Citation Nr: 21077157 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 12-20 815 DATE: December 28, 2021 REMANDED Entitlement to service connection for vaginal conditions, to include hidradenitis suppurativa, folliculitis, urinary tract infections, and vaginal infections, is remanded. Entitlement to service connection for gastric bypass with residual hernias is remanded. Entitlement to service connection for bilateral knee condition is remanded. Entitlement to service connection for bilateral shin splints is remanded. Entitlement to service connection for bilateral foot condition, to include blisters, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from June 1980 to June 1984. These issues were remanded by the Board of Veterans' Appeals (Board) in October 2017 and May 2021 for further development. Upon review of the record, the Board finds that the claims must be remanded to obtain new medical opinions. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of her claims. In July 2021, the Veteran underwent VA examinations for her vaginal condition, gastric bypass with residual hernias, bilateral knee condition, bilateral shin splints, and bilateral foot condition. The examiner opined that none of the Veteran's claimed conditions was caused or aggravated by her psychiatric disorder because of the lack of evidence in the Veteran's service treatment records or any other available medical records that clearly support causation or aggravation of the claimed conditions. Additionally, though the Veteran's obesity could be a factor in worsening the Veteran's bilateral foot condition, he ultimately concluded that none of the claimed conditions caused the Veteran to become obese or aggravated her obesity. First, the Board finds that the examination and opinion do not substantially comply with the Board's May 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Unfortunately, the July 2021 examiner failed to opine as to whether the Veteran's service connected major depressive disorder with anxiety disorder and posttraumatic stress disorder (PTSD) caused or aggravated her obesity, instead merely noting that none of the claimed conditions did. Second, the examiner used the wrong legal standard when he ultimately based his negative opinions on the lack of evidence that "clearly" support causation or aggravation of the claimed conditions by the service-connected psychiatric disorder, as the standard should be "as likely as not." Accordingly, a remand is necessary to obtain new medical opinions to ascertain the nature and etiology of the Veteran's vaginal condition, gastric bypass with residual hernias, bilateral knee condition, bilateral shin splints, and bilateral foot condition. The matters are REMANDED for the following action: 1. With the Veteran's help as appropriate, associate with the claims file any relevant outstanding treatment records. 2. Obtain an opinion from an appropriate medical examiner, such as a physician or nurse practitioner, to determine the nature and etiology of the Veteran's vaginal condition, to include to include hidradenitis suppurativa, folliculitis, urinary tract infections, and vaginal infections; gastric bypass with residual hernias; bilateral knee condition; bilateral shin splits; and bilateral foot condition. The claims file should be made available to the examiner for review in connection with the examination. The Veteran should be contacted, and an examination scheduled, if the examiner deems it necessary for a complete and well-informed opinion. Based on review of the record, the examiner should address: a) For each claimed condition, obtain a detailed history, to include any and all diagnoses and symptomology that have been present since 2006. b) For each diagnosis found, state whether it is at least as likely as not that the disorder was incurred in or is related to any event or injury in service. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she must explain why. 3. After a medical opinion has been obtained from a medical examiner, obtain an opinion from a psychiatrist or psychologist to evaluate the impact of the Veteran's psychiatric disorder on her claimed vaginal condition, to include to include hidradenitis suppurativa, folliculitis, urinary tract infections, and vaginal infections; gastric bypass with residual hernias; bilateral knee condition; bilateral shin splits; and bilateral foot condition. The claims file should be made available to the examiner for review in connection with the examination. The Veteran should be contacted, and an examination scheduled, if the examiner deems it necessary for a complete and well-informed opinion. Based on review of the record, the examiner should respond to the following: a) For all diagnoses present since 2006 that are related to a claimed vaginal condition; gastric bypass with residual hernias; bilateral knee condition; bilateral shin splits; and bilateral foot condition, was the disorder at least as likely as not caused or aggravated by the Veteran's service-connected major depressive disorder with anxiety disorder and PTSD, to include neglect of personal hygiene. An opinion must be provided regarding both causation and aggravation. b) For each disorder found, if the examiner finds that the condition was aggravated by her service-connected acquired psychiatric disorder, to include neglect of personal hygiene, then he/she should specify the baseline level of the disability prior to aggravation due to the service-connected condition. Note that aggravation means any incremental increase in disability in the non-service-connected condition (i.e., any additional impairment of earning capacity) resulting from the service-connected condition. c) Obesity as an intermediary step: i) State whether it is at least as likely as not that the Veteran's psychiatric disorder caused or aggravated her obesity. ii) If it is found that the Veteran's psychiatric disorder contributed to her obesity, state whether it is at least as likely as not that the Veteran's obesity was a substantial factor in the development of her: vaginal condition; gastric bypass with residual hernias; bilateral knee condition; bilateral shin splits; or bilateral foot condition. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she must explain why. Mary E. Rude Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, Associate 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.