Citation Nr: 21032388 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 08-18 088 DATE: May 26, 2021 ORDER Service connection for bilateral varicose veins is granted. A compensable rating prior to March 8, 2018 for hemopneumothorax is denied. A rating of 30 percent, and no higher, from March 8, 2018 to June 10, 2018 for hemopneumothorax is granted. A rating of 10 percent, and no higher, since June 11, 2018 for hemopneumothorax is granted. A rating in excess of 40 percent for residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, is denied. REMANDED Entitlement to a rating in excess of 20 percent for residuals of shell fragment wound to Muscle Group XII of right lower extremity (RLE) is remanded. Entitlement to a rating in excess of 20 percent prior to October 12, 2016 for residuals of paralysis of all radicular nerve groups of right upper extremity (RUE) is remanded. Entitlement to a rating in excess of 40 percent since October 12, 2016 for residuals of paralysis of all radicular nerve groups of RUE is remanded. Entitlement to service connection for right ankle disorder, to include as secondary to service-connected disabilities muscular or neurological disabilities of the upper and lower extremities, is remanded. Entitlement to service connection for left ankle disorder, to include as secondary to service-connected disabilities muscular or neurological disabilities of the upper and lower extremities, is remanded. Entitlement to service connection for an upper back disability, to include as secondary to service-connected muscular or neurological disabilities of the upper and lower extremities, is remanded. FINDINGS OF FACT 1. The Veteran's current diagnosis of bilateral varicose veins is as likely as not attributable to an in-service occurrence. 2. For the rating period prior to March 8, 2018, the Veteran's service-connected hemopneumothorax was not manifested by at least Forced Expiratory Volume in one second (FEV-1) of 71- to 80-percent predicted, or; FEV-1 to Forced Vital Capacity (FEV-1/FVC) of 71 to 80 percent, or; Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)) 66- to 80-percent predicted. 3. For the rating period from March 8, 2018 to June 10, 2018, the Veteran's service-connected hemopneumothorax was manifested, at worst, by post-bronchodilator FEV-1 of 65 percent predicted. 4. For the rating period since June 11, 2018, the Veteran's service-connected hemopneumothorax has been manifested, at worst, by post-bronchodilator FEV-1/FVC of 79 percent. 5. For the entire rating period, the Veteran's service-connected residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, has been assigned at 40 percent, the maximum rating authorized for the major extremity, under Diagnostic Code 5303. CONCLUSIONS OF LAW 1. With resolution of reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for bilateral varicose veins have been satisfied. 38 U.S.C. §§ 1110, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). 2. The criteria for entitlement to a compensable rating prior to March 8, 2018 for hemopneumothorax have not been met. 38 U.S.C. §§ 1155, 5107, 5110(a); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.97, Diagnostic Code 6843 (2020). 3. The criteria for entitlement to a rating of 30 percent, and no higher, from March 8, 2018 to June 10, 2018 for hemopneumothorax have been met. 38 U.S.C. §§ 1155, 5107, 5110(a); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.97, Diagnostic Code 6843. 4. The criteria for entitlement to a rating of 10 percent, and no higher, since June 11, 2018 for hemopneumothorax have not been met. 38 U.S.C. §§ 1155, 5107, 5110(a); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.97, Diagnostic Code 6843. 5. There is no legal basis for the assignment of a rating in excess of 40 percent for residuals of shell fragment wound to Muscle Group III, with fracture of right humerus. 38 C.F.R. § 4.73, Diagnostic Code 5303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1966 to September 1970. His awards and decorations include the Bronze Star medal with V Device, Purple Heart, and the Combat Infantryman Badge. In June 2012, June 2014, March 2016, and August 2017, the issues of entitlement to service connection for bilateral varicose veins, bilateral ankle disorder, and an upper back disability, as well as entitlement to higher ratings for residuals of paralysis of all radicular nerve groups of RUE, residual of shell fragment wound to Muscle Group XII of RLE, and residuals of shell fragment wound to Muscle Group III, with fracture of right humerus were remanded for additional evidentiary development and has been returned ot the Board for appellate review. In August 2017, the issue of entitlement to a compensable rating for hemopneumothorax was remanded for additional evidentiary development and there was substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Specifically, the Veteran was requested in a September 2017 notice letter to complete and return VA Form 21-4142 and VA Form 21-4142a in order for VA to contact and request any pertinent private treatment records. As of this date, the Veteran has yet to respond to this request. VA treatment records dated from June 2004 to November 2009 and from March 2016 to May 2018 were obtained and associated with the record. The Veteran was provided VA examinations for respiratory conditions in February 2018 and June 2018. The examinations were adequate because they described the Veteran's hemopneumothorax disability in detail sufficient to allow the Board to make a fully informed determination. A pulmonary function test (PFT) was conducted as part of the examination. Additionally, the issue was readjudicated in a February 2019 SSOC. This issue has been returned ot the Board for appellate review. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist with regards to the issues discussed below on the merits. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Entitlement to service connection for bilateral varicose veins Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. § 1110. In a December 2005 VA Form 21-4138, the Veteran requested service connection for blood problems. In the January 2007 VA rating decision on appeal, the agency of original jurisdiction (AOJ) recharacterized this claim as service connection for varicose veins and spider veins. During the appeal period, the Veteran has been diagnosed with the following diagnoses in VA examination reports for artery and vein conditions: varicose veins and spider veins on lower legs in August 2006, varicose veins in bilateral lower legs in July 2012, and varicose veins in bilateral lower extremities in February 2018 and June 2018. As a result, the Board finds the element of a current disability has been met in this case. Next, following the February 2018 VA examination, the VA examiner explained the following in an April 2018 VA medical opinion: One of the risk factors for varicose veins is prolonged standing. Servicemen have jobs that involve standing for long hours. It is well known that varicose veins can develop during in[-]service secondary to standing for long periods of time. . . . It is at least as likely as not the prolonged standing while in service . . . put him at risk for developing varicose veins. The Board finds this opinion was based on an accurate factual history and there is no probative contrary medical opinion of record that included consideration of the Veteran's in-service prolonged standing. As a result, the Board finds the element of an in-service occurrence, consistent with his combat service and military occupational specialty (MOS) as infantry operations and intelligence specialist, has been met in this case. See 38 U.S.C. § 1154(b). The Board also finds the element of a nexus between the Veteran's bilateral varicose veins and his in-service occurrence has been met in this case. For the reasons and bases discussed above and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted for bilateral varicose veins on a direct basis. See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as for the service-connected hemopneumothorax and residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, in this case, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. 38 C.F.R. § 4.2; Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. 2. Entitlement to a compensable rating for hemopneumothorax In a June 1971 VA rating decision, service connection for hemopneumothorax was granted and assigned a noncompensable (0 percent) disability rating effective from September 30, 1970 (date following separation from active service). See 38 C.F.R. § 4.97, Diagnostic Code 6843. On April 20, 2004, the Veteran's request for an increased rating for the service-connected right lung disability was received. In the January 2005 VA rating decision on appeal, the AOJ continued the noncompensable rating for service-connected hemopneumothorax and granted service connection for residual scars from shell fragment wounds, to include on the right lateral chest and right flank, assigned at 10 percent disabling effective from April 20, 2004. In the June 2009 VA rating decision, the AOJ increased the disability rating for service-connected residual scars to 20 percent for painful scar effective from October 23, 2008, and noted that the Veteran's intermittent pain for service-connected hemopneumothorax is currently compensated based on the separately service-connected painful scar. The Board considers whether a compensable rating for hemopneumothorax is warranted at any time since or within one year prior to the date of claim on April 20, 2004. Pursuant to the General Rating Formula for Restrictive Lung Disease (Diagnostic Codes 6840 through 6845): A 10 percent rating is assigned for FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted; A 30 percent rating is assigned for FEV-1 of 56- to 70-percent predicted, or; FEV-1/FVC of 56 to 70 percent, or; DLCO (SB) 56- to 65-percent predicted; A 60 percent rating is assigned for FEV-1 of 40- to 55-percent predicted, or; FEV-1/FVC of 40 to 55 percent, or; DLCO (SB) of 40- to 55-percent predicted, or; maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit); A 100 percent rating is assigned for FEV-1 less than 40 percent of predicted value, or; the ratio of FEV-1/FVC less than 40 percent, or; DLCO (SB) less than 40-percent predicted, or; maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or; cor pulmonale (right heart failure), or; right ventricular hypertrophy, or; pulmonary hypertension (shown by Echo or cardiac catheterization), or; episode(s) of acute respiratory failure, or; requires outpatient oxygen therapy; or rate primary disorder. 38 C.F.R. § 4.97. A. Noncompensable rating prior to March 8, 2018 At the September 8, 2004 VA examination for respiratory conditions, the Veteran reported having pleuritic right chest pain after exercise and surprised by having the following in the past few years: right sided pleuritic chest pain and dyspnea on exertion (DOE) after relatively mild exertion, such as climbing one flight of stairs and carrying groceries/supplies from the car to the house. He reported his inability to run fast without DOE or power walk/fast walk for more than a half mile before precipitating right sided pleuritic chest pain. He also denied the following symptoms: hemoptysis, fever, chills, orthopnea, paroxysmal nocturnal dyspnea (PND), or dyspnea/pain at rest. Following the evaluation, the VA examiner rendered the following impression: status post right hemopneumothorax status post closed thoracotomy right chest with secondary chronic elevated R hemidiaphragm and symptomatic dyspnea, functionally limited. Review of the October 2004 addendum VA examination report shows the Veteran's pulmonary function test (PFT) results on October 6, 2004 revealed the following pre-bronchodilator results: FEV-1 of 85-percent predicted and FEV/FVC of 87 percent. The VA examiner concluded these results were normal, post-bronchodilator test not indicated, the Veteran reported too much pain to inhale deep enough for the diffusion test, and there were no findings of cor pulmonale, pulmonary hypertension, right ventricular hypertrophy, or a history of respiratory failure. The Board notes that if the DLCO (SB) test is not of record, to evaluate based on alternative criteria as long as the examiner states why the test would not be useful or valid in a particular case, as the examiner did in this case. See 38 C.F.R. § 4.96(d)(2). Additionally, post-bronchodilator studies are required when PFTs are done for disability evaluation purposes except when the results of pre-bronchodilator PFTs are normal, as in this case. See 38 C.F.R. § 4.96(d)(4). Review of VA treatment records dated during the appeal prior to March 8, 2018 shows no change in the previous PFT results on October 12, 2004 assessments of the Veteran's respiratory and pulmonary systems. In January 2005, review of his respiratory system noted denial of any cough, congestion, wheezing or shortness of breath. In November 2005, review of his respiratory system revealed positive symptoms for dyspnea and DOE but negative for coughing and wheezing. In January 2008, review of his pulmonary system revealed no cough or congestion. At the January 2009 VA examination for general medical conditions, the Veteran reported symptoms of intermittent cough, slight shortness of breath, intermittent right subcostal pain, and intermittent pain with inspiration and expiration and with postural changes. He also denied any symptoms of wheezing, hemoptysis and use of medication for breathing. Review of the Veteran's pulmonary system revealed no deficits and clinical evaluation of the lungs were equal and clear. In March 2009 he denied wheezing but stated that he had DOE. In September 2009, he reported right side chest wall pain when sitting and dyspnea with "little effort or exertion." In April 2010 his lungs were clear to auscultation but with limited air distribution. He denied chest pain and dyspnea. In November 2010, his lungs were clear to auscultation with full air distribution. He continued to deny chest pain and dyspnea. Additionally, at a January 2015 routine appointment, he reported that he had "some right sided chest pain." A review of his respiratory system noted negative findings for shortness of breath (SOB), cough, wheeze, DOE, and hemoptysis. An October 2015 review of symptoms noted no SOB, cough, wheezing, DOE, or hemoptysis. His lungs were clear to auscultation with full air distribution. In March 2016, he denied chest pain and SOB. His lungs were clear to auscultation with limited air distribution. Before his March 8, 2018 VA examination his symptoms remained consistent. He had right-sided chest pain and occasional DOE on exertion. Sometimes his lungs, while clear to auscultation, had limited air distribution. He did not assert that his disability had increased in severity. These are the same symptoms he reported at his September 2004 VA examination: right chest pain and DOE after "relatively mild exertion." After a review of the evidence discussed above prior to March 8, 2018, the Board finds that the Veteran's service-connected hemopneumothorax was not manifested by at least FEV-1 of 71- to 80-percent predicted, or; FEV-1/FVC of 71 to 80 percent, or; DLCO (SB) 66- to 80-percent predicted. As a result, a compensable rating is denied prior to March 8, 2018 for service-connected hemopneumothorax. See 38 C.F.R. § 4.97, Diagnostic Code 6843. B. 30 percent rating since March 8, 2018 to June 10, 2018 After a review of the evidentiary record from March 8, 2018 to June 10, 2018, the Board finds that the Veteran's service-connected hemopneumothorax was manifested, at worst, by post-bronchodilator FEV-1 of 65 percent predicted, as noted by PFT results on March 8, 2018 noted in the February VA examination report for respiratory conditions. The VA examiner indicated that that DLCO (SB) testing was not indicated in Veteran's particular case, hence those results were not of record. See 38 C.F.R. § 4.96(d)(2). Additionally, the post-bronchodilator results were not poorer than the pre-bronchodilator results, hence the post-bronchodilator results are to be used for rating purposes. See id. at (d)(5). Review of VA treatment records during the appeal period are silent for PFT results or show any worsening of the Veteran's respiratory or pulmonary systems. As a result, a rating of 30 percent, and no higher, is warranted during this appeal period for service-connected hemopneumothorax. See 38 C.F.R. § 4.97, Diagnostic Code 6843. C. 10 percent rating since June 11, 2018 After a review of the evidentiary record since June 11, 2018, the Board finds that the Veteran's service-connected hemopneumothorax has been manifested, at worst, by post-bronchodilator FEV-1/FVC of 79 percent, as noted by PFT results on June 11, 2018 noted in the June 2018 VA examination report for respiratory conditions. The VA examiner indicated that that DLCO (SB) testing was not indicated in Veteran's particular case, hence those results were not of record. See 38 C.F.R. § 4.96(d)(2). Additionally, the post-bronchodilator results were not poorer than the pre-bronchodilator results, hence the post-bronchodilator results are to be used for rating purposes. See id. at (d)(5). There are also no VA treatment records dated during this appeal period. As a result, a rating of 10 percent, and no higher, is warranted for service-connected hemopneumothorax beginning June 11, 2018. See 38 C.F.R. § 4.97, Diagnostic Code 6843. The Board has considered the Veteran's reported history of symptomatology related to the service-connected hemopneumothorax. He is competent to report such symptoms and observations because this requires only personal knowledge as it comes through one's senses. Layno v. Brown, 6 Vet. App. 465, 470 (1994). His credible descriptions of his observable symptoms are not more closely described by the next-higher rating criteria of 60 percent at any time during the entire appeal period from March 8, 2018 to June 10, 2018 or by the next-higher rating criteria of 30 percent at any time during the entire appeal period since June 11, 2018. The Board has also considered the possibility of staged ratings and finds that the scheduler ratings for the service-connected disability on appeal have been in effect for appropriate periods on appeal. Accordingly, further staged ratings are inapplicable. Hart v. Mansfield, 21 Vet. App. 505 (2007). 3. Entitlement to a rating in excess of 40 percent for residuals of shell fragment wound to Muscle Group III, with fracture of right humerus In a February 1971 VA rating decision, service connection for residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, was granted. In a June 1971 VA rating decision, the Veteran was assigned a 40 percent disability rating effective from September 30, 1970 (date following separation from active service). See 38 C.F.R. § 4.73, Diagnostic Code 5303. On December 7, 2005, the Veteran's report of worsening symptoms of this service-connected disability was obtained and associated with the record. The Board considers whether a rating in excess of 40 percent for residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, is warranted at any time since or within one year prior to the date of claim on December 7, 2005. Diagnostic Code 5303 provides evaluations for a disability of Muscle Group III. The function of these muscles are as follows: elevation and abduction of arm to level of shoulder; act with 1 and 2 of Group II in forward and backward swing of arm. The muscle group includes intrinsic muscles of shoulder girdle: (1) Pectoralis major I (clavicular); (2) deltoid. 38 C.F.R. § 4.73. A severe injury warrants a 40 percent rating, the maximum available, for the dominant extremity. Id. In this case, review of the evidentiary shows the Veteran is right-handed, as noted in the January 2009, July 2012, July 2016, February 2017, February 2018, and June 2018 VA examination reports as well as in VA treatment records. As such, the Board finds that the Veteran's service-connected residuals of shell fragment wound to Muscle Group III, with fracture of right humerus has been assigned the maximum schedular rating available for Muscle Group III of the dominant extremity, and there is no legal basis upon which to award a higher schedular evaluation for this disability. As a result, a rating in excess of 40 percent is denied for the service-connected residuals of shell fragment wound to Muscle Group III, with fracture of right humerus. See 38 C.F.R. § 4.73, Diagnostic Code 5303. Review of the evidentiary record does not reflect that there are any other musculoskeletal disorders or muscle injuries of the right humerus that the Veteran's residuals of shell fragment wound to Muscle Group III, with fracture of right humerus are more properly rated under another Diagnostic Code. Accordingly, an increased evaluation under alternate Diagnostic Codes is not warranted in this case. Lastly, pursuant to the Veteran's assertions during the course of the appeal, the Board notes that the issue of entitlement to service connection for a blood condition, claimed as a bluish patch on right hand, was denied on the merits in the June 2014 Board decision. There is no indication of record that the Veteran has submitted a formal request to reopen this previously denied claim. As a result, consideration regarding those reported symptoms as associated with his service-connected residuals of shell fragment wound to Muscle Group III, with fracture of right humerus, is not currently on appeal and will not be discussed at this time. REASONS FOR REMAND 1. Entitlement to a rating in excess of 20 percent for residuals of shell fragment wound to Muscle Group XII of RLE In a February 1971 VA rating decision, service connection for residuals of shell fragment wounds to the RLE was granted and assigned at 10 percent disabling effective from September 30, 1970 (the date following separation from active service). See 38 C.F.R. § 4.73, Diagnostic Code 5312. On December 7, 2005, the Veteran's report of worsening symptoms of this service-connected disability was obtained and associated with the record. In the January 2007 VA rating decision on appeal, the AOJ increased the disability rating for service-connected residuals of shell fragment wound to Muscle Group XII of RLE to 20 percent disabling effective from December 7, 2005. Id. The Board considers whether a rating in excess of 20 percent for residuals of shell fragment wound to Muscle Group XII of RLE is warranted at any time since or within one year prior to the date of claim on December 7, 2005. Pursuant to the August 2017 remand directives, the Veteran underwent a underwent a VA examination for muscle injuries in February 2018 and VA examinations for knee and lower leg conditions and for muscle injuries in June 2018. In February 2018, the VA examiner affirmed the Veteran's injury to a muscle group of the foot or leg, specifically Muscle Group XII (anterior muscles of the leg) and marked "no" for any present injury to a muscle group of the pelvic girdle and thigh (Muscle Groups XIII through XVIII, including the knee). Upon clinical evaluation, the Veteran demonstrated consistent weakness and occasional fatigue-pain, both on the right foot affecting Muscle Group XI. In June 2018, the VA examiner also affirmed the Veteran's injury to a muscle group of the foot or leg, specifically Muscle Group XII (anterior muscles of the leg) and marked "no" for any present injury to a muscle group of the pelvic girdle and thigh (Muscle Groups XIII through XVIII, including the knee). Upon clinical evaluation, the Veteran demonstrated consistent lowered threshold fatigue and consistent fatigue-pain, both on the right side affecting Muscle Group XII. Pursuant to the rating criteria under Diagnostic Code 5312 for this service-connected disability on appeal, consideration of the Veteran's dorsiflexion, extension of toes, and stabilization of arch is warranted. After review of the evidentiary record, including the most recent VA examination reports in 2018 for this claim on appeal, the Board finds that additional examination(s) is needed, particularly of the Veteran's right foot/toes, in order to properly adjudicate this claim on appeal. 2. Entitlement to a rating in excess of 20 percent prior to October 12, 2016 for residuals of paralysis of all radicular nerve groups of the RUE 3. Entitlement to a rating in excess of 40 percent since October 12, 2016 for residuals of paralysis of all radicular nerve groups of the RUE In a February 1971 VA rating decision, service connection for residuals of incomplete paralysis of the right radial nerve was granted and assigned at 10 percent disabling effective from September 30, 1970 (the date following separation from active service). See 38 C.F.R. § 4.124A, Diagnostic Code 8514. On December 7, 2005, the Veteran's report of worsening symptoms of this service-connected disability was obtained and associated with the record. In the January 2007 VA rating decision on appeal, the AOJ increased the disability rating for service-connected residuals of paralysis of all radicular nerve groups of the RUE to 20 percent disabling effective from December 7, 2005. Id. In the May 2017 VA rating decision, the AOJ also assigned the service-connected residuals of paralysis of all radicular nerve groups of the RUE a 40 percent disability rating effective from October 12, 2016. Id. at Diagnostic Code 8513. Since the 20 and 40 percent disability ratings are not the maximum ratings available prior to October 12, 2016 or thereafter, the issue has been characterized accordingly. See AB v. Brown, 6 Vet. App. 35 (1993). The Board considers whether a rating in excess of 20 percent from December 7, 2004 (includes one year prior to the date of claim) to October 11, 2016 for residuals of paralysis of all radicular nerve groups of the RUE is warranted in this case under Diagnostic Code 8514. See 38 C.F.R. § 4.124A. The Board also considers whether a rating in excess of 40 percent since October 12, 2016 for residuals of paralysis of all radicular nerve groups of the RUE is warranted in this case under Diagnostic Code 8513. Id. Since these issues were last remanded in August 2017, the requested additional evidentiary development to ascertain the severity of the Veteran's service- connected residuals of paralysis of all radicular nerve groups of the RUE has not been conducted. In its remand, the Board noted that the July 2016 and February 2017 examinations included inconsistent and conflicting findings. Review of the record shows this service-connected disability was last evaluated by a VA examiner in February 2017, and as noted in the August 2017 Board remand, that VA examination report is inadequate to properly adjudicate the claim at this time. "[A] remand by... the Board confers on the veteran or other claimant, as a matter of law, a right to compliance with the remand orders." Stegall, 11 Vet. App. at 271. As such, compliance with the terms of the August 2017 remand is necessary prior to appellate review, and if not, "the Board itself errs in failing to ensure compliance." Id. 4. Entitlement to service connection for right ankle disorder, to include as secondary to service-connected disabilities muscular or neurological disabilities of the upper and lower extremities 5. Entitlement to service connection for left ankle disorder, to include as secondary to service-connected disabilities muscular or neurological disabilities of the upper and lower extremities Pursuant to the August 2017 Board remand, the Veteran was afforded VA examinations for ankle conditions in February 2018 and June 2018, as well as VA medical opinions for the Veteran's ankle disorders in April 2018 and June 2018. While the April 2018 VA medical opinion addressed the Veteran's documented in-service injuries in 1969, a medical opinion regarding a nexus between the Veteran's in-service parachute jumps (evidenced by his DD Form 214 showing receipt of the parachute badge and completion of basic airborne training) and his current right ankle disorder (degenerative joint disease (DJD) and sprain) and left ankle disorder (pain with functional impairment and sprain) during the appeal period has not yet been addressed. Additionally, while the June 2018 VA opinion addressed this claim on a secondary basis, the rationale provided was based solely on the absence of a current disability. As a result, an addendum VA medical opinion is needed to properly adjudicate this claim on direct and secondary bases. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. 6. Entitlement to service connection for an upper back disability, to include as secondary to service-connected muscular or neurological disabilities of the upper and lower extremities Pursuant to the August 2017 Board remand, the Veteran was afforded VA examinations for back conditions in February 2018 and June 2018, as well as VA medical opinions for the Veteran's upper back disability in April 2018 and June 2018. While the April 2018 VA medical opinion addressed the Veteran's documented in-service injuries in 1969, a medical opinion regarding a nexus between the Veteran's in-service parachute jumps (evidenced by his DD Form 214 showing receipt of the parachute badge and completion of basic airborne training) and his current upper back disability (diagnosed as lumbosacral strain, intervertebral disc syndrome (IVDS), and spinal fusion) during the appeal period has not yet been addressed. Additionally, while the June 2018 VA opinion addressed this claim on a secondary basis, the rationale provided for causation was based solely on the absence of medical evidence to support a link, and the rationale provided for aggravation was based on the wrong evidentiary standard. As a result, an addendum VA medical opinion is needed to properly adjudicate this claim on direct and secondary bases. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. The matters are REMANDED for the following actions: 1. Schedule the Veteran for examination(s), including of the foot/toes, with appropriate clinician(s) to determine the current severity of his service-connected residuals of shell fragment wound to Muscle Group XII of RLE. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must provide all findings, along with a complete rationale for any opinions provided. 2. Schedule the Veteran for examination(s) with appropriate clinician(s) to determine the current severity of his service-connected residuals of paralysis of all radicular nerve groups of the RUE. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner must provide all findings, along with a complete rationale for any opinions provided. 3. Provide the Veteran's claims file to an appropriate clinician to provide an opinion regarding the Veteran's bilateral ankle disorder. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner's attention to the following: Review of the Veteran's DD Form 214 documents his receipt of the parachute badge and completion of basic airborne training The examiner is advised that pain plus functional impairment is considered a disability for VA purposes, even if no diagnosable condition is present. The examiner must opine as to the following for the right ankle disorder: (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right ankle disorder (diagnosed as DJD and sprain, even if since resolved) (i) is related to an incident of service, to include consideration of parachute jumps or (ii) if symptoms of arthritis began within one year after discharge from active service. (b.) Whether it is at least as likely as not that the Veteran's right ankle disorder was proximately due to or the result of his service-connected muscular or neurological disabilities of the upper and lower extremities. (c.) Whether it is at least as likely as not that the Veteran's right ankle disorder was aggravated beyond its natural progression by his service-connected muscular or neurological disabilities of the upper and lower extremities. The examiner must opine as to the following for the left ankle disorder: (d.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left ankle disorder (diagnosed as pain with functional impairment and sprain, even if since resolved) is related to an incident of service, to include consideration of parachute jumps. (e.) Whether it is at least as likely as not that the Veteran's left ankle disorder was proximately due to or the result of his service-connected muscular or neurological disabilities of the upper and lower extremities. (f.) Whether it is at least as likely as not that the Veteran's left ankle disorder was aggravated beyond its natural progression by his service-connected muscular or neurological disabilities of the upper and lower extremities. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 4. Provide the Veteran's claims file to an appropriate clinician to provide an opinion regarding the Veteran's upper back disability. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner's attention to the following: Review of the Veteran's DD Form 214 documents his receipt of the parachute badge and completion of basic airborne training The examiner must opine as to the following: (a.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's upper back disability (diagnosed as lumbosacral strain, IVDS, spinal fusion, even if since resolved) is related to an incident of service, to include consideration of parachute jumps. (b.) Whether it is at least as likely as not that the Veteran's upper back disability was proximately due to or the result of his service-connected muscular or neurological disabilities of the upper and lower extremities. (c.) Whether it is at least as likely as not that the Veteran's upper back disability was aggravated beyond its natural progression by his service-connected muscular or neurological disabilities of the upper and lower extremities. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. Then, review all examination reports and medical opinions provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. (Continued on the next page) 6. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Carter, 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.