Citation Nr: 21026527 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 18-31 430 DATE: May 3, 2021 REMANDED Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for right iliac artery hematoma (claimed as pain, weakness, and numbness of the right leg) is remanded. Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for numbness, pain, and nerve damage of the left leg is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from June 1960 to June 1964. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in St. Louis, Missouri. In April 2019, the Veteran, his spouse, his daughter, and his grandson testified at a Board video-conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. In September 2019, the Board remanded the case to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. 1. Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for right iliac artery hematoma (claimed as pain, weakness, and numbness of the right leg) is remanded. 2. Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for numbness, pain, and nerve damage of the left leg is remanded. Although the Board sincerely regrets the delay, additional development is required to ensure compliance with the previous remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). As noted above, this case was remanded by the Board in September 2019. In the remand, the Board directed that the AOJ obtain an advisory medical opinion from an independent medical expert. Specifically, the examiner was to offer an opinion as to the likelihood that the Veteran suffered additional disability as a result of VA surgery performed on an abdominal aortic aneurysm and/or as a result of the administration of too much blood thinning medication. The examiner was to offer a further opinion as to whether any additional disability, if present, was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. An independent evaluation was obtained in February 2021. The examiner opined that it was less likely than not that: (1) the claimed condition was caused by or became worse as a result of VA treatment; (2) additional disability resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel; (3) additional disability resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, and (4) VA failed to timely diagnose and/or properly treat the claimed disease or disability which allowed the disease or disability to continue to progress. The Board finds that the February 2021 report is not in compliance with the Board's remand instructions. As to whether the Veteran suffered an additional disability as a result of the administration of too much blood thinning medication (warfarin-dosing), the September 2019 remand instructed the examiner to discuss a July 2015 medical opinion from a Dr. L.S. which noted that "warfarin dosing in this case was not optimal and likely contributed to a potentially-avoidable bleeding complication." In the report, the examiner noted the opinion from Dr. L.S., but did not discuss the significance of the opinion. Further development is required. These matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed, obtain an addendum medical opinion from the independent (non-VA) medical expert who reviewed the Veteran's case in February 2021, pursuant to the authority of 38 U.S.C. § 5109. The physician should be asked to review the record and prepare a supplemental report discussing the July 2015 medical opinion from Dr. L.S. and the extent to which, if any, that opinion impacts on the physician's opinion with respect to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran suffered additional disability as a result of VA treatment in the form of a retroperitoneal hematoma and associated ischemic lumbar plexopathy (as noted in an October 2020 VA examination report) or otherwise, and if so, whether the additional disability was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA, or an event not reasonably foreseeable. If the February 2021 physician is unavailable or otherwise unable to provide the opinion requested, arrange to obtain the requested information from another qualified independent (non-VA) medical expert. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the expert selected to offer the requested opinion. A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a statement in support of claim. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kettler, 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.