Citation Nr: 18160931 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 10-45 888 DATE: December 28, 2018 REMANDED Entitlement to service connection for varicose veins of the left lower extremity, to include as due to herbicide exposure is remanded. Entitlement to service connection for varicose veins of the right lower extremity, to include due to herbicide exposure is remanded. Entitlement to service connection for psoriasis of the elbow, to include as due to herbicide exposure is remanded. REASONS FOR REMAND 1. Entitlement to service connection for varicose veins of the left lower extremity, to include as due to herbicide exposure is remanded. 2. Entitlement to service connection for varicose veins of the right lower extremity, to include due to herbicide exposure is remanded. The Veteran is seeking service connection for varicose veins of his left and right lower extremities. In November 2017 the Veteran’s claims were remanded by the Board in order to obtain an addendum opinion, but that opinion is inadequate. The December 2017 VA opinion provider noted the Veteran’s service treatment records (STRs) were silent for treatment for varicose veins. The opinion provider also noted medical literature does not support a contention of varicose veins being caused by herbicide exposure. The opinion provider listed the risk factors for varicose veins and noted that the Veteran’s risk factors are being over 40 and chronic venous insufficiency. The opinion is inadequate because the provider seemingly equated a lack of positive medical literature to the presence of negative medical literature. Moreover, while the opinion provider indicated the Veteran had some risk factors for varicose veins she did not indicate why this precluded the possibility of the Veteran’s varicose veins from being etiologically related to his active service. As such, an addendum opinion must be obtained on remand. 3. Entitlement to service connection for psoriasis of the elbow, to include as due to herbicide exposure is remanded. The December 2017 addendum opinion was obtained after the Board remand is inadequate. The opinion provider gave a negative opinion, noting that the Veteran’s STRS were silent for the treatment of psoriasis. The opinion provider listed several risk factors for psoriasis but did not indicate which were associated with the Veteran. The December 2017 addendum opinion is inadequate because the provider did not provide an adequate rationale for the conclusion. The opinion provider listed several risk factors for psoriasis and failed to indicate which the Veteran had or their significance. Moreover, the opinion provider did not address whether the Veteran’s psoriasis could be etiologically related to his herbicide exposure. As such, an addendum opinion must be obtained on remand. Moreover, the Veteran continues to receive treatment at a VA medical center. As such, any and all outstanding VA treatment records must be obtained on remand. The matters are REMANDED for the following action: 1. Attempt to obtain and associate with the claims file any and all outstanding VA treatment records. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s bilateral varicose veins are at least as likely as not related to his active service to include his herbicide exposure. A complete rationale is requested. If the opinion provider cannot provide an opinion without resort to speculation, the opinion provider should what, if any, additional evidence would permit such an opinion to be made. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s psoriasis of the elbow is at least as likely as not related to his active service to include his herbicide exposure. The examiner must consider the Veteran’s personal circumstances and how the recognized risk factor(s) apply in his particular case.   A complete rationale is requested. If the opinion provider cannot provide an opinion without resort to speculation, the opinion provider should what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Biggins, Associate Counsel