Citation Nr: 20021850 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 19-15 920 DATE: March 27, 2020 REMANDED Entitlement to service connection for cold injury residuals of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1953 to March 1955. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in January 2015 by a Regional Office (RO) of the Department of Veterans’ Affairs (VA). In December 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. At such time and in February 2020, the Veteran submitted additional evidence and argument in support of his appeal. 38 U.S.C. § 7105(e)(1). Entitlement to service connection for cold injury residuals of the bilateral lower extremities. The Veteran asserts that he developed lower extremity disorders, manifested by poor circulation and peripheral vascular disease (PVD), as a result of his exposure to extreme cold during his nine months of service in Korea, resulting in his eventual bilateral lower extremity amputations. At his December 2019 Board hearing, the Veteran testified that he and his fellow servicemen were provided with inadequate footwear (socks and shoes) and housing, which offered little protection from the extreme cold weather, with temperatures ranging from the low 40 degrees to below 0 (zero) Fahrenheit. He also reports seeking VA treatment for related symptoms soon after service. Finally, the Veteran contends that his claim is further supported by the fact that he initially filed a claim for service connection for bilateral lower extremity disorders, claimed as bad athletic feet with soreness and loose skin, within two months of his separation from service in May 1955. The Veteran’s attorney requests that the Board remand the claim in order to obtain such reportedly outstanding VA treatment records (which would span from 1955 until 1969, the first VA treatment of record) and a VA medical opinion addressing whether the Veteran’s current bilateral lower extremity disorder is related to his reported in-service exposure to cold weather. Consequently, as VA has constructive possession of such alleged treatment records, a remand is necessary in order to attempt to obtain. Further, given that the Veteran is competent to report his exposure to low temperatures, which is consistent with the circumstances of his service in Korea, has current bilateral lower extremities disorders, i.e., PVD, which led to his double lower extremity amputation, and has submitted medical treatises that address the nature of symptoms associated with frostbite, VA’s duty to obtain a medical opinion is triggered. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (holding that an examination is necessary if, inter alia, evidence indicates that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or service-connected disability). Thus, a remand is necessary in order to obtain a VA opinion addressing whether the Veteran’s current bilateral lower extremity disorder is related to his in-service exposure to cold weather. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records dated from March 1955 onward, to include any records that may be archived. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. After obtaining any outstanding VA treatment records, forward the record to an appropriate clinician so as to obtain an opinion addressing the etiology of the Veteran’s bilateral lower extremity disorders. The record and a copy of this Remand must be made available to the examiner. After a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any bilateral lower extremity disorder present before the Veteran’s double lower extremity amputation, to include PVD, had its onset in or is otherwise related to his military service, to specifically include his in-service exposure to extreme cold temperatures. When rendering this opinion, the clinician is asked to review and consider comment on the clinical significance of the following evidence: (a.) The Veteran’s May 1955 VA service connection claim for bad athletic feet with soreness and loose skin; (b.) Any pre-1969 VA treatment records obtained pursuant to the Board’s remand directives; (c.) Post-service VA orthopedic treatment, including for a right knee injury in July 1969, a right great toe injury in July 1970, treatment for gout affecting the left knee in July 1972, right knee surgical repair post-injury in January 1976, treatment for gout of the left knee June 1981, left great toe pain and swelling in July 1981, and continued bilateral knee treatment through 1990; (d.) September 1991 VA examination for diffuse arthralgia, at which time the Veteran was noted to have normal pedal pulses and no varicosities, with bilateral lower extremity ranges of motion deemed normal, as well as normal deep tendon reflexes and sensory examination; (e.) April 2012 VA treatment noting the Veteran’s history of PVD secondary to frostbite in Korea and a motor vehicle accident, status post femoral peroneal bypass with infection followed by right below the knee amputation in December 2009; (f.) May 2012 private inpatient treatment records noting the Veteran’s history of PVD secondary to diabetes mellitus, at which time the Veteran was treated for gangrenous left lower extremity infection, including an amputation of the left second and third toes; and (g.) April 2013 private inpatient treatment records reflecting the Veteran’s left below the knee amputation; and (h.) Medical treatises that address the nature of symptoms associated with frostbite received in December 2019. A complete rationale must be provided for the requested opinion. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Northcutt, 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.