Citation Nr: 1007397 Decision Date: 03/01/10 Archive Date: 03/11/10 DOCKET NO. 07-19 799 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Whether the severance of entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction, as of April 1, 2005, was proper, to include a claim for restoration of service connection for that disability. 2. Whether the severance of entitlement to special monthly compensation based on the loss of use of a creative organ, as of April 1, 2005, was proper, to include a claim for restoration of entitlement to that benefit. 3. Entitlement to service connection for superficial varicosities of the lower extremities, to include as secondary to diabetes mellitus, type II, with erectile dysfunction. 4. Entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction. 5. Entitlement to service connection for nephropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction. 6. Entitlement to service connection for a skin disorder involving both legs, to include as secondary to diabetes mellitus, type II, with erectile dysfunction. 7. Entitlement to service connection for peripheral vascular disease of the lower extremities/arteriosclerosis obliterans, to include as secondary to diabetes mellitus, type II, with erectile dysfunction. REPRESENTATION Appellant represented by: National Veterans Organization of America, Inc. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert J. Burriesci, Associate Counsel INTRODUCTION The Veteran served on active duty from February 1972 to December 1973 and from September 1978 to May 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Board notes that the appellant requested a hearing before a decision review officer (DRO) in connection with the current claims. The DRO hearing was scheduled and subsequently held in October 2004 at the Atlanta RO. The appellant testified at that time and the hearing transcript is of record. The issue of entitlement to service connection for nephropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The evidence does not show that the grant of service connection for diabetes mellitus, type II, with erectile dysfunction was clearly and unmistakably erroneous. 2. The evidence does not show that the grant of entitlement to special monthly compensation based on the loss of use of a creative organ was clearly and unmistakably erroneous. 3. The medical evidence reveals that the Veteran has superficial varicosities of the lower extremities which are proximately due to a service-connected disability. 4. The medical evidence reveals that the Veteran has peripheral neuropathy which is proximately due to a service- connected disability. 5. The medical evidence reveals that the Veteran has a skin disorder involving both legs which is proximately due to a service-connected disability. 6. The medical evidence reveals that the Veteran has peripheral vascular disease of the lower extremities/arteriosclerosis obliterans which is proximately due to a service-connected disability. CONCLUSIONS OF LAW 1. The criteria to sever service connection for the Veteran's diabetes mellitus, type II, with erectile dysfunction have not been met. 38 U.S.C.A. §§ 1110, 5109 (West 2002); 38 C.F.R. §§ 3.105(d), 3.303, 3.310 (2009). 2. The criteria to sever entitlement to special monthly compensation based on the loss of use of a creative organ have not been met. 38 U.S.C.A. §§ 1110, 1131, 5109 (West 2002); 38 C.F.R. §§ 3.105(d), 3.303, 3.310 (2009). 3. Superficial varicosities of the lower extremities are proximately due to or aggravated by a service-connected disability. 38 U.S.C.A. § 1110, 1131 (West 2002); 38 C.F.R. § 3.310 (2009); Allen v. Brown, 7 Vet. App. 439, 448 (1995). 4. Peripheral neuropathy is proximately due to or aggravated by a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.310 (2009); Allen v. Brown, 7 Vet. App. 439, 448 (1995). 5. A skin disorder involving both legs is proximately due to or aggravated by a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.310 (2009); Allen v. Brown, 7 Vet. App. 439, 448 (1995). 6. Peripheral vascular disease of the lower extremities/arteriosclerosis obliterans is proximately due to or aggravated by a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.310 (2009); Allen v. Brown, 7 Vet. App. 439, 448 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). In this case, the Board is granting in full the benefits sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. II. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in line of duty. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. The law also provides that service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Generally, to establish service connection, there must be (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of in- service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus between the current disability and the in-service disease or injury. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that a Veteran seeking disability benefits must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). In addition to the elements of direct service connection, service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); Wallin v. West, 11 Vet. App. 509, 512 (1998). Where a service-connected disability aggravates a non-service-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. Evidence of a temporary flare-up, without more, does not satisfy the level of proof required to establish an increase in disability. Cf. Davis v. Principi, 276 F. 3d 1341, 1346- 47 (Fed. Cir. 2002); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The Board notes that the regulation addressing service connection for disabilities on a secondary basis, 38 C.F.R. § 3.310, was amended in September 2006. See 71 Fed. Reg. 52,744-52,747 (Sept. 7, 2006), effective October 10, 2006. The change was made to conform VA regulations to decisions from the Court, specifically Allen v. Brown, 7 Vet. App. 439 (1995). The prior regulation addressed whether a service- connected disability was the cause of a secondary disability. The Allen decision provides for consideration of whether a service-connected disability aggravates a nonservice- connected disability. The change in regulations includes the holding from Allen in a new section, 38 C.F.R. § 3.310(b). The Court has held that where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The Federal Circuit has also recognized the Board's "authority to discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the Veteran. A. Severance of Service Connection The Veteran seeks restoration of entitlement to service connection for diabetes mellitus, to include as secondary to service-connected residuals of an injury to the left quadriceps, femoris, and restoration of entitlement to special monthly compensation based on the loss of use of a creative organ. On September 11, 2001, the Veteran filed his claim of entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction, to include as secondary to service-connected residuals of an injury to the left quadriceps, femoris. In an April 2003 rating decision, the RO granted service connection for diabetes mellitus, type II, with erectile dysfunction as secondary to service-connected residuals of an injury to the left quadriceps, femoris on the basis that a medical examiner rendered the opinion in a VA medical examination report, dated in February 2003, that the Veteran's diabetes mellitus was related to the Veteran's inability to exercise due to his left quadriceps, femoris injury. The medical evidence of record at the time of the April 2003 RO rating decision included private treatment records from Drs. L.R., C.D.J., D.K., W.J.A., Johnson Family Practice, and Pinnacle Imaging; VA treatment records; and the reports of VA medical examinations, dated in April 1993 and February 2003. The records revealed that the Veteran was diagnosed with diabetes mellitus, type II, and erectile dysfunction. After examination in February 2003, an opinion was rendered stating that the Veteran's injuries were related to the Veteran's service. In a letter dated in December 2002, Dr. C.D.J. stated that the Veteran's diabetes mellitus was not directly caused by the Veteran's left leg disability; however, "it represents a contributing factor to the fact that you are requiring the amount of medication you do because of your inability to exercise as a consequence of [the] leg injury." In a letter dated in June 2002, Dr. W.J.A. stated that the Veteran's diabetes could benefit if the Veteran were able to exercise more. In a letter dated in December 2002, Dr. L.R. stated that "[i]t is also very likely that [the Veteran's] inability to exercise adequately, could certainly have contributed to the progression of his diabetes through the years." In March 2004 the Veteran's claims folder was reviewed by a VA physician. The physician rendered the opinion that "it is unlikely that a closed thigh injury suffered in 1978 could directly cause a patient to develop diabetes mellitus in 2001." However, the examiner further noted that "[i]nactivity secondary to injury related disability would exacerbated all diabetic predispostions, both primary and secondary." In a letter dated in April 2004, Dr. D.D. stated that the Veteran was diagnosed with diabetes mellitus, type II, with a number of complications including peripheral vascular disease and peripheral neuropathy affecting the lower extremities. Dr. D.D. rendered the opinion that these conditions are aggravated by the Veteran's diabetes and are due to the Veteran's diabetic state. In letters dated in May and August 2004, Dr. C.N.B. rendered the opinion that the Veteran's diabetes and hyperlipidemia were secondary to the Veteran's service-connected leg injury due to the inability to exercise adequately. In May 2004 the Veteran's claims folder was reviewed by a VA endocrinologist. The endocrinologist rendered the opinion that the Veterans' diabetes mellitus was not caused by a closed thigh injury. In addition the examiner stated that he could not render an opinion regarding whether the Veteran's thigh injury aggravated the Veteran's diabetes without resort to speculation. However, he indicated that blood sugars and hyperglycemia related complications can be affected by activity and exercise capacity, diet, pharmacological intervention, and subject involvement. In a May 2004 rating decision, the RO proposed to sever service connection for diabetes mellitus, type II, with erectile dysfunction and discontinue entitlement to special monthly compensation based on the loss of use of a creative organ on the basis that the grant of service connection was clearly and unmistakably erroneous. The RO reasoned that the April 2003 grant of entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction was clearly and unmistakably erroneous because it was based upon an inaccurate interpretation of the report of a VA examination dated in February 2003. The RO stated in the rating decision that the February 2003 VA examination report did not associate the Veteran's diabetes mellitus with an inability to exercise due to the Veteran's service-connected left thigh condition. In addition, a VA endocrinologist rendered the opinion in May 2004 that the Veteran's diabetes mellitus was not related to the Veteran's left thigh injury and that he could not render an opinion without resort to speculation that the Veteran's left thigh injury aggravated the Veteran's diabetes mellitus. The RO stated in the rating decision that the severance of entitlement to special monthly compensation based on the loss of use of a creative organ is based upon the severance of service connection for diabetes mellitus. In a June 2004 letter, the RO notified the Veteran of the proposed action and provided the Veteran with a copy of the RO rating decision outlining the detailed reasons for the proposed severance. In a letter dated in August 2004, Dr. C.D.J. indicated that the Veteran's thigh condition rendered the Veteran incapable of taking the level of exercise that would be most beneficial to his diabetes. Dr. C.D.J. also reported that after reviewing the opinion of the VA endocrinologist, the VA endocrinologist was totally in error and that it is more likely than not that the Veteran's diabetes has been made worse and the complications secondary to diabetes have been accelerated as a consequence of the Veteran's inability to exercise. Subsequently, the Veteran was afforded a hearing before a Decision Review Office (DRO) at the Atlanta RO. In RO rating decisions, dated in January 2005 and March 2005, entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction and entitlement to special monthly compensation based on the loss of use of a creative organ were severed effective April 1, 2005. Once service connection has been granted, it can be severed only where the evidence establishes that the grant is clearly and unmistakably erroneous (the burden being on the Government), and only where certain procedural safeguards have been met. Stallworth v. Nicholson, 20 Vet. App. 482, 487 (2006); Daniels v. Gober, 10 Vet. App. 474, 478 (1997). Severance of service connection based on any standard less than that set forth in 38 C.F.R. 3.105(d) is erroneous as a matter of law. Stallworth v. Nicholson, 20 Vet. App. at 488; Graves v. Brown, 6 Vet. App. 166, 170 (1994); see also Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). In Stallworth, the United States Court of Appeals for Veterans Claims (Court) recognized that 38 C.F.R. 3.105(d) contemplates consideration of evidence that post-dates the award of service connection and that VA is not limited to the law and the record that existed at the time of the original decision. Id. at 488; see also Allen v. Nicholson, 21 Vet. App. 54, 59 (2007). In fact, the Court noted that the regulation specifically allows a change in medical diagnosis to serve as a basis for severance. Indeed, in Stallworth, the Court, quoting Venturella v. Gober, 10 Vet. App. 340, 343 (1997), reiterated, "If the Court were to conclude that . . . a service-connection award can be terminated pursuant to § 3.105(d) only on the basis of the law and record as it existed at the time of the award thereof, VA would be placed in the impossible situation of being forever bound to a prior determination regardless of changes in the law or later developments in the factual record." Id. at 488. The Stallworth Court added, "Consequently, the severance decision focuses-not on whether the original decision was clearly erroneous-but on whether the current evidence established that service connection is clearly erroneous." Id. (Emphasis in original). The Court has stated that clear and unmistakable error is a very specific and rare kind of error. It is the kind of error, of fact or of law, that, when called to the attention of reviewers, compels the conclusion, to which reasonable minds could not differ, that the results would be manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). To warrant revision of a decision on the ground of clear and unmistakable error in a severance of service connection case, there must have been an error in the adjudication of the appeal that, had it not been made, would have manifestly changed the outcome, i.e., whether, based on the current evidence of record, a grant of service connection would be clearly and unmistakably erroneous. Stallworth; Allen. In light of the evidence above, the Board finds that there is conflicting evidence regarding whether the Veteran's diabetes mellitus, type II, with erectile dysfunction is related to or permanently aggravated by the Veteran's service-connected left thigh condition, as evidence by statements of Drs. C.N.B., C.D.J., L.R., D.K., and W.J.A. and the VA endocrinologist. The RO severed entitlement to service connection for diabetes mellitus on the basis that the RO erroneously interpreted a VA medical examination report, dated in February 2003, to indicate that the Veteran's diabetes mellitus was related to the Veteran's inability to exercise due to his left quadriceps, femoris injury. The evidence submitted by Drs. C.N.B. C.D.J., L.R., D.K., and W.J.A. prior to and subsequent to the grant of entitlement to service connection reveals opinions associating the Veteran's diabetes mellitus, type II, with the Veteran's inability to exercise. While the opinion of a VA endocrinologist, dated in May 2004, indicates that the Veteran's diabetes mellitus, type II, is not related to the Veteran's inability to exercise due to his service-connected left thigh condition, this does not rise to the kind of error that, when called to the attention of reviewers, compels the conclusion, to which reasonable minds could not differ, that the results would be manifestly different but for the error. Thus, after a careful review of the evidence of record, the Board finds that VA has not met the high evidentiary burden of showing clear and unmistakable error, and thus the severance of service connection for diabetes mellitus, type II, with erectile dysfunction was improper and entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction is restored. As entitlement to special monthly compensation based on the loss of use of a creative organ was severed on the basis that entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction was severed, and this decision restores entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction, entitlement to special monthly compensation based on the loss of use of a creative organ is also restored. B. Superficial Varicosities The Veteran seeks entitlement to service connection for superficial varicosities of the lower extremities. The Veteran contends that his condition is due to or permanently aggravated by his service-connected diabetes mellitus, type II, with erectile dysfunction. The Veteran's service treatment records do not reveal any complaint, diagnosis or treatment for any superficial varicosities of the lower extremities. In a letter dated in December 2003, Dr. D.D. noted that the Veteran had superficial varicosities. Dr. D.D. stated that the Veteran's conditions are, in part, complicated by the Veteran's diabetes mellitus. In light of the evidence, the Board finds that entitlement to service connection for superficial varicosities of the lower extremities, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is warranted. The decision above restores entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction. In December 2003, Dr. D.D. rendered the opinion that the Veteran's superficial varicosities are, in part, complicated by the Veteran's diabetes mellitus condition. As such, the evidence is at least in equipoise that the Veteran's superficial varicosities of the lower extremities are due to or permanently aggravated by the Veteran's service-connected diabetes mellitus and service connection for superficial varicosities is therefore granted. C. Peripheral Neuropathy The Veteran seeks entitlement to service connection for peripheral neuropathy. The Veteran contends that his condition is due to or permanently aggravated by his service- connected diabetes mellitus, type II, with erectile dysfunction. The Veteran's service treatment records do not reveal any complaint, diagnosis or treatment for any peripheral neuropathy. In February 2002 and April 2002 the Veteran was examined by Dr. D.K., a private physician. The physician noted that there was some nerve damage in the thigh as evidence by the Veteran's altered sensation in the skin over the area where the Veteran's muscle rupture occurred. Upon an examination with electromyography the Veteran was noted to be normal. Dr. D.K. did not diagnose the Veteran with any peripheral neuropathy. In VA treatment notes, dated in May 2002, June 2002, and September 2002, upon physical examination the Veteran was note noted to have any neurological conditions. In a private treatment report, dated in May 2002, the Veteran was reported to have undergone a nerve conduction study. After the study, Dr. D.K. noted that the study revealed mild slowing of motor conduction, likely reflecting diabetic neuropathy. In February 2003, the Veteran was afforded a VA Compensation and Pension (C&P) examination regarding unrelated claims. The Veteran reported that he experienced tingling and numbness in his feet. Upon examination the Veteran was noted to have normal motor function of the upper and lower extremities. The Veteran's sensory function was noted to be slightly abnormal in the upper extremities evidenced by slightly diminished sensations on the palmar surface of both hands. However sensation to light touch and pain was within normal limits. The examiner did not diagnose the Veteran with any peripheral neuropathy. In a statement, dated in May 2003, Dr. D.D. noted that the Veteran "suffers from the diabetic complication of peripheral neuropathy of both legs and that the Veteran had been seen and evaluated by neurologist, Dr. D.K." Dr. D.D. reported that the Veteran "had nerve conduction velocity studies which confirmed the presence of slowing of the motor conduction velocities consistent with diabetes mellitus." In another statement, dated in May 2003, Dr. D.D. noted that the Veteran was diagnosed with diabetes mellitus, type II, and diagnosed the Veteran with peripheral neuropathy as a complication of the Veteran's diabetes mellitus. Dr. D.D. noted that the opinion was based upon nerve conduction studies, EMG, and arterial Doppler studies. In a subsequent statement, dated in August 2003, Dr. D.D. again rendered the opinion that the Veteran had peripheral neuropathy as a complication of diabetes mellitus. In a statement dated in July 2003, Dr. D.D. stated that the Veteran's type II diabetes mellitus was complicated by diabetic neuropathy. In a letter dated in December 2003, Dr. D.D. stated that the Veteran has diabetic neuropathy as a complication of diabetes that arose as a result of the Veteran's diabetes mellitus. In a letter dated in April 2004, Dr. D.D. stated that the Veteran has peripheral neuropathy as a complication of the Veteran's diabetes mellitus and that this condition is aggravated by the Veteran's diabetes mellitus. In a statement dated in August 2003, Dr. D.M., a private physician, reported that the Veteran was diagnosed with diabetes mellitus, type II. The physician diagnosed the Veteran with diabetic neuropathy. In May 2004, Dr. D.S., reported that the Veteran has bilateral neuropathy and that the Veteran's diabetes mellitus was a major contributor to his bilateral neuropathy. In May 2004, Dr. C.N.B. rendered the opinion, after reviewing the reports of Dr. D.K. that the Veteran had diabetic neuropathy. In a VA treatment note, dated in August 2003, the Veteran was noted to be diagnosed with diabetic neuropathy. In light of the evidence, the Board finds that entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is warranted. The decision above restores entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction. The evidence reveals that the Veteran's peripheral neuropathy has been diagnosed as diabetic peripheral neuropathy and diabetic neuropathy. In addition, multiple physicians have associated the Veteran's peripheral neuropathy with the Veteran's service-connected diabetes mellitus stating that the condition was due to, contributed to, and/or complicated by the Veteran's diabetes mellitus. As such, entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. D. Skin Disorder The Veteran seeks entitlement to service connection for a skin disorder involving both legs. The Veteran contends that his condition is due to or permanently aggravated by his service-connected diabetes mellitus, type II, with erectile dysfunction. The Veteran's service treatment records do not reveal any complaint, diagnosis or treatment for any skin disorder. In February 2003, the Veteran was afforded a VA C&P examination regarding unrelated claims. The Veteran reported that his diabetes mellitus had not affected his skin. The examiner did not diagnose the Veteran with any skin condition. In a statement submitted by Dr. G.S., dated in June 2003, the Veteran was noted to have classic venous stasis skin changes over both ankles that was significant. Dr. G.S. noted that the symptoms are not reversible. In a letter dated in December 2003, Dr. D.D. noted that the Veteran had extensive brawny edema from the knees down and including the feet and stasis dermatitis changes and that these conditions are complicated in part by the Veteran's diabetes mellitus. In light of the evidence, the Board finds that entitlement to service connection for a skin disorder involving both legs, to include as secondary to diabetes mellitus, type II, with erectile dysfunction is warranted. The decision above restores entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction. The Veteran has been diagnosed with venous stasis skin changes and stasis dermatitis. These changes have been noted to be permanent and Dr. D.D. has rendered the opinion that the condition is complicated by the Veteran's service-connected diabetes mellitus. As such, entitlement to service connection for a skin disorder involving both legs, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. E. Peripheral Vascular Disease of the Lower Extremities/Arteriosclerosis Obliterans The Veteran seeks entitlement to service connection for peripheral vascular disease of the lower extremities/arteriosclerosis obliterans. The Veteran contends that his condition is due to or permanently aggravated by his service-connected diabetes mellitus, type II, with erectile dysfunction. The Veteran's service treatment records do not reveal any complaint, diagnosis or treatment for any peripheral vascular disease of the lower extremities/arteriosclerosis obliterans. In VA treatment notes, dated in May 2002, June 2002, and September 2002, upon physical examination the Veteran was not noted to have any peripheral vascular conditions. In a letter dated in December 2002, Dr. C.D.J., a private physician diagnosed the Veteran with hypertensive vascular disease. The physician noted that the Veteran was encouraged to walk to increase circulation in his lower extremities. However, Dr. C.D.J. did not diagnose the Veteran with any peripheral vascular disease of the lower extremities/arteriosclerosis obliterans nor did Dr. C.D.J. render an opinion associating the Veteran's condition with the Veteran's active service or with any service-connected disability. In a subsequent letter dated in December 2002, Dr. C.D.J. rendered the opinion that limitation imposed by the Veteran's leg pain hindered the Veteran's ability to maintain the exercise that would be necessary to better control his hypertension. However, Dr. C.D.J. did not diagnose the Veteran with any peripheral vascular disease of the lower extremities/arteriosclerosis obliterans. In February 2003, the Veteran was afforded a VA C&P examination regarding unrelated claims. The Veteran reported that his diabetes mellitus had not affected his arteries. The examiner did not diagnose the Veteran with any vascular condition. In a statement, dated in May 2003, Dr. D.D. noted that the Veteran had been recently diagnosed with arterial insufficiency in the lower extremities as evidence by an arterial Doppler performed in March 2002. Dr. D.D. reported that the study showed an ankle brachial index of 0.82 in the right lower extremity and of 1.2 in the left lower extremity. The conclusions of the study were reported to be "evidence of mild tibial vessel occlusal disease, both lower [extremities]. The ankle brachial index is compatible with mild claudication in the right leg and is normal in the left leg." In another statement, dated in May 2003, Dr. D.D. noted that the Veteran was diagnosed with diabetes mellitus, type II, and diagnosed the Veteran with peripheral vascular disease mainly affecting the lower extremities as a complication of the Veteran's diabetes mellitus. Dr. D.D. noted that the opinion was based upon nerve conduction studies, EMG, and arterial Doppler studies. In a subsequent statement, dated in August 2003, Dr. D.D. again rendered the opinion that the Veteran had peripheral vascular disease as a complication of diabetes mellitus. In a statement dated in July 2003, Dr. D.D. stated that the Veteran's type II diabetes mellitus was complicated by peripheral vascular disease of the lower extremities. In a statement dated in August 2003, Dr. D.M., a private physician, reported that the Veteran was diagnosed with diabetes mellitus, type II. The physician further diagnosed the Veteran with peripheral vascular disease as a complication of diabetes mellitus, type II. In a letter dated in December 2003, Dr. D.D. reported that the Veteran has clear and obvious physical findings that support venous insufficiency. Dr. D.D. also reported that the Veteran's peripheral vascular disease has been demonstrated by two separate Doppler studies. In a letter dated in April 2004, Dr. D.D. stated that the Veteran has peripheral vascular disease as a complication of the Veteran's diabetes mellitus and that this condition is aggravated by the Veteran's diabetes mellitus. In another statement, dated in April 2004, Dr. D.D. stated that the Veteran has peripheral neuropathy as a complication of the Veteran's diabetes mellitus and that this condition is aggravated by the Veteran's diabetes mellitus. In May 2004, Dr. D.S., reported that the Veteran had arterial insufficiency and that the Veteran's diabetes mellitus was a major contributor to his arterial insufficiency. Dr. C.N.B., in an opinion letter dated in May 2004, indicated that the Veteran "likely" had diabetic related arterial sclerosis. In light of the evidence, the Board finds that entitlement to service connection for peripheral vascular disease of the lower extremities/arteriosclerosis obliterans, to include as secondary to diabetes mellitus, type II, with erectile dysfunction is warranted. The decision above restores entitlement to service connection for diabetes mellitus, type II, with erectile dysfunction. The Veteran has been diagnosed with peripheral vascular disease as well as diabetic related arterial sclerosis and arterial insufficiency. Drs. D.D. and D.M. have each indicated that the Veteran's peripheral vascular disease is a complication of the Veteran's diabetes mellitus. As such, entitlement to service connection for peripheral vascular disease of the lower extremities/arteriosclerosis obliterans, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. ORDER Severance of service connection for diabetes mellitus, type II, with erectile dysfunction, as of April 1, 2005, was improper, and the appeal for restoration of service connection is granted. Severance of entitlement to special monthly compensation based on the loss of use of a creative organ, as of April 1, 2005, was improper, and the appeal for restoration of service connection is granted. Entitlement to service connection for superficial varicosities of the lower extremities, to include as secondary to service-connected diabetes mellitus, type II, with erectile dysfunction, is granted. Entitlement to service connection for peripheral neuropathy, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. Entitlement to service connection for a skin disorder involving both legs, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. Entitlement to service connection for peripheral vascular disease of the lower extremities/arteriosclerosis obliterans, to include as secondary to diabetes mellitus, type II, with erectile dysfunction, is granted. (CONTINUED ON NEXT PAGE) REMAND The Veteran seeks entitlement to service connection for nephropathy. The Veteran contends that his condition is due to or permanently aggravated by his service-connected diabetes mellitus, type II, with erectile dysfunction. The Veteran's service treatment records do not reveal any complaint, diagnosis or treatment for any nephropathy. A review of the claims folder reveals that the Veteran was granted Social Security Disability Insurance benefits due to his diabetes mellitus, type II, and his peripheral neuropathy. However, the complete records regarding this award of benefits have not been associated with the claims folder and the record contains no indication that any attempt was made to obtain the Veteran's complete Social Security Administration (SSA) record. Because SSA records are potentially relevant to the Board's determination, VA is obliged to attempt to obtain and consider those records. 38 U.S.C.A. § 5103A(c)(3); 38 C.F.R. § 3.159(c)(2); see also Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir., 2009); Voerth v. West, 13 Vet. App. 117, 121 (1999); Baker v. West, 11 Vet. App. 163, 169 (1998) (when VA put on notice of SSA records prior to issuance of final decision, Board must seek to obtain records). Therefore, this claim must be remanded to obtain the Veteran's complete SSA record. Accordingly, the case is REMANDED for the following action: 1. Request, directly from the SSA, complete copies of any determination on a claim for disability benefits from that agency, together with the medical records that served as the basis for any such determination. All attempts to fulfill this development should be documented in the claims file. If the search for these records is negative, that should be noted and the Veteran must be informed in writing. 2. Thereafter, readjudicate the Veteran's claim. If the benefit sought on appeal are not granted in full, the RO should issue the Veteran and his representative a supplemental statement of the case and provide the Veteran an opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ Michael J. Skaltsounis Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs