Citation Nr: 21013775 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 09-27 744A DATE: March 10, 2021 REMANDED Entitlement to service connection for a left great toe disability is remanded. Entitlement to service connection for a right hand and fingers disability is remanded. Entitlement to service connection for a left hand and fingers disability is remanded. Entitlement to a compensable disability rating for residuals of a right great toe injury is remanded. INTRODUCTION The Veteran served honorably on active duty with the United States Army from January 1966 to July 1989. The Board notes that the Veteran currently has two appeals in appellate status. The Veterans Service Organization listed at the top of this document represents the Veteran in the issues listed above. An attorney represents the Veteran in the other issues on appeal, and he has specifically limited his representation to those issues, which have been addressed in a separate decision. These matters were most recently before the Board in November 2020, at which time they were remanded for additional development. The case has since been returned for further 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). In the course of the November 2020 remand, the Board acknowledged the Veteran’s reports of pain, diffuse tenderness, and decreased sensation of the hands and fingers. By way of an April 2015 memorandum, the Veteran’s representative asserted his current manifestations may be consequentially related to his service-connected disabilities. Additionally, the Board notes that during a November 2017 VA neck examination the examiner indicated the Veteran has radicular pain or other signs and symptoms attributable to radiculopathy. In particular, the examiner noted a C5/C6 nerve root radiculopathy in the right upper extremity, as well as decreased left thumb sensory impairments. The Board also observes the Veteran is presently service connected for a cervical spine disability; however, to date the RO has not obtained a medical opinion addressing his asserted secondary theory of entitlement to service connection for his claimed left and right hand disabilities. 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 November 2020 remand, the Board instructed the RO to obtain a VA arthritis conditions examination in order to properly evaluate the Veteran’s possible bilateral gout disability. However, following that remand the Veteran was provided a VA foot conditions examination in December 2020. The examiner, like the prior January 2020, indicated “a diagnosis for gout cannot be given without a (sic) arthritis DBQ.” Based on the foregoing, the Board finds substantial compliance with the November 2020 remand instructions has not been achieved. As such, a remand is necessary. Accordingly, these matters are REMANDED for the following actions: 1. Afford the Veteran a VA non-degenerative arthritis conditions examination by an examiner, who has not previously examined this Veteran, to address the etiology of any gout of the right and/or left great toe. 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 any diagnosed gout of the left great toe at least as likely as not (a 50 percent probability or greater) originated during the Veteran’s period of active service or is otherwise etiologically related to his active service. The examiner should also state an opinion with respect to whether any diagnosed gout of the right great toe at least as likely as not (a 50 percent probability or greater) was caused or aggravated by his currently service-connected right great toe disability. 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. 2. Also, obtain a VA examination by an examiner with sufficient experience and expertise, who has not previously examined the Veteran, to address the etiology of the Veteran’s claimed bilateral hand/finger disabilities. 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 medical records and lay statements, the examiner should state an opinion with respect to whether any diagnosed left or right hand/fingers disability at least as likely as not (a 50 percent probability or greater) originated during his period of active service or are otherwise etiologically related to his active service. Following a review of the relevant medical records and lay statements, the appropriate examiner should also state an opinion with respect to whether the Veteran’s left and right hand/fingers manifestations, to include pain, diffuse tenderness, and decreased sensation of the hands and fingers, at least as likely as not (a 50 percent probability or greater): a) were caused by a service-connected disability; or (Continued on the next page)   b) were worsened to any degree by a service-connected disability. The examiner must provide a complete rationale for all proffered opinions. In this respect, the examiner must discuss and consider the Veteran’s competent lay statements. Additionally, the examiner is asked to review and consider the findings of the November 2017 VA neck examiner, including her findings of radicular pain or other symptoms attributable to radiculopathy, as well as her notation of a right upper extremity C5/C6 nerve root radiculopathy and decreased left thumb sensory impairments. 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.