Citation Nr: 21011617 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-29 633 DATE: March 2, 2021 REMANDED Entitlement to service connection for ulcers, to include as secondary to service-connected acquired psychiatric disorder, to include bipolar disorder, is remanded. Entitlement to service connection for a partial finger amputation, to include as secondary to service-connected Parkinson’s disease, is remanded. REASONS FOR REMAND The Veteran had active service from November 1969 to November 1973, and from July 1975 to April 1976. He also served in the Air National Guard. The case was most recently before the Board in September 2019 when it was remanded for additional development. There has not been substantial compliance with the Board’s remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for ulcers, to include as secondary to service-connected acquired psychiatric disorder, is remanded. 2. Entitlement to service connection for a partial finger amputation, to include as secondary to service-connected Parkinson’s disease, is remanded. The claims must be remanded because medical opinions obtained after the September 2019 remand are inadequate. In a December 2020 rating decision, service connection was granted for an acquired psychiatric disorder, to include bipolar disorder and for Parkinson’s Disease, to include peripheral vestibular disorder-recurring ataxia with dizziness and gait leaning to one side. None of the VA medical opinions obtained to date adequately discuss whether the claimed disabilities are caused or aggravated by the service-connected disabilities. As such, there has not be adequate compliance with the prior Board remands and the claims must be remanded for additional development. Pursuant to the Board’s September 2019 Remand the Veteran was asked to identify all private providers in letters dated in October 2019 and February 2020. There was no response to these requests. However, in an October 2020 VA examination report, the Veteran reported that he saw a psychiatrist every 2 months and has seen a counselor through Prairie View. On remand, another attempt must be made to obtain and associate with the claims file treatment records regarding the Veteran. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers. Make two requests for the authorized records from all identified private providers, unless it is clear after the first request that a second request would be futile. 2. Thereafter, schedule the Veteran for examinations (or telehealth interviews, review of the records, etc., if in-person examinations are not feasible) to determine the nature and etiology of any ulcer disability and partial amputation of the finger disability found to be present. Copies of all pertinent records must be made available to the examiners for review. Based on the examinations and reviews of the record, the examiners must answer the following: (a) Is it at least as likely as not that any diagnosed ulcer disability and/or partial amputation of the finger disability is related to an in-service injury, event, or disease? (b) Is it at least as likely as not that any diagnosed ulcer disability and/or partial amputation of the finger disability is (i) caused by or (ii) aggravated by any service-connected disability, including acquired psychiatric disability and Parkinson’s Disease? Aggravation here is defined as any increase in disability. In rendering the opinion the examiners must comment on the history and prior treatment for ulcers, the statements of the Veteran that he almost cut his finger off at work because he had a lapse in memory, and any significance of tremors in the upper extremities to any partial amputation of the finger. A complete rationale should be provided for all opinions expressed. (Continued on the next page)   3. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. LARKIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert J. Burriesci, 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.