Citation Nr: 21021206 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-01 949 DATE: April 12, 2021 REMANDED Entitlement to service connection for idiopathic thrombocytopenic purpura (ITP) with splenectomy is remanded. REASONS FOR REMAND The Veteran served in the United States Navy on active duty from February 1966 to November 1969. This matter originally came before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in August 2018. A transcript of the hearing is associated with the claims file. The Board remanded this claim in July 2020 for a new VA examination. Entitlement to service connection for idiopathic thrombocytopenic purpura (ITP) with splenectomy is remanded. While the Board sincerely regrets further delay, a fully-informed decision on the issue of entitlement to service connection for ITP can not be made because there has not been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998).   In July 2020, the Board found that the January 2014 VA examination was inadequate, and remanded for a new examination to be conducted by a hematologist, given the complexity of the medical question at issue, and to specifically address the Veteran’s lay statements from his August 2018 hearing and January 2016 correspondence. A new VA examination was provided in August 2020. However, the examiner’s specialty was in family medicine, not hematology. As such, a remand is necessary to afford the Veteran a VA opinion from a hematologist. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion to the January 2014 VA examination for the Veteran’s ITP with splenectomy from a hematologist. The hematologist should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s ITP with splenectomy, a. Had its onset in service, or b. Is otherwise related to an in-service injury, event, or disease, to include exposure to herbicides. In rendering this opinion, the hematologist must consider and address the following: i. The August 2018 hearing wherein the Veteran testified that he believes his ITP could be related to taking anti-malaria pills, his sexually transmitted disease in service, or Agent Orange because of ITP’s connection to presumptive conditions that affect the immune system. ii. The January 2016 correspondence wherein the Veteran states he had no symptoms of ITP before he was diagnosed and therefore could have had ITP in service, he did not have a viral infection between his separation from service and diagnosis of ITP, the cause of ITP is unknown, and that his ITP is similar to presumptive conditions that affect the immune system. iii. Dr. R.O.’s medical opinion (received in April 2013), including his rationale that ITP is related to presumptive conditions from Agent Orange that affect the immune system. iv. Service treatment records showing the Veteran took anti-malaria tablets. v. May 1967 service treatment records regarding the treatment of a sexually transmitted disease. The hematologist is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the hematologist cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Associate 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.