Citation Nr: 22018548 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 13-03 554 DATE: March 29, 2022 REMANDED Entitlement to service connection for a right ankle disability, to include as secondary to a service-connected left ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1974 to July 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In his January 2013 VA Form 9, the Veteran requested a Travel Board hearing. The Veteran withdrew his hearing request in an October 2015 correspondence. There are no additional hearing requests in the record; therefore, the Board deems his request for a hearing withdrawn. See 38 C.F.R. § 20.704 (e). The Board remanded this claim for further evidentiary development in November 2017 and August 2018. The case has returned to the Board for appellate review. Unfortunately, the Board finds an additional remand is warranted to comply with the Board's August 2018 remand. Following the August 2018 remand, the Veteran was afforded another VA examination in August 2019. However, the Board finds the August 2019 VA medical opinion does not substantially comply with the August 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). In its August 2018 remand, the Board directed the VA examiner to consider the Veteran's service treatment records (STRs) reflecting complaints of right heel pain and right ankle pain. A review of the August 2019 opinion illustrates that the examiner did not address either of these matters. Specifically, the August 2019 examiner provided a negative nexus opinion with the rationale that there is no record of a chronic right ankle condition diagnosed while in service or on the separation examination, and no record of ankle pain until over 30 years after the Veteran's military service. Thus, the Board finds that an additional VA opinion is required. See Stegall, 11 Vet. App. at 271. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file all VA treatment records from August 2020 to present. 2. Thereafter, obtain an addendum opinion from a VA examiner of appropriate expertise to ascertain the etiology of the Veteran's right ankle disability. (If it is determined that additional examination is needed, it should be scheduled in accordance with applicable procedures.) The claims file should be made available to and be reviewed by the examiner in conjunction with the examination. Further physical examination is left to the discretion of the examiner. Thereafter, the examiner should address the following: (a.) Offer an opinion as to whether it is at least as likely as not that the Veteran's right ankle disability had causal origins in service or is otherwise related to the Veteran's active-duty service, to include the STRs reflecting complaints of right heel pain and right ankle swelling. (b.) A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above question, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (c.) The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. The AOJ must ensure that the examiner's report complies with this remand and answers the questions presented in the request. The AOJ must also ensure that the examiner documents consideration of the electronic claims file. If the report is insufficient, the AOJ should take corrective action. 4. Readjudicate the Veteran's claim. If the claim remains denied, issue a supplemental statement of the case and allow the Veteran and his representative the opportunity to respond. Then return to the Board for further appellate review. J. Smith Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Frazier, Associate Attorney 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.