Citation Nr: 21032230 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 14-39 302 DATE: May 26, 2021 REMANDED Entitlement to service connection for a vaginal and uterine condition is remanded. Entitlement to service connection for a bilateral foot condition is remanded. Entitlement to service connection for a bilateral ankle condition is remanded. REASONS FOR REMAND Although the Board regrets further delay, remand is necessary to ensure compliance with previous remand directives and proper development. When there is not substantial compliance with Board remand requests, the Board errs as a matter of law when it does not ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Vaginal and Uterine Condition As part of the November 2020 Board remand, the RO was required to obtain a medical opinion on the etiology of the Veteran's current vaginal and uterine disabilities and whether they pre-existed service. In January 2021 the Veteran was provided with a VA gynecological condition examination and a VA skin diseases examination regarding her claimed disabilities. However, the Board finds these opinions to be inadequate. The examiner opined that the Veteran's claimed uterine and vaginal disabilities were less likely than not (less than a 50 percent probability) incurred in, or caused by, service. The rationale provided was that the Veteran's claim's file shows that she had a hysterectomy in 2012 and her uterine and vaginal conditions are resolved. However, the examiner did not opine on whether the Veteran's hysterectomy was necessitated by the conditions which the Veteran was claiming service-connection. Additionally, while the examiner opined that there was no evidence of any gynecological conditions pre-existing service, the rationale used to support that opinion was citations to the Veteran's medical records discussing her mammograms and service-connected breast conditions. The examiner did not discuss the required medical records as indicated by the Board remand in formulating their opinion. Based upon the above, the VA examiner did not adequately assess whether the Veteran's claimed vaginal and uterine disabilities were related to her active duty service and the Board finds that a new examination and opinion is necessary. Bilateral Foot Condition As part of the November 2020 Board remand the RO was required to provide the Veteran with a VA examination to determine the nature and etiology of any diagnosed foot disabilities. The examiner was told to consider specific pieces of evidence while formulating their opinion. The Veteran was provided with a January 2021 VA Foot conditions examination, however, for the reasons discussed below, the Board finds this examination to be inadequate. The examiner cited to different treatment notes; however, they did not provide any opinion regarding the etiology of the Veteran's foot disabilities. The examiner noted that the Veteran complained of foot pain since active duty service and was diagnosed with plantar fasciitis outside of her service period but provided no opinion regarding the etiology of her foot disabilities. As such, the Board finds this opinion to be inadequate. Based upon the above, the VA examiner did not adequately assess whether the Veteran's claimed bilateral foot disabilities were related to her active duty service and the Board finds that a new examination and opinion is necessary. Bilateral Ankle Condition The Veteran has asserted her bilateral ankle condition is due at least in part to her bilateral foot conditions. The issue of entitlement to service connection for a bilateral ankle condition is intertwined with the above-remanded issue of entitlement to service connection for a bilateral foot condition. Issues are considered to be inextricably intertwined when a determination on one issue could have a significant impact on the outcome of another. Harris v. Derwinski,1 Vet. App. 180 (1991). Therefore, the Board defers consideration of this issue at this time The matters are REMANDED for the following action: 1. Obtain a medical opinion from an examiner, who has not previously examined the Veteran, with sufficient expertise to address the etiology of the Veteran's claimed vaginal and uterine conditions. The need for a new examination is left to the discretion of the examiner. The examiner should identify all of the Veteran's current vaginal and uterine disorders, including menorrhagia, genital herpes, leiomyomata, and status post-hysterectomy. All pertinent evidence of record must be made available to and reviewed by the examiner. For each condition identified, the examiner must opine whether clear and unmistakable evidence establishes that it pre-existed service. If so, the examiner must identify the evidence and opine whether the condition was clearly and unmistakably not aggravated by the Veteran's active service. Following a review of the relevant records and lay statements, for any condition which did not clearly and unmistakably preexist service or was not clearly and unmistakably aggravated by service, the examiner should state an opinion with respect to whether the Veteran's disability at least as likely as not (a 50 percent probability or greater) originated during her period of active service or is otherwise etiologically related to her active duty service. The examiner must specifically address the following information when formulating their opinions: The Veteran's June 1989 entry examination noting her pelvis and vagina as "normal." September 1991 inservice treatment for cervical polyps and excessive vaginal bleeding due to cervicitis. November 1996 and January 1997 inservice treatment records noting mild gynecological disfiguration, erythema, small cysts and papules. October 2010 VA treatment records noting diagnoses of menorrhagia, leiomyomata and a history of genital herpes as well as cryoablation surgery to decrease excessive bleeding. June 2011 VA examination in which the examiner opined the Veteran's condition pre-existed service and is due to risk factors such as family, age, race, etc. The examiner must provide a complete rationale for all proffered opinions. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. 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 answer as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 2. Afford the Veteran a VA examination by an examiner, who has not previously examined her, with sufficient expertise to address the etiology of the Veteran's claimed bilateral foot disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner. Following a review of the relevant records and lay statements, for each disability diagnosed, the examiner should state an opinion whether the Veteran's foot disability at least as likely as not (a 50 percent probability or greater) originated during her period of active service or is otherwise etiologically related to service. The examiner must specifically address the following information in formulating their opinions: The Veteran's separation examination statements and post-service reports to VA treatment providers documenting the onset of her foot pain after deployment to Saudi Arabia in 1991. September and October 2008 diagnoses of bilateral pes planus and acquired hallux valgus deformity, as well as complaints of chronic bunion pain. November 2008 surgery to correct hallux valgus deformities and July through September 2009 physical therapy for great toe pain. The examiner must provide a complete rationale for all proffered opinions. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. 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 answer as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.