Citation Nr: 21069451 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 06-17 775 DATE: November 18, 2021 REMANDED Entitlement to service connection for arthritis is remanded. Entitlement to service connection for peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran had active service from June 1965 to June 1969, including service in the Republic of Vietnam. This appeal originates from a June 2005 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). These matters return to the Board of Veterans' Appeals (Board) following Board remands in January 2012, January 2013, July 2017, January 2020, and June 2021. The Board finds that additional remand is necessary. A remand by the Board confers on the Veteran, as a matter of law, the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). As discussed further below, the Board finds that there has not been substantial compliance with its June 2021 remand directives and that additional remand is necessary. 1. Entitlement to service connection for arthritis is remanded. The Veteran's arthritis claim arises from a November 2004 written statement to VA that he had osteoarthritis. Development of a claim for service connection for arthritis was added to the Veteran's already pending claim relating to other claimed disabilities. In June 2021 the Board directed that the Veteran be afforded a VA examination to determine the nature and etiology of any diagnoses of arthritis. A VA examination and series of opinions was obtained in August 2021. However, each opinion was limited to consideration of a diagnosis of non-degenerative arthritis. There is nothing in the Board's June 2021 remand suggesting that the Veteran's claim was limited to non-degenerative arthritis. Accordingly, the Board finds that there has not been substantial compliance with its June 2021 remand directives. The Board notes that, consistent with the June 2021 remand directives, the August 2021 VA examiner elicited information from the Veteran concerning the onset and course of symptoms relating to his claimed arthritis. The Veteran reported bilateral pain and numbness in his hands and numbness in the first, second, and third fingers, resulting in difficulty holding objects. In light of the foregoing, the Board finds that an addendum VA opinion should be obtained that addresses the question of whether the Veteran has any diagnosis of arthritis, non-degenerative or otherwise, which may be the result of an event, injury, or occurrence in service; or proximately due to or aggravated by another service-connected disability. 2. Entitlement to service connection for peripheral neuropathy is remanded. The Veteran's peripheral neuropathy claim arises from a September 2004 written statement to VA seeking service connection for a disability specifically identified as peripheral neuropathy. The Veteran had previously filed a claim in September 2004 for a disability specifically identified as carpal tunnel syndrome. The Board construes these claims as constituting separate claims for distinct disabilities. In this regard, the Board notes a February 2012 VA examination note documented sensory neuropathy in the dorsal aspect of the right foot, and a November 2017 VA Orthotics Prosthetics note reflecting that the Veteran was being fitted with tri laminar diabetic type insoles, and characterizing the Veteran as having diabetes and peripheral neuropathy and/or limited sensation. 2/03/2012, VA Examination, p. 9. In June 2021 the Board directed that the Veteran be afforded a VA examination to determine the nature and etiology of any diagnoses of peripheral neuropathy. A VA examination and series of opinions were obtained in August 2021. However, the Board finds that these opinions are inadequate. It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA must consider all lay and medical evidence of record. 38 U.S.C. § 1154(a); 38 U.S.C. § 5107; 38 C.F.R. § 3.303. The August 2021 VA examiner's report only discusses the Veteran's bilateral carpal tunnel syndrome which, as discussed above, is a separate claim distinct from his claim from peripheral neuropathy. Further, the August 2021 provided an unclear discussion of the Veteran's disability picture, stating: "[m]edical literature support [sic] claim of hepatitis C aggravating peripheral neuropathy beyond its normal progression. Veteran's peripheral neuropathy is at least as likely as not aggravated beyond its natural progression by [his] service-connected hepatitis C." This statement notwithstanding. The examiner checked the box stating "no" in response to the form question soliciting an opinion as to whether the Veteran's claimed disability (i.e., peripheral neuropathy) was at least as likely as not aggravated beyond its normal progression by a service-connected disability. The Board cannot reconcile these conflicting propositions in the absence of a clear explanation from the medical examiner. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Once VA undertakes the effort to provide an examination when developing a claim, the examination must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In light of the foregoing, the Board finds that the August 2021 VA examination and opinions do not represent substantial compliance with the Board's June 2021 remand directives. Accordingly, an addendum opinion that directly addresses the Veteran's distinct peripheral neuropathy claim and that reflects a factually accurate, fully articulated, sound reasoning for any conclusion should be obtained. The matters are REMANDED for the following action: 1. Forward the claims file, including this remand, to the examiner who provided the August 2021 opinion. If the August 2021 VA examiner is unavailable, or is unable to offer the opinion sought, the requested opinions should be obtained from another appropriately qualified clinician. The examiner shall indicate in the addendum report that the claims file was reviewed. The need for an additional in person examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should provide an opinion that identifies and discusses any arthritis (to include degenerative, non-degenerative, or otherwise) and/or peripheral neuropathy (other than carpal tunnel syndrome) disabilities identified on examination or upon review of the medical records. For each diagnosed disability, the examiner is requested to state: (a.) Whether the Veteran's disability is at least as likely as not related to an in-service injury, event, or disease, or whether it first had its onset during a period of active service. (b.) Whether the Veteran's disability is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. The examiner should also opine as to whether such disabilities are proximately due to or aggravated by any medication used to treat any service-connected disability. Regarding any arthritis, the examiner should consider the August 2019 VA examiner's statement that "the Veteran's medical record is quite specific regarding the etiology of his renal failure being the combination of long-term Indocin for his joint pain and starting an ACE-inhibitor for blood pressure control and rhabdomyolysis. Marissa Caylor Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. 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.