Citation Nr: 22012771 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 13-00 505 DATE: March 7, 2022 REMANDED Entitlement to service connection for a left arm disability is remanded. Entitlement to service connection for anomic aphasia is remanded. Entitlement to service connection for memory loss symptoms is remanded. REASONS FOR REMAND The Veteran served on active duty in the from January 1988 to September 1989 in the United States Air Force, and from April to June 2003 and September to December 2003 in the United States Army. Unfortunately, there has not been substantial compliance with the Board's previous remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The December 2021 opinion is inadequate. 1. Service connection for left arm disability (claimed as pain/paralysis and numbness of left hand/arm with pinched nerve) is remanded. The claim must be remanded because the June 2021 VA opinion obtained on remand is inadequate. The June 2021 peripheral nerve examination included a diagnosis of left ulnar nerve neuropathy, however, the accompanying medical opinion failed to adequately assess the question of secondary aggravation by service-connected disability. The Board specifically notes that the incorrect standard for secondary service connection due to aggravation was used. 2. Service connection for aphasia is remanded. The claim must be remanded again because the December 2021 VA opinion is inadequate because it is internally inconsistent. The December 2021 VA opinion provider said the condition is a "diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology." However, the examiner later ascribed the diagnosis to a known diagnosis; specifically, as a residual of post-service surgeries. The basis of the relating the aphasia the post-service surgeries focused on the "transient" nature of aphasia as a known side effect of anestheia. No opinion has addressed the significance, if any, of the Veteran's assertion that the aphasia has been persistent. 3. Service connection for memory loss is remanded. Finally, because a decision on the remanded issue of entitlement to service connection for aphasia could significantly impact a decision on the issue of entitlement to service connection for memory loss, the issues are inextricably intertwined. A remand of the claim for entitlement to service connection for memory loss is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the right wrist disability. Copies of all pertinent records must be made available to the examiner for review. The examiner must answer the following: whether it is at least as likely as not that the diagnosed right ulnar nerve neuropathy aggravated by (defined as any increase in disability) the service-connected cervical spine and left upper extremity radiculopathy disabilities. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the nature and likely etiology of the Veteran's aphasia. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner must answer the following: Is it at least as likely as not that the diagnosed aphasia is related to the Veteran's service? Why or why not? The examiner must specifically discuss the significance, if any, of the persistent nature of the Veteran's aphasia, as opposed to transient aphasia which prior examiners have noted can be a complication of anesthesia. 3. Confirm that the VA medical opinions provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to service connection for memory loss. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.