Citation Nr: 21073757 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 10-11 246A DATE: December 10, 2021 REMANDED Entitlement to service connection for gout, to include as due to toxic herbicide exposure and type II diabetes mellitus is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1965 to December 1966. In a February 2020 decision, the Board denied the Veteran's claim seeking TDIU. The Veteran appealed the September 2020 decision to the United States Court of Appeals for Veterans Claims (Court). In January 2021, the Court granted a Joint Motion for Remand (January JMR), vacating the Board's decision and returning the Veteran's claim seeking TDIU to the Board. In a September 2020 decision, the Board denied the Veteran's claim seeking service connection for gout. The Veteran appealed the September 2020 decision to the Court. In April 2021, the Court granted a Joint Motion for Remand (April JMR), vacating the Board's decision and returning the Veteran's claim seeking service connection for gout to the Board. With respect to the Veteran's claim seeking TDIU, the January JMR indicates that the Board erred by depriving the Veteran of due process to the extent that the Board granted the Veteran's request for additional time to submit evidence from November 14, 2019 to February 12, 2020 and by failing to consider favorable evidence submitted during that time period, including an affidavit and argument that his service-connected conditions precluded his ability to secured and follow a substantially gainful occupation. Thus, the JMR directed the Board to consider the favorable evidence submitted by the Veteran when determining his entitlement to TDIU. With respect to the Veteran's claim seeking service connection for gout, the April JMR indicates that the Board erred by relying on the opinion by the April 2019 VA examiner because the opinion was inadequate to the extent that the examiner (i) failed to explain how the medical literature or risk factors identified in the rationale related to the Veteran's gout and (ii) failed to offer any rational explaining the conclusion that the Veteran's gout was not aggravated by his diabetes mellitus, type II, and hypertension. Thus, the JMR directed the Board to remand the Veteran's claim to the RO so the RO can obtain a new VA medical opinion that opines and explains whether it is at least as likely as not that his gout is related to, proximately due to, or aggravated beyond its natural progression by (i) diabetes mellitus, type II, and (ii) hypertension. 1. Entitlement to service connection for gout, to include as due to toxic herbicide exposure and type II diabetes mellitus is remanded. 2. Entitlement to a total disability rating based on individual unemployability is remanded. With respect to the Veteran's claim seeking service connection for gout, to include as due to toxic herbicide exposure and type II diabetes mellitus, the Board concludes that a remand of that claim is require because the opinion by the April 2019 VA examiner is inadequate for adjudication purposes. As set forth above, the April 2019 VA examiner's opinion is inadequate because the examiner cites medical literature in support of the opinion that it is less likely than not that the Veteran's gout is related to proximately due to, or aggravated beyond its natural progression by his diabetes mellitus, type II, and hypertension, but does not explain how the medical literature relates to the Veterans gout, and because he offered no rationale for that opinion other than referencing the study. Accordingly, the examination is inadequate, and a new addendum opinion is necessary to determine whether the Veteran's gout is related to, proximately due to, or aggravated beyond its natural progression by his service-connected diabetes mellitus, type II, and hypertension. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). With respect to the Veteran's claims of entitlement to TDIU, the Board concludes that a remand is required because the outcome of the Veteran's claim seeking service-connection for gout may have a direction bearing on the adjudication of TDIU. Accordingly, TDIU must be remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. The AOJ should return the claims file to the VA examiner who performed the November 2020 VA examination (or a comparably qualified physician if that examiner is no longer available) to obtain an addendum opinion. The claims file, including any new records, should be provided to the examiner. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's gout is related to, proximately due to, or aggravated beyond its natural progression by his service-connected (i) diabetes mellitus, type II, and/or (ii) hypertension. If the examiner cannot provide the requested opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide more definitive opinions is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. The AOJ should undertake any other development deemed necessary in order to adjudicate the Veteran's entitlement to TDIU, including obtaining any VA examinations or opinions. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Crosnicker, Associate Counsel