Citation Nr: 21075331 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 94-24 809 DATE: December 20, 2021 REMANDED Entitlement to service connection for left hand disability is remanded. Entitlement to service connection for bilateral knee disability is remanded. Entitlement to service connection for inflammatory arthritis, to include Reiter's syndrome, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to February 26, 2008, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1979 to June 1982. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Board remanded the appeal. 1. Entitlement to service connection for left hand disability 2. Entitlement to service connection for bilateral knee disability is remanded. 3. Entitlement to service connection for inflammatory arthritis To ensure that VA has met its duty to assist, the Board finds that remand is necessary. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Further, remand is necessary to ensure compliance with the Board's prior remand directives. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Remand is necessary to obtain an addendum medical opinion. Here, although September 2021 VA examination addendum opinions were obtained, they are inadequate because they (1) did not adequately address direct service connection, (2) did not adequately address the theories of secondary service connection and (3) did not provide an adequate rationale regarding whether the claimed conditions had onset in service or are otherwise related to service, or as secondary to service-connected disability. See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016) ("the VA examiner's failure to consider [a veteran's] testimony when formulating her opinion renders that opinion inadequate."); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that it is adequate). The September 2021 VAMOs merely state that the disabilities are not proximately due to service-connected disability or aggravated by service-connected disability. The September 2021 VAMOs are conclusory in nature without any meaningful discussion of the Veteran's claimed disabilities or medical history in the context of any relevant studies or research. Additionally, the opinion does not support the conclusions reached with any true analysis. See also, Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) ("[A] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two."). Moreover, the VAMO does not adequately address the independent theories of secondary service connection (causation and aggravation). See Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (an examiner must provide a rationale that deals with causation and aggravation as independent concepts). Accordingly, the claims are remanded for further development. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 4. Entitlement to a TDIU prior to February 26, 2008 The issue of TDIU is inextricably intertwined with the claims on appeal. Therefore, the Board must defer consideration of that claim at this time. See Harris v. Derwinski, 1 Vet. App. 181 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's left hand arthritis, bilateral knee arthritis, and inflammatory arthritis. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptom consistent with the Veteran's claims. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician must opine on: (a.) Whether each condition (left hand arthritis, bilateral knee arthritis, and inflammatory arthritis) at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) is related to an in-service injury, event, or disease. In forming the opinion, the examiner must indicate whether any of the symptoms of the Veteran's claimed disabilities are part and parcel of already service-connected disabilities. (b.) Whether each condition (left hand arthritis, bilateral knee arthritis, and inflammatory arthritis) is at least as likely as not (1) proximately due to service-connected disability or (2) aggravated beyond the natural progression by service-connected disability. NOTE (1): The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the clinician must indicate this in the examination report and provide a rationale for that determination. NOTE (2): A negative medical opinion should not be predicated solely on the absence of documented complaints, findings, or diagnoses in service. NOTE (3): Separate findings and rationales are required as to the causation and aggravation prongs of secondary service connection as these are independent concepts. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU prior to February 26, 2008. 3. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. SONJA S. AN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Edwards 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.