Citation Nr: 18147109 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 14-26 677 DATE: November 2, 2018 REMANDED The issue of entitlement to an increased rating for hidradenitis suppurativa is remanded. The issue of entitlement to restoration of a 60 percent disability rating for hidradenitis suppurativa is remanded. The issue of entitlement to an increased rating for peripheral vascular disease in the right leg is remanded. The issue of entitlement to restoration of a 20 percent disability rating for peripheral vascular disease in the right leg is remanded. The issue of entitlement to an increased rating for peripheral vascular disease in the left leg is remanded. The issue of entitlement to restoration of a 20 percent disability rating for peripheral vascular disease in the left leg is remanded. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to July 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a February 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The claims for increased ratings and restoration of ratings are remanded. A remand of the claims on appeal is warranted for the following reasons. First, an addendum medical opinion should be requested from the Veteran’s treating VA physician, J.W., M.D. In October 2012, this physician provided a medical opinion which commented on the nature and severity of the Veteran’s hidradenitis suppurativa and peripheral vascular disease. Second, any outstanding VA treatment records from VA Medical Center Richmond should be included in the claims file. Third, the Veteran should be provided VA examinations into his increased rating claims. The record indicates that the disorders at issue may have worsened since the most recent examinations conducted over seven years ago in September 2011. See Green v. Derwinski, 1 Vet. App. 121 (1991). Service connection has been in effect for hidradenitis suppurativa since June 2008. Service connection has been in effect for bilateral peripheral vascular disease since January 2009. In August 2012, the RO proposed reducing the assigned rating for each disorder – from 60 to 0 percent for hidradenitis suppurativa, and from 20 to 0 percent for peripheral vascular disease in each leg. In the February 2013 rating decision on appeal, the RO effected the reductions from May 1, 2013. It appears that the August 2012 proposal and February 2013 decision followed requisite notification procedure in reducing the evaluations. See 38 C.F.R. § 3.105(e). This was necessary because – as noted in the February 2013 rating decision code sheet – the reduced ratings resulted in a reduction in the amount of compensation payable to the Veteran. The combined disability rating declined from 90 to 60 percent effective May 1, 2013. What is not clear in this matter is whether the reductions were warranted based on the medical and lay evidence of record prior to and since May 2013. It is not clear that the evidence demonstrated improvement in hidradenitis suppurativa and peripheral vascular disease. The September 2011 VA report indicates that the disorders had improved. In the report, the examiner noted the Veteran’s skin as clear, and noted normal peripheral pulses in the lower extremities with an ankle/brachial index of 1.23 in each leg. See 38 C.F.R. §§ 4.104, 4.118, Diagnostic Codes 7114, 7815 (2018). Moreover, VA treatment records dated between 2011 and June 2014 do not contain specific information about the skin and vascular system countering the September 2011 medical findings. However, the treating physician’s October 2012 statement indicates that the disorders at issue did not improve. In the statement, the physician indicated continued disability related to hidradenitis suppurativa and peripheral vascular disease. He described the skin disorder as painful and disabling, and stated that the peripheral vascular disease caused difficulty with walking. He also stated that the Veteran’s service-connected disabilities – to include the two issues addressed here – render the Veteran unemployable. See Rice v. Shinseki, 22 Vet. App. 447 (2009). He did not, however, provide specific evidence addressing the relevant rating criteria, such as the area of skin then affected by hidradenitis suppurativa, whether the Veteran used systemic therapy, or whether the Veteran had diminished peripheral pulses or an ankle/brachial index at or below 0.9. See 38 C.F.R. §§ 4.104, 4.118, Diagnostic Codes 7114, 7815 (2018). Nevertheless, as the record now stands, it is not clear that the Veteran experienced an improvement in the disabilities reflecting an improvement in his ability to function under the ordinary conditions of life and work. 38 C.F.R. §§ 4.2, 4.10. This division in the evidence makes the VA treatment records important here. The VA records in the claims file dated after the February 2013 rating decision pertain to treatment received at VA Medical Center (VAMC) Hampton, Virginia. As indicated, these records tend to support the RO’s decision to reduce ratings. But, with regard to treatment at VAMC Richmond, Virginia, the claims file does not contain treatment records dated in the relevant time period. In his March 2013 notice of disagreement contesting the reductions in rating, the Veteran asserted that treatment records at VAMC Richmond, as well as VAMC Hampton, would support his claims. On remand, any outstanding treatment records from VAMC Richmond should be included in the claims file. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims to the extent possible. Include in the record any outstanding VA treatment records, if any. In particular, any outstanding VA treatment records from VAMC Richmond should be included in the claims file. All records/responses received must be associated with the claims file. 2. Request an addendum medical report from the Veteran’s treating physician, J.W., M.D., which expands on the October 2012 statement indicating that the Veteran continued experiencing at that time severe disability related to service-connected hidradenitis suppurativa and peripheral vascular disease. The physician should attempt to provide a retrospective report addressing the nature and severity of the Veteran’s disorders since May 2013, particularly regarding: (a). The skin area affected by hidradenitis suppurativa, and whether the Veteran used since then systemic therapy such as corticosteroids or other immunosuppressive drugs. (b). Whether peripheral vascular disease causes claudication from walking, and whether peripheral pulses have been diminished, or whether the ankle/brachial index has been 0.9 or less since May 2013. 3. Schedule a VA compensation examination to determine the current nature and severity of hidradenitis suppurativa. See 38 C.F.R. § 4.118, Diagnostic Code 7815 (2018). The examiner should review the claims folder. In a report detailing the nature and severity of the disorder, the examiner should comment on the following: (a). What area of the skin is affected by hidradenitis suppurativa? (b). Does the Veteran treat the disorder with systemic therapy such as corticosteroids or other immunosuppressive drugs? 4. Schedule a VA compensation examination to determine the current nature and severity of bilateral lower extremity peripheral vascular disease. See 38 C.F.R. § 4.104, Diagnostic Code 7114 (2018). The examiner should review the claims folder. In a report detailing the nature and severity of the disorders, the examiner should comment on the following: (a). Does walking cause claudication in the Veteran’s legs? (b). Are peripheral pulses diminished in the lower extremities? Is the ankle/brachial index in either leg at 0.9 or less? What is the ankle/brachial index for each leg? (c). Does the disorder cause ulcers, pain, coldness, or trophic changes? G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher McEntee, Counsel