Citation Nr: 18153350 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 16-41 239 DATE: November 28, 2018 REMANDED Entitlement to service connection for peripheral vascular disease (PVD) of the left lower extremity is remanded. Entitlement to service connection for amputation of the lower left leg is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from March 1966 to March 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that, although not raised by the Veteran, the issue of service connection for PVD of the left lower extremity is reasonably raised by the record. The Veteran originally applied for service connection for PVD without distinguishing which extremity or extremities the condition affected; the RO narrowed the issue unprompted in a December 2015 rating decision. Further, the record indicates the amputation is causally related to the PVD condition. As such, the Board has taken jurisdiction of the issue of entitlement to service connection for PVD of the left lower extremity. See Robinson v. Mansfield, 21 Vet. App. 545 (2008) (Board is obligated to consider all matters in an appeal reasonably raised by a liberal reading of all documents and oral testimony in the record). 1. Entitlement to service connection for PVD of the left lower extremity is remanded. Evidence in the record reflects the diagnosis of PVD is applicable to both of the Veteran’s lower extremities. For instance, a July 2012 record from the Veteran’s private cardiologist lists PVD as a current diagnosis, describing a stent having been placed in the Veteran’s left iliac artery. Another record, from February 2014, similarly describes peripheral artery disease with a history of left femoral popliteal bypass surgery, as well as history of occlusion of the left superficial femoral artery. The June 2014 record detailing the first amputation procedure listed a pre- and post-operative diagnosis as ischemia to the left lower extremity, which the Board notes is proximate in time to the Veteran’s February 2015 application for service connection for the amputation. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013) (recent diagnoses predating filing of claim are relevant evidence in determining whether a current disability existed at time claim was filed or during its pendency); see also McClain v. Nicholson, 21 Vet. App. 319 (2007) (service connection may be granted for a disability that resolves prior to the adjudication of the claim). Further, a March 2017 examination indicates the Veteran continues to experience diminished blood flow in his left thigh after the lower leg was amputated in June 2014. The December 2015 VA opined that the PVD is likely to be secondary to the Veteran’s diet-controlled diabetes mellitus, and did not distinguish between the right and left lower extremities in the opinion or in identifying the diagnosis in the December 2015 diabetes examination report or in the October 2015 artery and veins examination report. However, the Board notes the diagnosis of diabetes was made in February 2015, after the Veteran was treated with amputations of the left lower extremity in June and December 2014. Accordingly, a new opinion is necessary to address the current diagnosis of PVD and its etiology. 2. Entitlement to service connection for amputation of the lower left leg is remanded. As there is evidence the amputation of the left leg through the knee is due to or a residual of PVD of the left lower extremity, this issue is intertwined with the above remanded issue and is also remanded at this time. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician to determine whether the PVD of the left lower extremity is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all current arterial conditions currently found in the lower left extremity. The examiner should also state whether the diagnosis of peripheral vascular disease (PVD) noted in the record was applicable to the Veteran’s left lower extremity at the time of his amputation procedures in June and December 2014. For each arterial condition identified, including any that may have resolved following the amputation procedures, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service, to include exposure to herbicide agents. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the arterial condition of the left lower extremity is or was (a) caused by or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected disabilities, including diabetes mellitus and coronary artery disease. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the arterial condition prior to aggravation by the service-connected disabilities. Please note, causation and aggravation are separate concepts and must be addressed independently. If the examiner finds that the arterial condition of the left lower extremity was caused by or aggravated by diabetes mellitus, the examiner must explain the significance of the diagnosis of diabetes in February 2015 and whether it could have caused the arterial condition prior to its diagnosis. In providing the above opinions, the examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. After completing the above, and any other development deemed necessary, readjudicate the appeal. If any benefit sought remains denied, provide an additional supplemental statement of the case to the Veteran and his representative, and return the appeal to the Board. J. GALLAGHER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel