Citation Nr: 22018035 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-57 793 DATE: March 28, 2022 REMANDED Entitlement to service connection for sickle cell anemia is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1992 to November 1994. This matter comes before the Board of Veterans' Appeals (Board) from a September 2016 rating decision by the Agency of Original Jurisdiction (AOJ). In December 2019, the Board remanded the claim to the AOJ to obtain a new examination. Entitlement to service connection for sickle cell anemia is remanded. The Veteran contends that his sickle cell anemia is related to service. His representative contends that the most recent VA opinion did not address the conditions of the Veteran's service when providing a negative opinion. See September 2021 Appellate Brief. A VA medical opinion was obtained in February 2020. Regarding aggravation of a pre-existing condition, the examiner stated that temporary aggravation is plausible, but there is no evidence of permanent aggravation of the pre-existing Sickle Cell Trait. Additionally, the examiner stated that the current medical literature does not support. The examiner stated that a nexus has not been established. Unlike sickle cell disease, the examiner opined, a serious illness in which patients have two genes that cause the production of abnormal hemoglobin (the substance in red blood cells that helps carry oxygen), individuals with sickle cell trait carry only one defective gene and typically live normal lives. Rarely, the examiner explained, extreme conditions such as severe dehydration and high-intensity physical activity can lead to serious health issues, including sudden death, for individuals with sickle cell trait. The Board regrets the further delay but finds that a remand is necessary in this appeal to afford the Veteran full consideration of his claim. Specifically, the examiner noted that severe dehydration and high-intensity physical activity can lead to sudden death. This result constitutes what the Board would regard as a permanent worsening of the condition. However, the opinion does not address the Veteran's medical history as it relates to service in extreme heat that may cause severe dehydration or high-intensity physical activity. As such, a remand is needed to consider whether the Veteran experienced any such symptoms or environmental conditions during service and, if so, whether they aggravated his sickle cell trait. The matter is REMANDED for the following action: 1. Obtain an additional medical opinion from an appropriate clinician. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the examiner. After the record review, the reviewing clinician is asked to respond to the following: If the Veteran's sickle cell trait is considered a congenital disease, opine whether it was at least as likely as not (a 50 percent or greater probability) aggravated (non-temporary increase in severity) by service and, if so, whether any increase in severity was clearly and unmistakably (undebatable) due to its natural progress. In rendering the opinion above, the examiner should address the Veteran's medical history as it relates to any in-service environmental conditions and symptoms such associated with severe dehydration or high-intensity physical activity. Specifically, the examiner should consider and discuss whether the Veteran experienced any such symptoms, conditions, or activity during service and, if so, whether they aggravated his sickle cell trait. 2. Then, readjudicate the Veteran's claim. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wilson, 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.