include records relating to treatment from Northside Hospital, Dr. R. Vanapalli, Peachtree Orthopaedic Clinic, Mercy Medical Center, and Dr. S. Hasan Neurology Practice, as well as records relating to treatment at Atlanta VAMC from May 2021 to current. Pursuant to 38 C.F.R. § 3.159(e), any efforts to secure these records MUST be documented in the electronic claims file, and the Veteran MUST be informed if any of these records are unable to be secured. 2. After completing the development above, and any additional development warranted by the record, obtain an advisory medical opinion from an independent medical expert pursuant to 38 U.S.C. § 5109 and 38 C.F.R. § 3.328. The AOJ must follow its established procedures for requesting such an advisory opinion. The entire claims file must be provided to, and reviewed by, the physician. If the physician determines it to be necessary, an examination should be scheduled and any indicated tests, studies, or evaluations should be performed. The physician is asked to: (a.) If an examination is conducted, obtain the Veteran's detailed lay history, including onset and progression of symptomatology, as well as a detailed accounting of any medication used for the treatment of his service-connected conditions. (b.) Opine as to: i. Whether it is at least as likely as not (i.e. a 50 percent or greater probability) that the Veteran's hypertension had its onset during, or is otherwise related to, his active duty service; ii. Whether it is at least as likely as not (i.e. a 50 percent or greater probability) that the Veteran's hypertension was caused by a service-connected condition, to include any medication used for the treatment thereof and any pain symptomatology associated therewith. iii. Whether it is at least as likely as not (i.e. a 50 percent or greater probability) that the Veteran's hypertension underwent an incremental increase (aggravated), regardless of permanence, by a service-connection condition, to include any medication used for the treatment thereof and any pain symptomatology associated therewith. The term incremental increase in disability means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any incremental increase in disability need not be permanent. The term at least as likely as not does not mean within the realm of medical possibility. Rather, it means that the weight of the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. Any opinion expressed by the physician should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the physician should identify and specifically cite each reference material utilized. If the physician is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The physician is also advised that noting that a condition did not manifest in service as the sole basis for forming a negative nexus opinion, without additional explanation, will not be adequate. 3. After completing the development in Section One above, and any additional development warranted by the record, schedule the Veteran for an examination with an appropriate clinician regarding the nature and severity of his service-connected right ankle condition. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be conducted. The examiner is asked to: (a.) Obtain the Veteran's detailed lay history, including onset and progression of symptomatology. If the Veteran describes flare-ups, document the frequency, severity, and duration thereof. (b.) Test and document the range of motion (ROM) for the left and right ankles in active motion, passive motion, weight-bearing, and non-weight-bearing, on both an initial and after repetitive use basis. For each ROM, the examiner is asked to explicitly identify the degree in which pain is first evidenced by the Veteran's visible behavior. If the examiner is unable to conduct the required testing, or concludes that the required testing is not necessary in this case, a thorough explanation should be provided. (c.) Identify the nature and severity of all current manifestations of the Veteran's service-connected right ankle condition. The extent of any weakened movement, excess fatigability, and incoordination should be described. Any additional impairment due to such should be assessed in terms of the degree of additional ROM loss. Additional limitation following repetitive use over time, if any, must also be noted. (d.) If the Veteran describes flare-ups, after documenting the frequency, severity, and duration thereof, express an opinion as to whether there would be additional functional impairment during such flare-ups. The examiner should assess such impairments in terms of the degree of additional ROM loss and provide an explanation as to how such was determined. (e.) Clearly indicate whether any medications the Veteran uses affects the severity of his right ankle condition. If so, identify each medication and clearly explain how such medication affects the condition. (f.) If any medication was productive of ameliorative effects, clearly identify such effects and opine as to the severity of the Veteran's right ankle condition absent such medication. (g.) In formulating the requested opinions, the examiner is asked to consider and specifically address the December 2012 VA examination, which noted calcis or astragalus with marked deformity. Any opinion expressed by the examiner must be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If it is not feasible to perform a requested assessment to any degree of medical certainty without resort to speculation, a thorough explanation as to why the assessment cannot be performed should be provided. The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. 4. After completing the development in Section One above, and any additional development warranted by the record, schedule the Veteran for an examination with an appropriate clinician regarding the severity of his service-connected hemorrhoids. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be conducted. The examiner is asked to: (a.) Obtain the Veteran's detailed lay history, including onset and progression of symptomatology. (b.) Provide a full description of the disability and report all signs and symptoms necessary for evaluating the disability under the rating criteria. Any opinion expressed by the examiner must be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If it is not feasible to perform a requested assessment to any degree of medical certainty without resort to speculation, a thorough explanation as to why the assessment cannot be performed should be provided. The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. 5. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development action is incomplete, the appropriate corrective action must be implemented. If any report or opinion does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. T. Martin III, 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.