Citation Nr: 22019099 Decision Date: 03/31/22 Archive Date: 03/31/22 DOCKET NO. 16-28 000 DATE: March 31, 2022 REMANDED Service connection for rheumatoid arthritis of the sacroiliac joints is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from July 1962 to February 1966 and from March 1971 to June 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This claim was previously before the Board in October 2021 at which time it was remanded for additional development. It has since been returned to the Board for further appellate consideration. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). 1. Service connection for rheumatoid arthritis of the sacroiliac joints is remanded. Although the Board regrets additional delay, additional development is required prior to adjudicating the claim for service connection for rheumatoid arthritis of the sacroiliac joints. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In the October 2021 Board remand, the Board directed the RO to secure an adequate VA opinion. The examiner was instructed to provide an etiology opinion with respect to the claimed condition. Moreover, the Board explained that the lack of documented treatment in service could not serve as the sole basis for a negative finding. Pursuant to the Board's October 2021 remand, the Veteran was afforded a VA examination in December 2021. The examiner noted the following diagnoses: rheumatoid arthritis and degenerative disc disease. The examiner opined it was at least as likely as not that the claimed condition was incurred in or caused by the claimed in-service injury, event, or illness. Although the examiner provided a positive nexus opinion, the rationale was negative. The examiner reasoned that the 1972 separation examination showed no complaints of back pain or a diagnosis of rheumatoid arthritis. The examiner noted that a diagnosis of rheumatoid arthritis was not made until December 1989, which was after service. Therefore, the examiner concluded a nexus cannot be made. In December 2021 VA obtained an addendum opinion from the same examiner. The examiner wrote that box 3A was erroneously marked and box 3B should have been marked. The examiner opined the Veteran's current rheumatoid arthritis of the sacroiliac joints is less likely than not incurred in or caused by service. The examiner did not provide rationale for this opinion. The Board finds the October 2021 VA opinion is inadequate, because the examiner largely relied on the absence of complaint of or a diagnosis of rheumatoid arthritis in the Veteran's STRs. The mere absence of documentation in STRs of a claimed disorder is not, in itself, an adequate basis on which to rest a medical opinion. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Also, the VA examiner impermissibly relied on an absence of documented symptoms during service without explaining why, as a medical matter, the Veteran would have sought treatment or complained of the condition during service, or why an absence of treatment as opposed to symptoms was otherwise medically significant. See McKinney v. McDonald, 28 Vet. App. 15, 30 (2016); Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015); Buczynski v. Shinseki, 24 Vet. App. 221, 223-24 (2011). Moreover, the December 2021 VA addendum opinion is not accompanied by supporting rationale or medical explanation. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). Accordingly, remand is required. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disability on appeal. 2. Following the receipt of any outstanding records, obtain an addendum opinion from a different VA examiner regarding the etiology of rheumatoid arthritis of the sacroiliac joints. The Veteran's entire claims file, to include a copy of this remand, should be provided to the examiner. If an examination is deemed necessary, it shall be provided. Following a complete review of the record, the examiner is asked to provide the following opinion: Whether it is at least as likely as not (50 percent or greater probability) that the rheumatoid arthritis of the sacroiliac joints had onset in or is otherwise related to active service. 3. The examiner SHOULD NOT rely on silence in the medical records unless it can be explained: (a) why the silence in the available records can be taken as proof that the symptom(s) did not occur, including why the fact would have normally been recorded if present, or (b) why the absence of medical records is medically significant. 4. In addressing the above, the examiner must consider and discuss all pertinent medical and lay evidence of record, to include competent, lay assertions as to the nature, onset, and continuity of symptoms. If lay assertions in any regard are discounted, the examiner should clearly state, and explain why. 5. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.