Citation Nr: 21013541 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 20-22 824 DATE: March 9, 2021 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for erectile dysfunction (ED) is remanded. Entitlement to service connection for kidney disease is remanded. INTRODUCTION The Veteran served on active duty in the United States Army from February 1964 to January 1966. When this case was previously before the Board in August 2020, the above-noted issues were remanded for further development. The case has since been returned for additional appellate review. REASONS FOR REMAND While further delay of this appeal is quite regrettable, the Board finds additional development is yet again required before the Veteran’s claims are decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the course of the above-noted August 2020 remand, the Board instructed the RO to obtain new examinations and medical opinions addressing the Veteran’s claims by an examiner who had “yet to examine the Veteran.” Following that remand the RO obtained VA examinations addressing the Veteran’s claimed disabilities in both November 2020 and December 2020. However, those examinations were performed by the same Physician’s Assistant that performed the Veteran’s prior September 2018 examinations. Additionally, the examiner found the Veteran’s claimed hypertension, ED, and kidney disease were less likely than not incurred in service. The examiner appears to have largely focused her opinions on the lack of a diagnosis of these disorders in service, or for many years thereafter. Critically, the examiner wholly failed to acknowledge or discuss the Veteran’s assertions that his exposure to herbicides in service may have caused his current disabilities. To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the above-noted deficiencies, the Board finds substantial compliance with the prior remand instructions has not been achieved, and as such, a remand is again required. Accordingly, these matters are REMANDED for the following actions: Afford the Veteran a VA examination by an examiner, who has not previously examined this Veteran, to address the etiology of the Veteran’s claimed hypertension, erectile dysfunction, and kidney disease. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether the Veteran’s hypertension, ED, or kidney disease at least as likely as not (a 50 percent probability or greater): a) originated during the Veteran’s period of active service or is otherwise etiologically related to his active service, to specifically include his conceded exposure to herbicide agents therein; b) was caused by the Veteran’s service-connected diabetes mellitus; or c) was worsened to any degree by his service-connected diabetes mellitus. The examiner must specifically address the Veteran’s reports relative to the etiology of the claimed disabilities. 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 shall provide a complete explanation as to why this is so. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Fraser, 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.