Citation Nr: 22016382 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 18-31 430 DATE: March 22, 2022 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. This case was most recently before the Board in October 2021, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denials 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, the Board remanded this case for additional development in October 2021. In the remand, the Board asked that the AOJ obtain an addendum medical opinion from an independent medical expert. The Board specifically requested that the examiner 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" and the extent to which that private report impacted the medical expert's opinion. In December 2021, the AOJ obtained an addendum opinion. However, although the December 2021 opinion noted that all records had been reviewed, it did not substantively discuss in any way the July 2015 opinion from Dr. L.S., or indicate the extent to which, if any, that opinion impacted the medical expert's opinion with respect to whether it was at least as likely as not that the Veteran suffered additional disability as a result of VA treatment. Given the examiner's failure to comply with the Board's remand directives, the case must again be remanded. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Stegall, 11 Vet. App. at 271. These matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from the independent (non-VA) medical expert who reviewed the Veteran's case in December 2021, pursuant to the authority of 38 U.S.C. § 5109. The medical expert 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 the medical expert'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. In rendering the above opinion, the physician MUST specifically consider and discuss the July 2015 medical opinion from Dr. L.S., referenced above. Simply stating that the claims file was reviewed, without further discussion of the July 2015 opinion, is inadequate. A complete medical rationale for all opinions expressed must be provided. 2. 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, review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full (if any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action). The issues on appeal should then 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, 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.