Citation Nr: 18160811 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 07-11 344 DATE: December 27, 2018 REMANDED Entitlement to special monthly compensation (SMC) based on the anatomical loss of right lower extremity is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1969 to October 1970. The matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated October 2009. In March 2016, the Board remanded the appeal. Subsequently, in May 2017, the Board denied entitlement to SMC based on the anatomical loss of right lower extremity. The Veteran appealed the denial of entitlement to SMC based on the anatomical loss of right lower extremity to the Court of Appeals for Veterans Claims (CAVC). Counsel for the Veteran and the Secretary of VA (the parties) filed a Joint Motion for Remand (JMR). An Order of the Court dated April 16, 2018 granted the motion and remanded the case to the Board. 1. Entitlement to SMC based on the anatomical loss of right lower extremity is remanded. The Board finds that the claim on appeal must be remanded for further development. In this case, the Veteran underwent a right below the knee amputation, and in May 2017, the Board denied entitlement to SMC based on the anatomical loss of right lower extremity because the Board found that the right leg amputation is not related to a service-connected disability. However, the parties agreed in the April 2018 JMR that the Board’s May 2017 denial of the Veteran’s claim for entitlement to SMC based on the anatomical loss of right lower extremity should be vacated because 1) the Board failed to adequately consider whether the right knee amputation could be proximately due to or the result of the Veteran’s service-connected diabetes, 2) the Board relied upon an April 2012 VA negative nexus opinion, in which the examiner failed to explain how the Veteran’s peripheral vascular disease (which the examiner found led to the amputation) could not have been aggravated by the Veteran’s service-connected diabetes, and 3) the Board failed to consider in its denial an August 2008 VA compensation examination where the examiner indicated that the Veteran’s non-service connected peripheral vascular disease was worsened or increased by his service-connected diabetes and that diabetes is well-known to worsen and complicate treatment for peripheral vascular disease. In light of the Court’s Order granting the parties’ JMR, the claim for entitlement to SMC based on the anatomical loss of right lower extremity is remanded for a new etiology opinion. The matter is REMANDED for the following action: 1. Forward the record and a copy of this Remand to a qualified VA examiner for preparation of an opinion. If the examiner deems that a new examination is necessary, then schedule the Veteran for a new examination. The examiner is asked to offer an opinion as to: a) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right knee amputation could be proximately due to or the result of or otherwise related to the Veteran’s service-connected diabetes? b) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s peripheral vascular disease was caused by his service-connected diabetes? c) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s peripheral vascular disease was aggravated (worsened beyond the normal progression) by his service-connected diabetes? If aggravation is found, the examiner must attempt to establish the baseline level of severity of the peripheral vascular disease prior to aggravation by the service-connected disability. If the Veteran’s peripheral vascular disease was aggravated by the service-connected disability, the examiner should quantify the approximate degree of aggravation. For all opinions, the RO should ensure that a rationale is provided, to include specific discussion of the medical principles involved and the relevant facts. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). (The Agency of Original Jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.) ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. J. Cho, Associate Counsel