Citation Nr: 19155136 Decision Date: 07/17/19 Archive Date: 07/16/19 DOCKET NO. 16-41 112 DATE: July 17, 2019 REMANDED Entitlement to an increased rating in excess of 20 percent for deep vein thrombosis of the left lower extremity is remanded for additional development. Entitlement to an increased rating in excess of 20 percent for deep vein thrombosis of the right lower extremity is remanded for additional development. REASONS FOR REMAND The Veteran served on active military service with the U.S. Air Force from June 2005 to December 2005. During this time, she was awarded the National Defense Service Medal, among other awards. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Entitlement to an increased rating in excess of 20 percent for deep vein thrombosis of the bilateral lower extremities is remanded. While the Board sincerely regrets the delay, a remand is required before the Board may make a determination on the merits of the instant appeal. The Veteran has asserted that her service-connected deep vein thrombosis (DVT) of the bilateral lower extremities warrants a higher rating than the 20 percent currently assigned for each lower extremity. In conjunction with her claim for increased ratings, the Veteran underwent a VA artery and vein examination in October 2018. The Veteran is currently rated as 20 percent disabled bilaterally under Diagnostic Code 7121. A 20 percent disability rating is assigned for persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. See 38 C.F.R. § 4.104, Diagnostic Code 7121. A 40 percent disability rating is warranted for persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. Id. A 60 percent disability rating is warranted for persistent edema or subcutaneous induration, stasis pigmentation or eczema, and persistent ulceration. Id. However, the October 2018 examiner did not ask the Veteran about persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration, as set forth by the 40 percent rating criteria. The Board finds that the information elicited during the October 2018 examination is insufficient for making a determination on the DVT of the bilateral lower extremities increased rating claims. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one). The matters are REMANDED for the following action: 1. Obtain any additional outstanding VA treatment records for the Veteran and associate them with the claims file. All attempts to secure any identified records and any response received must be documented in the case file. 2. Then, the AOJ should schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected bilateral DVT of the lower extremities. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. Additionally, based upon a review of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an addendum opinion as to the findings of the April 2019 VA examination for artery and vein conditions, including whether or not the Veteran has persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. 3. The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the specific examiner. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Raj, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.