Citation Nr: 21013859 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-51 732 DATE: March 10, 2021 REMANDED Entitlement to service connection for a left leg disability, claimed as knot on left leg and bone, is remanded. Entitlement to service connection for residual of nose injury is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1961 to October 1964. This matter comes before the Board of Veterans Appeals (Board) on appeal from an August 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded by the Board in February 2020, to obtain new VA examinations for the Veteran’s claimed disabilities. Unfortunately, a second remand is necessary. When a case is remanded, a veteran is entitled to substantial compliance with all remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). If the RO does not substantially comply with the Board’s remand instructions, the Board is legally bound to continue remanding until the mistake is corrected. See id. In February 2020, the Board remanded based on a finding that the July 2015 VA examination, which the RO relied upon when denying the Veteran’s claim, was inadequate. 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). While a new VA examination was conducted in December 2020, the Board finds that the medical opinion provided by this examiner is not adequate. The December 2020 examiner offered the following opinion regarding the Veteran’s claimed nose disability: After a review of the medical and scientific evidence in the e-file, the Veteran’s claimed deviated condition is less likely as not the result of the Veteran’s service. There is no medical or scientific evidence linking any nose injury from the time in service to their current condition today. The STR’s are silent for a nose injury. The Separation Medical Exam dated 10/20/1964 is silent for a nose condition. The C&P exam from 2015 notes a traumatic deviated septum with a date of diagnosis of 1961, however the STR’s are silent for a deviated septum condition. There must be significant pathology to support the Veteran’s claim. The Veteran’s current condition is more likely than not from a post military service injury. Unfortunately, without any further evidence the Veteran’s claim cannot be supported at this time. This opinion is too vague because it does not establish what the examiner believes the Veteran’s “current condition” is, or exactly what “post military service injury” is believed to have caused the unspecified condition. The opinion also does not acknowledge the Veteran’s lay testimony about having suffered a broken nose during basic training in 1961. The same examiner offered a nearly identical opinion regarding the Veteran’s claimed left leg disability: After a review of the medical and scientific evidence in the e-file, the Veteran’s claimed left leg peripheral nerve condition with numbness is less likely as not the result of the Veteran’s service. There is no medical or scientific evidence linking any leg or peripheral nerve injury from the time in service to their current condition today. The STR’s are silent for a leg or peripheral nerve injury. The Separation Medical Exam dated 10/20/1964 is silent for a leg or peripheral nerve condition. The C&P exam from 2015 notes arthritis to the knees but no date of diagnosis. There must be significant pathology to support the Veteran’s claim. The Veteran’s current condition is more likely than not from a post military service injury. Unfortunately, without any further evidence the Veteran’s claim cannot be supported at this time This opinion once again does not mention what the Veteran’s “current condition” actually is, does not consider the Veteran’s lay testimony about being struck in the leg by a sledgehammer during service, and alleges that the Veteran’s (unspecified) disability was caused by a “post military service injury” without explaining what this injury was. In addition, the opinion does not acknowledge a note in the Veteran’s service treatment records from 1963, which indicates that the Veteran complained of swelling and tenderness in his left leg while on active duty. The Veteran’s case has been Advanced on the Docket, in recognition of the need for a speedy resolution to his appeal. The decision to remand, putting the Veteran through further delay, is not made lightly. However, until an adequate medical opinion is provided, the Board simply cannot decide these matters. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician, who has not already provided an opinion in this case, regarding the nature and etiology of the Veteran’s left leg disability. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, the examiner should answer the following: (a) What left leg condition(s) does the Veteran currently have? (b) Is it at least as likely as not (50 percent or greater probability) that any left leg condition present during the period of the claim had its onset in service, or is otherwise related to an in-service injury, disease, or event? (d) If the Veteran has a left leg condition that is unrelated to his military service, what is the likely etiology of his left leg condition(s)? The examiner must review the entire claims file, and the opinion must reflect consideration of Veteran’s full medical history, his lay testimony, and the record as a whole. The examiner should specifically address the Veteran’s statements regarding his alleged in-service left leg injury, and pertinent notations in his STRs. The examiner must provide a complete rationale for all opinions stated, citing all evidence and medical literature relied upon. If the examiner cannot provide an opinion without resorting to speculation, the examiner must explain why. 2. Obtain an opinion from an appropriate clinician regarding the nature and etiology of the Veteran’s nose disability. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, the examiner should answer the following: (a) What nose condition(s) does the Veteran currently have? (b) Is it at least as likely as not (50 percent or greater probability) that any nose condition present during the period of the claim had its onset in service, or is otherwise related to an in-service injury, disease, or event? (d) If the Veteran has a nose condition that is unrelated to his military service, what is the likely etiology of his left leg condition(s)? The examiner must review the entire claims file, and the opinion must reflect consideration of Veteran’s full medical history, his lay testimony, and the record as a whole. The examiner should specifically address the Veteran’s statements regarding his alleged in-service nose injury, and pertinent notations in his STRs. The examiner must provide a complete rationale for all opinions stated, citing all evidence and medical literature relied upon. If the examiner cannot provide an opinion without resorting to speculation, the examiner must explain why. 3. This case has been Advanced on the Docket. The AOJ must review the examination reports and opinions to ensure they are adequate and comply with the Board’s specific remand directives herein. If an opinion is deficient in any manner, the Agency of Original Jurisdiction must undertake immediate corrective action before returning the case to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.