Citation Nr: 21001844 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-29 504 DATE: January 12, 2021 REMANDED Entitlement to service connection for a left leg disability, to include varicose veins, is remanded. Entitlement to an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from August 1971 to October 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2020. This case was previously before the Board in June 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. 1. Entitlement to service connection for a left leg disability, to include varicose veins, is remanded. The prior Board remand found the January 2013 VA opinion inadequate, as it did not address whether the current varicose veins were related to the trauma the Veteran experienced to his left knee in service. A new opinion was sought in August 2020, where the VA examiner opined the current varicose veins were less likely than not caused by the in-service left knee injury or subsequent surgery. The examiner explained that the varicose veins could not be connected to the location of the trauma, as they are very extensive. The examiner did not provide any further rationale regarding a potential connection, nor address the Veteran’s report in the examination, at the Board hearing, and throughout the claims file that the varicose veins and associated leg pain had its onset in 1972, the year he separated from service. This opinion is therefore inadequate, and a remand is necessary to obtain an adequate opinion fully addressing the Veteran’s claim. 2. Entitlement to an acquired psychiatric disorder is remanded. The Veteran’s VA treatment records added to the claims file in June 2020 reflect consultations with mental health professionals in 2014, 2015, and 2017. In December 2014, anxiety and depression symptoms were identified. In March 2017, anxiety and irritability were identified. In July 2017, a diagnosis of unspecified insomnia disorder was made. The Board also notes VA anger management counseling in 1996 and consistent complaints of anxiety and anger problems throughout the record. Therefore, there is evidence of current psychiatric disorder symptoms that the Veteran asserts have persisted since service, and that have been exacerbated by his left leg disabilities. As the January 2013 VA examiner was not able to consider this evidence, a remand is necessary to obtain a new examination. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (VA is obliged to provide an examination where there is insufficient information to decide the claim and there is an indication the current disability may be associated with service). Further, the Board notes a January 2015 mental health treatment note indicates the Veteran’s interest in counseling at the Vet Center. Although the record does not indicate whether the Veteran sought treatment at the Vet Center, on remand, the RO should clarify with the Veteran if there are relevant mental health records from the Vet Center and, if so, attempt to obtain those records on the Veteran’s behalf. The matters are REMANDED for the following action: 1. Ask the Veteran to identify whether he received treatment at any Vet Center during the pendency of this claim. If the Veteran responds affirmatively, take appropriate steps to attempt to obtain relevant records from any Vet Center identified by the Veteran, and associate those records with the claims file. 2. Forward the claims file to an appropriate clinician to determine whether any current left leg disability, to include varicose veins, is related to the Veteran’s military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should identify all left leg disabilities currently found. For each left leg disability identified, to include varicose veins, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service, to include the car accident during service. The examiner should specifically address the Veteran’s lay statements regarding ongoing left leg pain since service. The examiner should address any other pertinent evidence of record. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 3. Forward the claims file to an appropriate clinician to determine whether any current psychiatric disorder is related to the Veteran’s military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should identify all psychiatric disorders currently found. For each disorder identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the psychiatric disorder began in or is otherwise caused by the Veteran’s active service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the psychiatric disorder is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected disabilities. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the psychiatric disorder prior to aggravation by the service-connected disabilities. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner should specifically address the Veteran’s lay statements regarding ongoing psychiatric symptoms since service, including anger and anxiety, as well as the symptoms of anxiety, anger, depression and irritability noted in his VA treatment records. The examiner should address any other pertinent evidence of record. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Josey, 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.