Citation Nr: 21070960 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 16-04 976 DATE: November 29, 2021 REMANDED Entitlement to service connection for a disability manifested by arthritis and fluid accumulation on the left side of the body is remanded. INTRODUCTION The Veteran served under honorable conditions on active duty in the United States Army during the Vietnam Era, from August 1966 to August 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 Rating Decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston Salem, North Carolina. When this matter came before the Board in September 2018 it was denied on the merits. Thereafter, the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court) which, in March 2020, entered its Memorandum Decision vacating and remanding the matter for further proceedings consistent with the findings therein. In August 2021, the Board remanded the matter for additional development, specifically, a VA examination and medical nexus opinion adequate for adjudication purposes. The additional development has been conducted and the matter returns to the Board for further appellate review. The Board notes the Veteran has a separate appeal pending before the Board involving service connection claims for left shoulder, bilateral chronic axillary neuropathy, and bilateral leg muscle strain and pain. As the Veteran requested a hearing before a Veterans Law Judge (VLJ) by live videoconference, which is scheduled for December 2021, these issues will be the subject of a subsequent Board decision. Additionally, in June 2021, the Veteran's attorney representative moved to withdraw her representation, which was promptly recognized by the RO. As such, the Veteran is now proceeding pro se (i.e., representing himself) on this issue. While further delay is regrettable, for the reasons set forth below, the Board finds remand is again required. Finally, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). REASONS FOR REMAND Entitlement to service connection for a disability manifested by arthritis and fluid accumulation on the left side of the body is remanded. The Veteran seeks entitlement to service connection for "injuries to the left side of [his] body" after the ambulance he was operating was struck by another vehicle while serving at Fort Knox, Kentucky between approximately January and April 1969. Pursuant to the Board's prior remand directives, in order to comply with the Court's March 2020 Memorandum Decision the Veteran was afforded another VA examination in September 2021. For the following reasons, the Board finds the VA examination report inadequate for adjudication purposes and, consequently, there has not been substantial compliance with the prior remand directives such that remand is again required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stegall v. West, 11 Vet. App. 268, 271 (1998). The VA examiner was directed to provide a medical nexus opinion that considered "the Veteran's competent and credible reports of an in-service motor vehicle accident while working for a hospital in Fort Knox, Kentucky," as well as, his "credible and competent reports regarding the onset of pain during service, and a continuity of such symptomology after service." Unfortunately, the examiner's reports and, most significantly, her opinion rationale fail to address the Veteran's October 2018 and September 2020 statements referenced in the remand directives and are devoid of discussion of continuity of symptomology. Moreover, although the Board previously found an in-service injury or event has been established, specifically, the motor vehicle accident, the examiner reported that, "[t]he Veteran's service records show no objective evidence for any motor vehicle accidents during service." Based upon the foregoing, remand is again required to afford the Veteran another VA examination and to procure a medical nexus opinion adequate for adjudication purposes. Accordingly, the matter is REMANDED for the following action: Schedule the Veteran for an in-person VA examination with a physician who has not previously offered an opinion in this matter and possessing the necessary expertise to fully assess and provide an opinion regarding the nature, severity, and likely etiology of the Veteran's arthritis and fluid accumulation on the left side of his body. The examiner must obtain a full history from the Veteran. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, such as in-service events, in-service and post-service observable symptomology, and functional limitations. All pertinent symptomology and manifestations, including onset, progression, and continuity of symptomology must be elicited from the Veteran and reported in detail. Based upon a review of all pertinent evidence in the Veteran's claims file including medical treatment records, lay statements, and the examination results, the examiner must offer an opinion based upon an accurate medical history with clear conclusions and supporting data as to whether it is at least as likely as not (i.e., 50 percent probability or greater) the Veteran's left side disability or disabilities including, but not limited to, arthritic changes of the left femur, left patellofemoral joint, left tibia/fibula, and/or fluid accumulation manifested during active military service or within one year of separation, or is otherwise due to, related to, or etiologically associated with an in-service injury, event, or illness including, but not limited to, the conceded in-service motor vehicle accident while driving an ambulance. In offering the above opinion, the examiner must consider, discuss, and reconcile as necessary all pertinent lay and medical evidence of record including, but not limited to, the Veteran's July 2014, March 2018, October 2018, December 2018, April 2019, June 2019, and September 2020 statements regarding onset of pain during service and continuity of symptomology thereafter. The examiner is advised that the mere absence of evidence does not equate to unfavorable evidence. The Veteran's lay statements and reports of onset and symptomology must be considered and discussed. A complete and thorough rationale for all opinions expressed, with references to pertinent evidence of record and, as warranted, relevant medical literature must be provided. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Worsham, Attorney Advisor 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.