Entitlement to service connection for a left knee disability is remanded.

Citation Nr: 26001434 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 16-06 542 DATE: January 30, 2026 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) is remanded. Entitlement to service connection for a bilateral foot condition is remanded. REASONS FOR REMAND The Veteran served in the United States Army from September 1977 to October 1981, with additional periods of National Guard service from November 1981 to July 2005. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a November 2018 Board hearing. The transcript has been associated with the file. On October 21, 2025, a letter was sent to the Veteran advising him that the Veterans Law Judge who had previously presided over his hearing was no longer available to adjudicate his current appeal. The Veteran was informed that he had 30 days from the date of the letter to request a new hearing and that if he did not request such within 30 days, it would be assumed that the Veteran did not want another hearing. On November 5, 2025, the Veteran indicated that he did not want another Board hearing; therefore, the Board will adjudicate the appeal with the record on file. This issue was previously before the Board in May 2019, September 2020, and June 2023. The claims were remanded for further development. That development was completed, and the case has since been returned to the Board for review. As a matter of law, a remand by the Board confers upon the Veteran the right to compliance with the Board's remand order. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). In the June 2023 remand, the Board ordered the RO to first obtain a new memorandum summarizing all INACDUTRA dates beginning in November 1981. In May 2024, the RO obtained a new memorandum detailing all periods of ACDUTRA and INACDUTRA from 1981 to 2005. The RO was then to obtain new VA medical opinions for the Veteran's CTS, foot conditions, and left knee conditions, with the VA examiner opining as to whether the Veteran's conditions had onset in, were otherwise related to active service, or were due to a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. Further, the VA examiner was also to opine whether any of the conditions were caused by an injury during a period of INACDUTRA. The Board finds that there has been substantial compliance with this June 2023 directive. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active-duty service, i.e., full-time duty in the armed forces, while performing ACDUTRA in the Reserves, or from injury incurred or aggravated while performing inactive duty for training (INACDUTRA or IDT) in the Reserves. See 38 U.S.C. §§ 101(2), (22), (24); 38 U.S.C. § 1110; Acciola v. Peake, 22 Vet. App. 320, 324 (2008) (citing Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998); Paulson v. Brown, 7 Vet. App. 466, 470 (1995)). In the absence of such evidence, the period of ACDUTRA or INACDUTRA would not qualify as "active military, naval, or air service," and the appellant would not qualify as a "veteran" by virtue of the ACDUTRA or INACDUTRA alone. 38 U.S.C. § 101 (2), (24); see Acciola, 22 Vet. App. at 324. 1. Entitlement to service connection for a left knee disability is remanded. The Veteran states that he is entitled to service connection for a left knee disability. After a careful review of the record, the Board determines that the matter must be remanded. The reasons follow. In May 2024, the Veteran was afforded a VA examination. The Veteran was diagnosed with a left knee strain and left knee degenerative arthritis. The Veteran reported that the onset of the condition was in 1994 when he was in an accident while serving in the National Guard. He reported initially using a wrap brace and a heating pad for treatment. The Veteran stated that the knee pain has worsened over time. At the time of the VA examination, he complained of constant left knee pain that is worse with activity. He reported taking Tylenol or acetaminophen as needed. The Veteran stated that he has limitations with prolonged sitting, standing, and walking. He has trouble squatting, kneeling, or climbing stairs. The VA examiner opined that the condition was less likely than not the result of service. The VA examiner stated that the Veteran was in ACDUTRA service from September 5, 1977, to October 4, 1981, and INACDUTRA service from March 1993 to February 1994. The VA examiner stated that the Veteran's report of medical history in 1985 and 1999 is silent for the claimed condition. The Veteran's 1994 report of medical history noted right knee surgery in 1993, with an operative note stating right knee EUA, operative anthroscopy, and abrasion chondroplasty. The VA examiner stated that post-service records of 2006 and 2011 indicate evidence of a 1993 chainsaw accident to the left knee. The VA examiner reported a prior VA disability note for left knee strain and degenerative arthritis. The VA examiner stated that although there is evidence of a previous left knee injury caused from a chainsaw accident in the 1990s, there is a lack of documented evidence in chronicity of residual complaints of the left knee from 1990s to present. The VA examiner stated that the Veteran's current left knee symptoms were likely due to age and wear and tear over the years, rather than an injury which occurred in 1993 during ACDUTRA or INACDUTRA. In the VA examiner's aggravation opinion, the VA examiner stated that the Veteran's condition clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression during service. The VA examiner stated that the Veteran was in ACDUTRA service from September 5, 1977 to October 4, 1981 and INACDUTRA service from March 1993 to February 1994. The VA examiner stated that the report of medical history and examination from 1985 and 1999 are silent for the claimed condition. A report of medical history in 1994 noted right knee surgery in 1993, which included operative notes for right knee EUA, operative anthroscopy, and abrasion chondroplasty. Post-service 2006 and 2011 records indicate evidence of a chainsaw accident to the left knee in 1993. The VA examiner reported a prior VA disability note for left knee strain and degenerative arthritis. The VA examiner stated that although there is evidence of a prior left knee injury caused by a chainsaw accident in the 1990s, there is a lack of documented evidence in chronicity of residual complaints of a left knee condition from the 1990s to present. The VA examiner stated that the Veteran's current left knee symptoms are likely due to age and wear and tear over the years, rather than an injury that occurred in 1993 during INACDUTRA. The VA examiner stated that a nexus had not been established as a majority of the knee complaints began years following ACDUTRA service, therefore, the knee condition could not have been aggravated by service. The Board finds the direct and aggravation opinions to be inadequate. Both opinions state the incorrect ACDUTRA and INACDUTRA periods of service for the Veteran. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Additionally, while the VA examiner noted that there was no chronicity of care after the left knee injury from a chainsaw, there is also no evidence that the Veteran's chainsaw injury to his left knee was during a period of ACDUTRA or INACDUTRA, or otherwise. Rather, the Veteran stated that the left knee condition began in 1994 when he was in an accident while with the National Guard. The VA opinion did not address whether that accident could have caused the Veteran's current left knee strain and degenerative arthritis. In July 2024, the VA examiner issued an addendum opinion on the left knee and stated that the condition is less likely than not incurred in or caused by service. The VA examiner explained that the Veteran was on ACDUTRA service from September 5, 1977, to October 4, 1981, and INACDUTRA service from December 1982 to March 2006. The Veteran's report of medical history and examination in 1985 and 1999 is silent for the claimed condition. A 1994 report of medical history noted right knee surgery in 1993, with operative notes stating right knee EUA, operative anthroscopy, and abrasion chondroplasty. Post-service records from 2006 and 2011 indicate evidence of a chainsaw accident to the left knee in 1993 and a prior VA disability note found that the Veteran had left knee strain and degenerative arthritis. The VA examiner stated that although there is evidence of a previous left knee injury caused from a chainsaw accident in the 1990s, there is a lack of documented evidence in chronicity of residual complaints of left knee from the 1990s to present. The VA examiner stated that the Veteran's current knee symptoms are likely due to age and wear and tear over the years, rather than an injury that occurred in 1993 during ACDUTRA or INACDUTRA service periods. The Board finds the July 2024 VA addendum opinion to be inadequate. 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). The Board first notes that the Veteran was on periods of INACDUTRA from December 1982 to March 2005. The VA examiner addressed whether a chainsaw accident to the left knee caused the Veteran's current left knee strain and degenerative arthritis, though it is unclear if the Veteran was in a period of ACDUTRA or INACDUTRA when this injury occurred. However, the July 2024 VA examiner did not address the Veteran's lay statements. In an August 9, 2011, statement, the Veteran stated that he bumped his knee in a 1994 National Guard drill weekend motor vehicle accident. In his November 2018 hearing testimony, the Veteran alleged that his left knee condition was caused by overusing it while being a road guard. Neither of these contentions were addressed as to whether they could be the cause of the Veteran's current left knee strain and degenerative arthritis. As the July 2024 VA examination failed to consider the Veteran's lay statements, the opinion was inadequate. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that a VA examination is inadequate if it does not consider all the relevant evidence of record, including lay statements). 2. Entitlement to service connection for bilateral CTS is remanded. The Veteran states that he is entitled to service connection for CTS. After a careful review of the record, the Board determines that the matter must be remanded. The reasons follow. In May 2024, the Veteran was afforded a VA examination. The Veteran was diagnosed with bilateral carpal tunnel syndrome. The Veteran stated that the condition began in 2003-2004, with the gradual onset of bilateral hand cramping. He stated that his condition worsened over time. The Veteran stated that he eventually developed numbness and tingling in his thumb and wrist area. During the VA examination, the Veteran complained of intermittent symptoms that get worse with activity. The Veteran stated that he wore wrist braces mainly at night or when doing activities like exercising or cutting grass. He previously took Tylenol but is currently using Voltaren gel for his condition. He stated that his wrist and hand pain sometimes prevents him from doing anything. The Veteran stated that he has limitations with hand and wrist movements and repetitive movements. He has trouble cooking and doing household chores. In the VA examiner's direct service opinion, she stated that the Veteran was in ACDUTRA service from September 5, 1977, to October 4, 1981, and INACDUTRA service from March 1993 to February 1994. The VA examiner stated that the Veteran's records indicated evidence of an EMG study that was performed in 2003 which noted a history of upper extremity paresthesia in 1996, after ACUTRA and INACDUTRA service. At the VA examination, the Veteran reported that the condition began in 2003-2004. The VA examiner stated that other post-service records indicated evidence of a carpal tunnel diagnosis in 2006, 2010, 2013, 2015, and on the current examination. The VA examiner referenced the language of a prior June 2021 VA medical opinion which denied a nexus for carpal tunnel syndrome. The prior June 2021 VA opinion stated that the Veteran's active dates of service were September 6, 1977 to October 5, 1981, with verified dates of INACDUTRA service from March 1993 to February 1994. The prior VA examiner noted that there were no other verified dates for INACDUTRA service and stated that that Veteran was diagnosed with bilateral carpal tunnel in April 2003 by an EMG. According to the prior VA examiner, this was the first noted complaint of numbness of the fingers. The prior VA examiner stated that this was not during a period of active-duty service or verified INACDUTRA. The prior VA examiner stated that the Veteran's statements regarding his symptomatology and the perceived cause of his symptoms were noted, but the Veteran was not qualified to ascribe symptoms to a diagnosis or etiology. The prior VA examiner opined that there is no credible evidence that the Veteran's bilateral carpal tunnel syndrome development in 2003 was the result of excess push-ups 25 years earlier. The May 2024 VA examiner stated that the prior VA examination noted a diagnosis of carpal tunnel syndrome in 2019, and it appears from the record that the Veteran's carpal tunnel syndrome began following both ACUTRA and INACDUTRA periods of service. The VA examiner stated that the Veteran's record indicated an onset in 1996, and Veteran reported onset in 2003. Therefore, the VA examiner opined that there was no nexus. In the May 2024 aggravation opinion, the VA examiner stated that the Veteran's carpal tunnel syndrome which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression during service. The VA examiner stated that the Veteran was in ACDUTRA service from September 5, 1977 through October 4, 1981 and INACDUTRA service from March 1993 to February 1994. The VA examiner stated that the record indicated an EMG study was performed in 2003, which noted a history of upper extremity paresthesia in 1996, after ACUTRA and INACDUTRA service. At the VA examination, the Veteran stated that his condition began in 2003-2004, with other post-service records indicating evidence of a carpal tunnel syndrome diagnosis in 2006, 2010, 2013, 2015, and at the current examination. The VA examiner stated that a prior VA examination noted a diagnosis of carpal tunnel syndrome in 2019. Therefore, the VA examiner opined that based on the record, it appeared that the condition began following both ACUTRA and INACDUTRA service. The VA examiner stated that the Veteran's record indicated an onset in 1996, and Veteran reported onset in 2003. The VA examiner opined that a nexus was not established because the condition could not have been aggravated by service if the condition began following service. The Board finds the VA opinions to be inadequate. The VA examiner did not use the correct dates of ACDUTRA and INACDUTRA as outlined in the May 2024 memoandum associated with the Veteran's file. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). In a July 2024 addendum opinion, the VA medical examiner stated that it is at least as likely as not that the Veteran's bilateral carpal tunnel syndrome was incurred in, or caused by, service. The VA examiner stated that the Veteran was in ACDUTRA service from September 5, 1977, to October 4, 1981, and INACDUTRA service December 1982 to March 2006. The VA examiner went on to state that the record indicated an EMG study was performed in 2003 which noted a history of upper extremity paresthesia in 1996. At the VA examination, the Veteran stated that onset was 2003-2004. The VA examiner further stated that other post-service treatment records indicated evidence of carpal tunnel syndrome diagnosis in 2006, 2010, 2013, and 2015, as well as during the current VA examination. The VA examiner stated that per clarification from the VA, the Veteran's INACDUTRA service was December 1982 to March 2006, and pursuant to the Veteran's records, he was diagnosed with bilateral carpal tunnel syndrome by EMG in April 2003. The VA examiner stated this was during a period of active-duty service or verified INACDUTRA. The VA examiner stated that it appears that the Veteran's bilateral carpal tunnel syndrome began during INACDUTRA as records indicate onset in 1996 and Veteran reports onset in 2003, therefore, the VA examiner opined that a nexus had been established. The Board finds that the VA medical opinions, including the July 2024 addendum opinion, were inadequate. 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). A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The VA examiner again misidentified the periods of ACDUTRA and INACDUTRA. In opining that there was a nexus for service connection, the VA examiner stated that the carpal tunnel syndrome diagnosis was made in April 2003 when the Veteran was in INACDUTRA. However, review of the May 2024 memorandum outlining ACDUTRA and INACDUTRA service shows that the Veteran was not on ACDUTRA or INACDUTRA in April 2003. Further, the medical opinion does not discuss whether the condition was caused by a disease or an injury. 3. Entitlement to service connection for a bilateral foot condition is remanded. The Veteran states that he is entitled to service connection for a bilateral foot condition. After a careful review of the record, the Board determines that the matter must be remanded. The reasons follow. In May 2024, the Veteran was afforded a VA examination. The VA examiner diagnosed the Veteran with pes planus, plantar fascitis, right hallux valgus, and degenerative arthritis. The Veteran stated that the condition had its onset in 2000-2001. The onset began with bilateral foot pain from extended training and exercising. The Veteran believes that his foot pain began as a result of training in the boots. The Veteran stated that his symptoms have worsened over time. The Veteran complained of constant bilateral foot pain. To treat his condition, the Veteran stated that he soaks his feet in baths and uses Tylenol and Voltaren gel as needed. The Veteran reports wearing inserts and supports daily and stated that he is unable to run or jump. He stated that he is limited with prolonged standing or walking and needs to rest every 30 minutes. He also experiences difficulty lifting, pushing, and pulling heavy objects. In the VA examiner's direct service connection opinion, the VA examiner stated that the Veteran was in ACDUTRA service Sep 5, 1977 through Oct 4, 1981 and INACDUTRA service from March 1993 through February 1994. Records indicate that pes planus was first diagnosed in 1985 during a report of medical examination. Previous orthopedic records in 2014 also noted evidence of pes planus. At the time of the VA examination, the Veteran stated that the condition began in 2000-2001. The VA examiner noted that prior records indicated a diagnosis of pes planus, plantar fasciitis, hallux valgus right, and degenerative arthritis in 2019. The conditions were also noted on a 2019 X-ray. The VA examiner referenced a previous June 2021 medical opinion which stated that all available medical records were reviewed and pursuant to the Veteran's VA medical records the Veteran's dates of active-duty service were from September 6, 1977 to October 5, 1981. It was noted that there were verified dates of INACDUTRA service from March 1993 to February 1994. The prior VA examiner stated that there were no other listed verified dates of INACDUTRA in the Veteran's record. The prior VA examiner noted that the service treatment records contained complaints of a blister/ingrown toenail in June 1998, but that the condition resolved. The prior opinion went on to state that pes planus was first documented on a physical examination in August 1985, which, pursuant to VA records, was not a period of active-duty service in INACDUTRA. The VA examiner went on to state that the diagnoses of plantar fasciitis bilateral, right hallux valgus, calcaneal spur and bilateral arthritis were all made well after separation in 2019 by X-ray and were unrelated to the noted blister/ingrown toenail in 1998. After discussing this prior VA opinion, the May 2024 VA examiner stated that as noted in that prior opinion, the relevant conditions were diagnosed after ACDUTRA. The VA examiner stated that pursuant to the Veteran's statements, his foot symptoms began in 2000-2001, which is also after the Veteran's INACDUTRA period. The VA examiner opined that the foot conditions began following both ACDUTRA and INACDUTRA as records indicate onset in 1996 and Veteran reports onset in 2003. The VA examiner stated that the conditions began following ACDUTRA in 1985 and became symptomatic following INACDUTRA and opined that the conditions were not related to service. The May 2024 VA examiner also issued an aggravation opinion, in which the VA examiner stated that the Veteran was in ACDUTRA service from September 5, 1977 to October 4, 1981 and INACDUTRA service from March 1993 to February 1994. The VA examiner stated that the Veteran's records indicate that pes planus was first diagnosed in 1985 during a report of medical examination. The VA examiner reported that a previous 2014 orthopedic record also noted evidence of pes planus. At the VA examination, the Veteran stated that his condition began in 2000-2001.The VA examiner noted that prior records indicated a diagnosis of pes planus, plantar fasciitis, hallux valgus right, and degenerative arthritis in 2019. The conditions were also noted to be present in a 2019 X-ray. The VA examiner then referenced the negative nexus opinion from June 2021. The VA examiner stated that as in the previous medical opinion, the condition was diagnosed following ACDUTRA. The VA examiner also stated that pursuant to the Veteran's reports, the conditions began in 2000-2001, which is also after an INACDUTRA period of service. The VA examiner stated that it appears based on the evidence in the record, that the condition began following both ACDUTRA and INACDUTRA service, as records indicate onset in 1996 and Veteran reports onset in 2003. The VA examiner stated that it appears that the condition began following ACDUTRA in 1985 therefore could not have been aggravated by ACDUTRA. The Board finds these May 2024 medical opinions to be inadequate as they fail to consider the correct periods of ACDUTRA and INACDUTRA as outlined in the May 2024 memorandum associated with the file. In July 2024, the VA examiner submitted an addendum opinion, which stated that the Veteran was in ACDUTRA service from September 5, 1977, through October 4, 1981, and was in INADUTRA service from December 1982 to March 2006. The VA examiner stated that the Veteran's records indicate that pes planus was first diagnosed in 1985 during a report of medical examination. The VA examiner also noted that previous 2014 orthopedic records noted evidence of pes planus. The Veteran reported to the VA examiner that the condition began in 2000-2001. The VA examiner stated that prior records indicated diagnosis of pes planus, plantar fasciitis, hallux valgus right, and degenerative arthritis in 2019. These conditions were also noted in a 2019 foot X-ray. The VA examiner again cited to the June 2021 VA opinion, which determined that there was no nexus. The VA examiner stated that foot symptoms began in 2000 to 2001, and that it appears based on the record that the condition began during INACDUTRA as records indicate onset in 1996 and the Veteran reports onset in 2003. Therefore, the VA examiner opined that a nexus had been established. The Board finds that the addendum opinion is also inadequate. The opinion fails to note other periods of the Veteran's ACDUTRA service and notes that the Veteran was in INACDUTRA from December 1982 to March 2006, when the Veteran was in periods of INACDUTRA service between those dates. The VA opinion also states that the Veteran has four foot conditions: pes planus, plantar fasciitis, hallux valgus right, and degenerative arthritis. However, the only condition which occurred during a period of active duty was pes planus. The other conditions appear to have been aggravated during a period of ACDUTRA/INACDUTRA. As the opinion is unclear, a remand is necessary to determine whether service connection is warranted for pes planus based on the ACDUTRA and INACDUTRA dates contained in the May 2024 memorandum associated with the file. The matter is REMANDED for the following action: 1. Obtain an addendum opinion to assist in determining the etiology of any left knee disorder. An examination should be scheduled if deemed necessary. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. a) First, the examiner must opine whether each diagnosed left knee disorder at least as likely as not had onset in, or is otherwise related to active service, or is due to a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. b) Second, the examiner must opine whether each diagnosed left knee disorder at least as likely as not was caused by an injury during a period of INACDUTRA. In providing each of the requested opinions, the VA examiner must consider and address the Veteran's lay statements. Specifically, the opinion should address the August 9, 2011, statement, in which the Veteran stated that he bumped his knee in a 1994 National Guard drill weekend motor vehicle accident. In his November 2018 hearing testimony, the Veteran alleged that his left knee condition was caused by over usage from being a road guard. 2. Obtain an addendum opinion to assist in determining the etiology of the Veteran's bilateral carpal tunnel syndrome. An examination should be scheduled if deemed necessary. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. a) First, the examiner must opine whether each diagnosed bilateral carpal tunnel syndrome is at least as likely as not had onset in, or is otherwise related to active service, or is due to a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. The VA examiner must consider the Veteran's statements at the November 7, 2018 Board hearing that the condition began in basic training. b) Second, the examiner must opine whether each diagnosed bilateral carpal tunnel syndrome is at least as likely as not was caused by an injury during a period of INACDUTRA. The examiner must consider all lay evidence provided and any private medical treatment and determine if any treatment was close in time to any period of ACDUTRA or INACDUTRA service. 3. Obtain an addendum opinion to assist in determining the etiology of pes planus. An examination should be scheduled if deemed necessary. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. a) First, the examiner must opine whether pes planus is at least as likely as not had onset in, or is otherwise related to active service, or is due to a disease or injury incurred or aggravated in the line of duty while performing ACDUTRA. The VA examiner must opine as to when the condition had its onset, and if it was caused or aggravated by INACDUTRA. b) Second, the examiner must opine whether pes planus is at least as likely as not was caused by an injury during a period of INACDUTRA. The examiner must consider all lay evidence provided and any private medical treatment and determine if any treatment was close in time to any period of ACDUTRA or INACDUTRA service. FOR ALL REQUESTED OPINIONS, THE EXAMINER MUST CONSIDER THE APPROPRIATE ACDUTRA AND INACDUTRA DATES CONTAINED IN THE MAY 2024 MEMORANDUM. SEE VBMS ENTRY DOCUMENT TYPE "VA MEMO," RECEIPT DATE 05/13/2024. 4. THE BOARD REQUESTS THAT THE AGENCY OF ORIGINAL JURISDICTION (AOJ) REVIEW THE MEDICAL OPINION AND DETERMINE IF IT IS RESPONSIVE TO THE QUESTIONS ASKED IN THE ABOVE REMAND DIRECTIVE TO AVOID ANOTHER REMAND SHOULD THE MEDICAL OPINION BE NONRESPONSIVE. Prior to returning the case to the Board, the AOJ should ensure compliance with the Board's remand directives by confirming that the examiner's medical opinions are responsive to the questions asked above, to include the examiner addressing the evidence specifically listed in the remand directives and explain how each impacts and informs the etiology opinion provided. 5. Readjudicate the claims with review of all evidence received since the last prior adjudication of the claims. If any benefit sought is not granted, furnish the Veteran and representative, if any, with a SUPPLEMENTAL STATEMENT OF THE CASE and afford an opportunity to respond before the record is returned to the Board for further review. L.M. YASUI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fleming, Shelley M. 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.