Citation Nr: 18146321 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-23 497 DATE: October 31, 2018 REMANDED 1. Service connection for peripheral vascular disease (PVD) is remanded. 2. Service connection for residuals of a right foot amputation is remanded. 3. Service connection for a left knee total replacement is remanded. 4. A total disability rating based on individual unemployability (TDIU) is remanded.   REASONS FOR REMAND The Veteran served on active duty from January 1966 to February 1968. The case is on appeal from a February 2016 rating decision. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Entitlement to service connection for PVD is remanded. 2. Entitlement to service connection for residuals of a right foot amputation is remanded. 3. Entitlement to service connection for a left knee total replacement is remanded. The Veteran contends that he has PVD that is caused or aggravated by his service-connected diabetes. In addition, he contends that his diabetes or his PVD caused or aggravated his right foot condition resulting in amputation and residual disability. He further contends that his right foot disability caused or aggravated his left knee resulting in the need for a total replacement. The Veteran’s private treatment records show that he had surgery for an abdominal aortic resection in 2014 that resulted in a right foot embolization. A treatment record during this time noted a diagnosis of PVD. The Veteran subsequently had the top half of his right foot amputated. He was afforded an examination in regard to these claims in January 2016. The examiner did not find that the Veteran has been diagnosed with PVD and or that his right foot condition was caused by diabetes. Subsequently, another medical opinion was obtained in December 2016. The examiner reported that the Veteran is at risk for PVD, but found that the evidence is ambiguous as to whether he has such condition. However, the examiner did not reach a conclusion in regard to whether a PVD diagnosis is appropriate. In fact, the VA examiner stated that “It would be interesting to review that private documentation and see why his private provider states that in the 2012 timeframe, and why he placed that into the record.” The Board notes that there are private medical records in the file from the 2012 timeframe. It is not clear if the VA examiner missed those records or was referring to different records. To this extent, it must be clear that the examiner has indeed considered “all procurable and assembled data,” by obtaining all tests and records that might reasonably illuminate the medical analysis. When the record leaves this issue in doubt, it is the Board’s duty to remand for further development. Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). The Board accordingly finds that another examination and opinions should be obtained in regard to the Veteran’s service connection claims. Furthermore, on remand any further private medical records and all updated VA treatment records should be associated with the file. 4. Entitlement to a TDIU The Veteran contends that he is unable to work due to his service-connected conditions. In this regard, in an October 2015 correspondence, he reported that his service-connected tinnitus affects his ability to concentrate, and that he has posttraumatic stress disorder (PTSD) due to his service. He also stated that his service-connected diabetes mellitus, type 2, has resulted in amputation of half of his right foot and that his right foot amputation resulted in a need to have his left knee replaced. The Veteran further stated that his right foot and left knee conditions prevent him from working in his life-long occupation of truck driving. The Veteran also submitted a TDIU application in October 2015. He reported completing high school, but not taking college courses or completing any additional training. He also reported being a long distance truck driver until his diabetes became too severe and undergoing right foot amputation. He reported his last employer was Nebraska Salt and Grain. Thereafter, later in October 2015, a representative for Nebraska Salt and Grain submitted a form in regard to the Veteran. The representative reported that the Veteran last worked in January 2012. The development and decision on the remanded service connection issues will significantly impact a decision on the TDIU issue. Therefore, the issues are inextricably intertwined, and a remand of the TDIU issue is required. These claims are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for any doctor or facility having additional records. Make two requests for any authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain complete VA treatment records from September 2015. 3. After completing the records development indicated above, schedule the Veteran for an examination in regard to his peripheral vascular disease (PVD) claim. All necessary testing should be completed to determine if he has had PVD at any time during the period on appeal (since October 2015), unless it can be explained why such testing is not necessary. If the Veteran has had PVD, opine whether it is as at least as likely as not (a 50 percent or greater probability) that his PVD is caused or aggravated by his service-connected diabetes mellitus, type 2. 4. After completing the records development indicated above, schedule the Veteran for an examination by an appropriate medical professional to determine the nature and etiology of his right foot amputation and left knee total replacement. Thereafter, the examiner should: (a.) State whether it is as at least as likely as not that his right foot amputation or residual right foot disability was caused or aggravated by his service-connected diabetes mellitus, type 2. (b.) State whether it is as at least as likely as not that his right foot amputation or residual right foot disability was caused or aggravated by PVD. (c.) If the Veteran is found to have a right foot amputation or residual right foot disability that is caused or aggravated by diabetes mellitus, type 2, or PVD, state whether it is as at least as likely as not that his left knee replacement was caused or aggravated by his right foot disability. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Jimerfield, Associate Counsel