Citation Nr: 21006460 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 08-29 627 DATE: February 4, 2021 ORDER Entitlement to an initial staged rating in excess of 10 percent, prior to September 18, 2009, for lumbosacral strain with degenerative disc disease, is denied. Entitlement to an initial staged rating in excess of 20 percent, from September 18, 2009, for lumbosacral strain with degenerative disc disease, is denied. Entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy involving the sciatic nerve is denied. Entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy involving the sciatic nerve is denied. Entitlement to a separate 10 percent rating, but not higher, for right lower extremity radiculopathy involving the femoral nerve is granted. Entitlement to a separate 10 percent rating, but not higher, for left lower extremity radiculopathy involving the femoral nerve is granted. Entitlement to a separate 10 percent rating, but not higher, for right lower extremity radiculopathy involving the external popliteal nerve is granted. REMANDED The issue of entitlement to service connection for warts of the hands, neck and face is remanded. FINDINGS OF FACT 1. Prior to September 18, 2009, the Veteran’s lumbosacral strain with degenerative disc disease was manifested by pain and forward flexion limited to 60 degrees but not greater than 85 degrees and a combined range of motion of the thoracolumbar spine to 220 degrees. 2. From September 18, 2009, the Veteran’s lumbosacral strain with degenerative disc disease has been manifested by forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. 3. For the entire period of the appeal, the Veteran’s right lower extremity radiculopathy involving the sciatic nerve has been manifested by incomplete paralysis that was mild in severity and of an entirely sensory nature. 4. For the entire period of the appeal, the Veteran’s left lower extremity radiculopathy involving the sciatic nerve has been manifested by incomplete paralysis that was mild in severity and of an entirely sensory nature. 5. The Veteran’s right lower extremity radiculopathy has manifested by mild incomplete paralysis of the femoral nerve. 6. The Veteran’s left lower extremity radiculopathy has manifested by mild incomplete paralysis of the femoral nerve. 7. The Veteran’s right lower extremity radiculopathy has manifested by mild incomplete paralysis of the external popliteal nerve. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating in excess of 10 percent, prior to September 18, 2009, for lumbosacral strain with degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.59, 4.71a, Diagnostic Code 5242. 2. The criteria for entitlement to a staged initial rating in excess of 20 percent, from September 18, 2009, for lumbosacral strain with degenerative disc disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.59, 4.71a, Diagnostic Code 5242. 3. The criteria for entitlement to an initial rating in excess of 10 percent for right lower extremity radiculopathy involving the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8720. 4. The criteria for entitlement to an initial rating in excess of 10 percent for left lower extremity radiculopathy involving the sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8720. 5. The criteria for a separate 10 percent disability rating, but not higher, for right lower extremity radiculopathy involving the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8526. 6. The criteria for a separate 10 percent disability rating, but not higher, for left lower extremity radiculopathy involving the femoral nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8526. 7. The criteria for a separate 10 percent disability rating, but not higher, for right lower extremity radiculopathy involving the external popliteal nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8521. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1970 to February 1971 and from February 2003 to May 2004. These matters come before the Board of Veterans’ Appeals (Board) on appeal of September 2007 (low back disability and warts) and December 2009 (radiculopathy) rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In a January 2010 rating decision, the Agency of Original Jurisdiction (AOJ) increased the rating for the Veteran’s low back disability to 20 percent, effective September 18, 2009. As the increase did not satisfy the appeal in full, the issue remains on appeal and has been characterized as shown on the title page of this decision. See AB v. Brown, 6 Vet. App. 35 (1993). This case was previously remanded by the Board in January 2011, September 2015 and August 2018. The case has been returned to the Board for review. The Veteran testified at a video conference hearing before a Veterans Law Judge (VLJ) of the Board in October 2010. The law requires that the VLJ who conducts a hearing on an appeal must participate in any decision made on that appeal. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. However, the VLJ who conducted the October 2010 Board hearing is no longer employed by the Board. In June 2015, the Veteran and his representative were sent a letter notifying them that the VLJ who presided over the October 2010 hearing is no longer employed by the Board, and offering another hearing before a different VLJ. The letter notified the Veteran that he had 30 days from the date of letter to respond and that if no response was received the Board will assume the Veteran does not want another hearing and the Board will proceed accordingly. The Veteran did not respond to the letter. As such, the Board will consider the case on the evidence of record. The Board is cognizant of the ruling of the United States Court of Appeals for Veterans Claims (Court) in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a total rating based on individual unemployability (TDIU) due to service-connected disability, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran has not argued, and the record does not otherwise reflect, that the disabilities at issue render him unemployable. Accordingly, the Board concludes that a claim for TDIU has not been raised. Increased Ratings Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). In rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 1. Entitlement to higher initial ratings for lumbosacral strain with degenerative disc disease. The Veteran seeks higher initial ratings for his service-connected lumbosacral strain with degenerative disc disease. The Veteran’s service-connected low back disability is rated as 10 percent disabling prior to September 18, 2009 and 20 percent disabling from September 18, 2009 under 38 C.F.R. § 4.71a, Diagnostic Code 5242. The applicable rating period is from May 3, 2007, the effective date for the award of service connection for the low back disability, through the present. See 38 C.F.R. § 3.400. The Veteran’s service-connected low back sprain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5242, which pertains to degenerative arthritis of the spine. Diagnostic Code 5242 directs that the disability be rated under the General Rating Formula. Under the General Rating Formula, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned for limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Unfavorable ankylosis is defined as “a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching.” Fixation of a spinal segment in neutral position (0 degrees) always represents favorable ankylosis. 38 C.F.R. § 4.71a, Diagnostic Codes 5243, Note (5). Turning to the evidence of record, the medical treatment records dated during the relevant period show that the Veteran has reported back pain. However, they do not contain any range-of-motion measurements for the lumbar spine. They also do not show that the Veteran had favorable or unfavorable ankylosis of the thoracolumbar spine at any point during that period. As such, the medical treatment evidence of record does not show that the Veteran is entitled to higher initial staged ratings during the relevant period. The Veteran was provided a VA examination in August 2007. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported constant lower back pain. The Veteran denied flare-ups of his lumbar spine symptoms. Initial range-of-motion testing revealed forward flexion to 70 degrees on active and passive motion with pain at the endpoint; extension from 0 to 30 degrees with pain at the endpoint; right and left lateral flexion from 0 to 30 degrees with pain at the endpoint; and right and left lateral rotation from 0 to 30 degrees with pain at the endpoint. The Veteran was able to perform repetitive use testing without additional functional loss or limitation in range-of-motion. The Veteran was provided a VA examination in September 2009. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported that his low back was getting progressively worse. The Veteran reported severe weekly flare-ups with lifting, bending and prolonged sitting and standing. The Veteran did not report additional loss of range of motion with flare-ups. The Veteran did not have ankylosis of the spine and, although there was evidence of lumbar flattening, there was no evidence of scoliosis, lumbar lordosis, reverse lordosis, or kyphosis. Upon examination, the Veteran demonstrated forward flexion to 60 degrees with pain at the endpoint; extension to 20 degrees with pain at 15 degrees; right and left lateral flexion to 15 degrees with pain at the endpoint; and right and left lateral rotation with pain at the endpoint. The Veteran was able to perform repetitive use testing without additional functional loss or limitation in range-of-motion. The examiner reported that the Veteran’s lumbar spine disability affected his employability, as it decreased mobility, caused pain, and caused problems with lifting and carrying. The Veteran was provided a VA examination in March 2016. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported flare-ups on a daily basis. He did not report loss of range of motion due to flare-ups. Upon examination, the Veteran demonstrated forward flexion to 70 degrees. The examiner noted that there was pain with forward flexion, but that it did not cause functional loss. The Veteran was able to perform repetitive use testing without additional functional loss or limitation in range-of-motion. The Veteran did not have ankylosis of the spine. The Veteran was provided a VA examination in March 2020. The VA examiner reviewed the record, interviewed the Veteran and conducted an in-person examination. The Veteran reported low back pain induced/aggravated with repetitive bending, lifting, prolonged standing, walking, running and climbing. Upon examination, the Veteran demonstrated forward flexion to 75 degrees. He was able to perform repetitive use testing without additional loss of range of motion. The VA examiner opined that with repetitive use over time the Veteran’s forward flexion would be 75 degrees. The Veteran denied flare-ups of the thoracolumbar spine. He did not have ankylosis of the spine. Thus, prior to September 18, 2009, the Veteran’s low back disability manifested by pain and limited flexion with forward flexion limited to, at its most severe, 70 degrees and a combined range of motion of no less than 220 degrees. There was no evidence of muscle spasm or guarding severe enough to result in abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. In addition, there is no indication in the record that the Veteran had ankylosis of any portion of the spine. Under Diagnostic Code 5242, a 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees. A higher rating of 20 percent is not for assignment unless forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Higher ratings of 40 percent, 50 percent and 100 percent are not for assignment unless there is ankylosis of the spine. Thus, the range-of-motion measurements and symptoms of the Veteran’s low back disability recorded prior to September 18, 2009, are consistent with a rating of 10 percent, and no higher, under Diagnostic Code 5242. From September 18, 2009, the Veteran’s low back disability was manifested by pain and limited flexion with forward flexion limited to, at its most severe, 60 degrees. In addition, there is no indication in the record that the Veteran had ankylosis of any portion of the spine. Under Diagnostic Code 5242, a 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees. A higher rating of 40 percent is not for assignment unless forward flexion of the thoracolumbar spine is 30 degrees or less, and higher ratings of 50 percent and 100 percent are not for assignment unless there is ankylosis of the spine. Thus, the range-of-motion measurements and symptoms of the Veteran’s low back disability recorded from September 18, 2009, are consistent with a rating of 20 percent, and no higher, under Diagnostic Code 5242. The Board has considered whether the Veteran was entitled to a higher rating at any time during the relevant period under the criteria set forth in DeLuca. The VA examiners found that, following repetitive-use testing, the Veteran did not have additional functional loss due to pain, fatigability, incoordination, pain on movement, or weakness. Additionally, the March 2020 VA examiner opined that with repetitive use over time the Veteran’s forward flexion would be 75 degrees. Furthermore, the Veteran denied flare-ups at the March 2020 VA examination and did not report loss of range of motion with flare-ups during his earlier examinations. Thus, although the Veteran experiences pain with motion, such pain has not manifested to a degree that more nearly approximates the criteria for a higher rating under Diagnostic Code 5242 even after repetitive use and upon repetitive use over time. See DeLuca, 8 Vet. App. 202. The Board finds that the Veteran’s complaints of painful motion of the spine did not impair his functioning to a degree such that the criteria for a rating in excess of 10 percent, prior to September 18, 2009, and in excess of 20 percent from September 18. 2009, were more closely approximated. See Mitchell, 25 Vet. App. 32. The Board therefore finds that the criteria for initial staged ratings in excess of 10 percent prior to September 18, 2009, and in excess of 20 percent from September 18, 2009, under Diagnostic Code 5242 have not been met at any time during the relevant period. The preponderance of the evidence is against the assignment of higher ratings, the benefit-of-the-doubt doctrine is not for application, and the appeal must be denied. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Entitlement to a higher initial rating for right lower extremity radiculopathy 3. Entitlement to a higher initial rating for left lower extremity radiculopathy The Veteran seeks higher initial ratings for his service-connected bilateral lower extremity radiculopathy. The Veteran’s service-connected bilateral lower extremity radiculopathy is rated as 10 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8720. The applicable rating period is from September 4, 2009, the effective date for the award of service connection for bilateral lower extremity radiculopathy, through the present. See 38 C.F.R. § 3.400. Diagnostic Code 8720 corresponds to neuralgia of the sciatic nerve. Under Diagnostic Code 8720, a 10 percent rating is warranted for incomplete neuralgia of mild severity, while a 20 percent rating is warranted for moderate neuralgia and a 40 percent rating is warranted for incomplete neuralgia that is moderately severe in nature. The words “mild,” “moderate,” and “severe” as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Note at “Diseases of the Peripheral Nerves.” The maximum rating which may be assigned for neuritis not characterized by organic changes will be moderately severe incomplete paralysis for sciatic nerve involvement. See 38 C.F.R. § 4.123. Turning to the relevant evidence of record, the Veteran was provided a VA examination in September 2009. The Veteran reported numbness and tingling in the right leg and foot. He described moderate, dull aching pain. The Veteran was provided a VA examination in September 2011. The Veteran reported constant burning pains in both legs. The Veteran reported symptoms of moderate constant pain in the right lower extremity; moderate intermittent pain in the left lower extremity; moderate paresthesias and/or dysesthesias of the right lower extremity and mild paresthesias and/or dysesthesias of the left lower extremity; and moderate numbness of the right lower extremity. The Veteran demonstrated normal reflexes in the bilateral lower extremities and sensation was normal at both thighs, knees, lower legs, ankles, feet, and toes. There were no trophic changes and the Veteran’s gait was normal. The VA examiner concluded that the Veteran had mild incomplete paralysis of the right external popliteal nerve. The examiner reported that the Veteran’s peripheral neuropathy impacted his ability to work, as it caused pain in the legs and feet with walking or standing for a prolonged period of time. The Veteran was provided a VA examination in March 2016. The VA examiner reviewed the record, interviewed the Veteran, and conducted an in-person examination. Upon examination, the Veteran demonstrated symptoms of mild bilateral constant pain, intermittent pain, paresthesias and/or dysesthesias and numbness in the bilateral lower extremities. Reflexes and sensation were normal in each lower extremity, although a straight leg raising test was positive. The VA examiner concluded that the Veteran had mild radiculopathy in each lower extremity with involvement of the femoral nerve in both lower extremities and the sciatic nerve in the left lower extremity. The Veteran was provided a VA examination in March 2020. The VA examiner reviewed the record, interviewed the Veteran, and conducted an in-person examination. The Veteran reported symptoms of mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness of the bilateral lower extremities. On examination, reflexes were normal in the bilateral lower extremities, and there was normal sensation in each leg. The VA examiner determined that the Veteran had mild incomplete paralysis of the bilateral sciatic nerves. Upon consideration of the record, the Board finds that a rating in excess of 10 percent is not warranted for either the right or left lower extremity radiculopathy under Diagnostic Code 8720 for neuropathy impacting the sciatic nerves. The VA examiners evaluated the symptomatology of the bilateral lower extremity sciatic nerve radiculopathy as being only mild in severity. These impressions were based on an in-person examination as well as a thorough review of the claims file. Therefore, although the examiners’ assessments in that regard are not dispositive in determining the level of severity, the Board accepts them as highly probative evidence of the level of severity. Moreover, there is no objective medical evidence to suggest that the Veteran has experienced any radicular symptomatology in his lower extremities beyond the radiating pain from his lower back and some intermittent tingling and numbness. While the wholly sensory nature of the Veteran’s bilateral lower extremity radicular symptoms does not automatically preclude an increase, the evidence of record does not suggest that the bilateral lower extremity radiculopathy is more than mild in severity. The Board therefore finds that the criteria for a rating in excess of 10 percent under Diagnostic Code 8720 for bilateral lower extremity radiculopathy have not been met at any time during the relevant period. However, the Board finds that separate ratings are warranted for lumbar radiculopathy affecting the right and left anterior crural (femoral) nerves. In this regard, Diagnostic Code 8526 provides for a 10 percent disability rating for mild incomplete paralysis of the femoral nerve. As the March 2016 VA examiner documented findings of mild incomplete paralysis of the right and left femoral nerves, separate 10 percent ratings are warranted for mild incomplete paralysis of the anterior crural (femoral) nerve pursuant to Diagnostic Code 8526. Higher ratings greater than 10 percent are warranted for moderate incomplete paralysis of the femoral nerves, but there is no evidence to suggest that the impairment affecting the femoral nerves is any more than mild. Additionally, a separate rating is also warranted lumbar radiculopathy impacting the right external popliteal (common peroneal) nerve. Diagnostic Code 8521 provides for a 10 percent disability rating when there is mild incomplete paralysis of the external popliteal nerve. As the September 2011 VA examiner reported findings of mild incomplete paralysis of the right external popliteal nerve, a separate 10 percent rating is warranted. However, a higher rating is not warranted, because the evidence does not suggest that the incomplete paralysis impacting the right external popliteal nerve was moderate, severe, or complete. In sum, initial ratings greater than 10 percent for right and left lower extremity radiculopathy impacting the sciatic nerve is not warranted; however, separate 10 percent ratings are assigned for mild incomplete paralysis of the right femoral nerve, mild incomplete paralysis of the left femoral nerve, and mild incomplete paralysis of the right external popliteal nerve. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70 (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Entitlement to service connection for warts of the hands, neck, and face is remanded. The Veteran contends that he has warts of the hands, neck and face that is directly related to his active service. Specifically, the Veteran contends that he developed warts within six months of returning from Iraq. See May 2007 correspondence. The Board notes that the Veteran has been diagnosed with warts during the pendency of the appeal. In the August 2018 remand, the Board directed the RO to provide the Veteran with a VA examination related to his warts. The Veteran was provided a VA examination in March 2020. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the Board finds the March 2020 VA examination related to the Veteran’s warts is inadequate for decision-making purposes. Upon examination, the VA examiner diagnosed ichthyosis vulgaris and opined that the condition was less likely than not related to his active service since the condition is hereditary. However, the VA examiner did not address the Veteran’s diagnosed warts as directed by the August 2018 remand. Accordingly, the March 2020 VA examination is inadequate for decision making purposes and does not substantially comply with the Board’s August 2018 remand directives. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Board remand). The Board notes that the Veteran’s warts need to be addressed, even if not currently present on examination or if the disability resolved prior to VA’s adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Accordingly, a VA addendum opinion is required to address the etiology of the Veteran’s warts present at any point during the period on appeal or in close proximity to the Veteran’s claim for service connection. See Romanowsky v. Shinseki, 26 Vet. App. 289, 321 (2013). The matter is REMANDED for the following action: 1. Forward the record and a copy of this remand to the examiner who conducted the March 2020 VA examination, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the examiner should express an opinion as to: (a.) Whether it is at least as likely as not (50 percent or greater probability) that Veteran’s warts are related to his active service. The examiner should address the Veteran’s reports that his warts began six months after returning from Iraq. In providing the above opinion, the examiner should be mindful that even if the Veteran’s warts have resolved, an opinion is still required regarding the etiology of the diagnosed disability. See McClain v. Nicholson, 21 Vet. App. 319 (2007)). 2. After completion of the above, review the expanded record, including the evidence entered since the most recent statement of the case, and determine whether service connection for warts of the hand, face, and neck may be granted. If the benefit sought remains denied, furnish the Veteran and his representative with a supplemental statement of the case. The appropriate period should be allowed for response before the appeal is returned to the Board. MICHELLE P. KATZ Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. G. LeMoine, 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.