Citation Nr: 21076511 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-19 322 DATE: December 27, 2021 REMANDED The issue of service connection for a glucose-6-phosphate dehydrogenase (G6PD) deficiency is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to August 1971, including service in the Republic of Vietnam. This case is before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a Board hearing. The transcript of the hearing has been associated with the record. The Board notes, the Veteran also has open claims for service connection for nerve damage, sleep apnea, and prostate cancer, but those issues are not yet before the Board as VA has not yet certified that appeal; therefore, the Board currently lacks jurisdiction over those issues. The Board remanded the matter of service connection for G6PD deficiency for further development in February 2020 and July 2021, including for an opinion as to whether the Veteran's G6PD deficiency is a congenital defect or disease. A Board remand confers on the Veteran, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). Unfortunately, although an October 2021 VA examiner provided an addendum opinion, there has not been substantial compliance with the Board's previous remand directives. The examiner did not opine whether the Veteran's G6PD deficiency is either a congenital defect or a congenital disease. Another remand is required. Under VA's regulatory framework, congenital or developmental diseases are eligible for service connection, but congenital or developmental defects are not. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; VAOGCPREC 82-90. Defects are defined as "structural or inherent abnormalities or conditions that are more or less stationary in nature." VAOPGCPREC 82-90. On the other hand, a disease is defined broadly as "any deviation from or interruption of the normal structure or function of any part, organ, or system of the body..." and "a condition considered capable of improving or deteriorating." Id. "Any worseningany change at allmight demonstrate that the condition is a disease, in that VA considers defects to be 'more or less' static and immutable." Quirin v. Shinseki, 22 Vet. App. 390, 395 (citing VAOGCPREC 82-90). In reviewing the evidence, the Board finds that a new opinion is necessary because the evidence is insufficient to allow the Board to determine whether the Veteran's G6PD deficiency is either a congenital disease or a congenital defect. See 38 C.F.R. § 4.2; Quirin, 22 Vet. App. at 395 (citing VAOGCPREC 82-90) (guidance from medical authorities must support the determination of whether a condition is a disease or defect). If G6PD deficiency is determined to be a defect, the examiner should answer whether any other disease or injury was superimposed upon it due to service. The matters are REMANDED for the following action: Obtain an addendum opinion. The examiner must review the entire record, including a copy of this and the July 2021 Board Remand. The examiner is asked to respond to the following: a.) Is the Veteran's G6PD deficiency either a congenital disease OR a congenital defect? Defects are defined as "structural or inherent abnormalities or conditions that are more or less stationary in nature." VAOPGCPREC 82-90. Diseases, conversely, are defined broadly as "any deviation from or interruption of the normal structure or function of any part, organ, or system of the body..." and "a condition considered capable of improving or deteriorating." Id. "Any worsening any change at all might demonstrate that the condition is a disease, in that VA considers defects to be 'more or less' static and immutable." Quirin v. Shinseki, 22 Vet. App. 390, 395 (citing VAOGCPREC 82-90). In assessing whether a condition is a congenital disease or defect, the Board emphasizes that all evidence of record should be considered, including post-service medical records that could potentially show that the condition has worsened. b.) If it is determined that the G6PD deficiency is a congenital defect, then was there a disease or injury superimposed upon it as a result of service? The examiner should consider the service treatment records and the Veteran's contentions that taking malaria pills while in Vietnam or receiving blood transfusions of blood with an incompatible blood type caused by or aggravated his G6PD deficiency. The examiner should provide a complete rationale for all opinions provided. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Costa, Stephanie D. 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.