Citation Nr: 21070459 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 11-10 118 DATE: November 24, 2021 REMANDED Entitlement to service connection for chronic kidney disease, to include as due to presumed in-service exposure to herbicide agents, and/or secondary to service-connected posttraumatic stress disorder (PTSD) and/or diabetes mellitus is remanded. Entitlement to service connection for hypertension, to include as due to presumed in-service exposure to herbicide agents, and/or secondary to service-connected PTSD and/or to the claimed chronic kidney disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1968 to October 1969, to include service in the Republic of Vietnam. In February 2014, October 2020 and August 2021, the Board remanded the issues on appeal for further development. Specifically, in February 2021 the Board instructed the Regional Office (RO) to request further clarification from the Veteran regarding outstanding treatment records and to obtain such if appropriate. In addition, the Board requested that the RO obtain an opinion regarding the Veteran's claim that his conditions were due to his presumed herbicide exposure during service. Finally, the Board noted that the Veteran's claim for hypertension was inextricably intertwined with his claim for chronic kidney disease. Following the February 2014 Board remand, additional treatment records were associated with the file. Furthermore, the Veteran underwent additional testing in November 2015. However, in October 2020, the Board again remanded the claims as an additional theory of entitlement was raised by the Veteran's treatment records. In addition, the Board found that the November 2015 VA opinion needed clarification. In December 2020, the Veteran underwent further testing. However, in August 2021, the Board found the December 2020 opinion inadequate for adjudication purposes as the examiner failed to address both the causation and aggravation prong of secondary service connection. The Board ordered a remand so that the Veteran's claims could be fully addressed, specifically whether his chronic kidney disease was either caused or aggravated by his service-connected PTSD to include as a result of his prescribed psychiatric medications. In addition, the Board again noted that the Veteran's claim for hypertension was inextricably intertwined with his claim for service-connection for chronic kidney disease. While the Board finds that some of the Board's prior remand instructions were complied with (see D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268 (1998)), as will be discussed further below an additional remand is necessary as not all of its prior instructions were substantially complied with. Stegall, 11Vet. App. at 268. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 38 U.S.C.§ 5103A; 38 C.F.R.§ 3.159. In addition, where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall, 11Vet. App.at 268. Entitlement to service connection for chronic kidney disease, to include as due to presumed in-service exposure to herbicide agents, and/or secondary to service-connected PTSD and/or diabetes mellitus is remanded. As previously noted, the Veteran contends that he suffers from chronic kidney disease, as a result of his in-service herbicide exposure, and/or as secondary to his service-connected PTSD, to include prescribed medications, and/or as secondary to his service-connected diabetes mellitus. Furthermore, as previously noted, the Veteran has undergone numerous examinations regarding his claims. Most recently the Veteran was provided with a medical opinion in September 2021. Unfortunately, while the examiner adequately addressed some of the Veteran's issues and questions raised by the Board. The examination is still lacking about the Veteran's claim for secondary service connection. In the Board's August 2021 remand, the Board ordered that both the causation and aggravation prongs of secondary service connection be thoroughly addressed. This treatment was to include an adequate rationale and reasoning. Unfortunately, while the examiner found that the Veteran's chronic kidney disease was less likely than not caused by, proximately due to, or aggravated by his service-connected diabetes or his psychiatric disorder to include prescribed medications, he failed to provide clear and adequate rationales for his opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Therefore, not only did the September 2021 opinion fail to substantially address the Board's prior remand, see Stegall, 11 Vet. App. at 268, but it is also inadequate for adjudication purposes regarding the Veteran's secondary service connection claims. Therefore, on remand, an addendum opinion must be obtained which provides a thorough and adequate explanation for all opinions given. Entitlement to service connection for hypertension, to include as due to presumed in-service exposure to herbicide agents, and/or secondary to service-connected PTSD and/or to the claimed chronic kidney disease is remanded. The Board finds that the matter of entitlement to service connection for hypertension is inextricably intertwined with the claim for service connection for chronic kidney disease being remanded herein. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 2 Vet. App. 180, 183 (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a Veteran's claim for the second issue). Therefore, final adjudication of the claim for hypertension must be deferred until there is an adequate resolution of the claim for service connection for chronic kidney disease. Due to the amount of time which will pass on remand, updated treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated treatment records. 2. The Veteran should be provided with an appropriate VA examination to determine the nature and etiology of his chronic kidney disease. The record and a copy of this Remand must be made available to the examiner. The examiner shall note in the examination report that the record and the Remand have been reviewed. The examiner should respond to the following: (1) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's chronic kidney disease began during or is in any way related to his military service, to include his presumed in-service herbicide exposure? (2) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's chronic kidney disease was caused OR aggravated by his service-connected diabetes mellitus and/or his service-connected PTSD, to include any prescribed medications? For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. The examiner should consider all evidence of record, including lay statements and medical records. All opinions offered and conclusions reached should be accompanied by clear and thorough rationale consistent with the evidence of record. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Unger, 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.