Citation Nr: 20008330 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 14-07 847 DATE: January 31, 2020 REMANDED Entitlement to service connection for arteriosclerosis obliterans, claimed as circulatory problems, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1971 to February 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Puerto Rico, denying service connection for arteriosclerosis obliterans and high blood pressure. The Veteran filed a timely notice of disagreement (NOD) in November 2011, and in March 2014, the RO issued a statement of the case (SOC). In September 2015, the RO issued a supplemental statement of the case (SSOC), and in January 2018, the Board remanded the issues for additional development. In September 2019, the RO issued a SSOC. Following the January 2018 Board Remand, in a September 2019 rating decision the RO granted the Veteran’s claim seeking entitlement to service connection for hypertension, claimed as high blood pressure. As the full benefits sought on appeal, with respect to this issue, have been granted, the claim is no longer before the Board. Entitlement to service connection for arteriosclerosis obliterans, claimed as circulatory problems, is remanded. The Board regrets the additional delay, but for reasons explained below, finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board’s prior remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran is seeking service connection for arteriosclerosis obliterans. Specifically, the Veteran contends his circulatory problems, diagnosed as arteriosclerosis obliterans, are due to or were incurred during active service, to include exposure to herbicides in Vietnam. Alternatively, the Veteran asserts his current disability is secondary to his service-connected diabetes mellitus, type II, with erectile dysfunction due to Agent Orange Exposure. See October 2016 Representative Statement; December 2014 Correspondence. In January 2018, the Board remanded the Veteran’s claim on appeal. Specifically, the Board determined that a June 2011 VA examination was inadequate as it failed to opine as to the relationship between the Veteran’s diagnosed arteriosclerosis obliterans with his service-connected diabetes mellitus, type II. The Board therefore instructed the AOJ to schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his circulatory problems. The examiner was to reconcile all prior diagnoses, to include arteriosclerosis obliterans of the right upper extremity, decreased arterial flow, small vessels disease of the right upper extremity, and arterial occlusion of the left upper extremity with the current findings. The examiner was then to opine on the etiology of the Veteran’s current circulatory problems, to include direct and secondary service connection. On remand, the AOJ scheduled the Veteran for a VA artery and vein conditions examination. See January 2019 VA Examination. The examiner reviewed the Veteran’s claims file and opined that it was less that the Veteran’s claimed disability is related to active service, to include as due to service-connected diabetes mellitus, type II, as the Veteran denied a history of vascular disease. The Board finds that the January 2019 VA examination is inadequate and did not substantially comply with the Board’s January 2018 remand instructions. The examiner fails to determine the nature of the Veteran’s circulatory problems and does not reconcile his diagnosis of a lack of a current disability with the Veteran’s prior diagnoses of circulatory problems, to include the June 2011 VA examiner’s diagnosis of arteriosclerosis obliterans. Therefore, another remand for a VA examination is required. Stegall v. West, 11 Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: 1. The AOJ should obtain all outstanding VA treatment records and any private treatment records identified by the Veteran. All obtained records should be associated with the evidentiary record. 2. After all outstanding treatment records have been associated with the claims file, schedule the Veteran for an appropriate VA examination to determine the current nature and etiology of his circulatory problems, to include arteriosclerosis obliterans. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. After reviewing all available records, the examiner should opine on the following: Whether it is at least as likely as not (that is, a probability of at least 50 percent) that the Veteran’s circulatory problems, to include arteriosclerosis obliterans, were caused or aggravated by his service, to include as a result of conceded herbicide exposure and/or his service-connected diabetes mellitus, type II, with erectile dysfunction. In doing so, the examiner should consider the July 2009 D.V.L. Upper Arterial Physiologic Study and the January 2011 VA examination. If it is at least as likely as not that the service-connected diabetes mellitus, type II, aggravates (that is, permanently worsens) the Veteran’s circulatory problems, the examiner should identify the percentage of disability which is attributable to the aggravation. In such circumstances, the examiner should establish the baseline level of severity of the circulatory problem by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the circulatory problem. The examiner must explain the reasons behind any opinions expressed and conclusions reached. A discussion of the facts and medical principals involved would be of considerable assistance to the Board. (Continued on the next page)   After completing the above development and any other development deemed warranted, readjudicate the claim. If the benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and the requisite opportunity to respond before the case is returned to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.