Citation Nr: 21061437
Decision Date: 10/04/21	Archive Date: 10/04/21

DOCKET NO. 17-56 361
DATE: October 4, 2021

REMANDED

Entitlement to service connection for deep vein thrombosis (DVT), right leg, to include as secondary to service-connected right knee strain is remanded.

Entitlement to service connection for bilateral pulmonary embolism, to include as secondary to DVT, right leg is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 2008 to March 2012 with additional National Guard service, including a period on inactive duty for training (INACDUTRA).

The appeal was most recently before the Board in  March 2021, when it was remanded for additional development.  There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998).    

Entitlement to service connection for DVT, right leg, to include as secondary to service-connected right knee strain is remanded.

Entitlement to service connection for bilateral pulmonary embolism, to include as secondary to DVT, right leg is remanded.

The July 2021 VA opinion on the right leg DVT is inadequate because the examiner used the wrong standard for aggravation; the examiner addressed beyond natural progression, rather than the correct "any increase" in disability.  38 C.F.R. § 3.310 (b); Allen v. Brown, 7 Vet. App. 439 (1995).    

The claim for the bilateral pulmonary embolism, as secondary to a right leg DVT must be remanded also because the issues are inextricably intertwined.  

On remand, updated treatment records should be obtained.  See 38 C.F.R. § 3.159. See also Bell v. Derwinski, 2 Vet. App. 611 (1992).       

The matters are REMANDED for the following action:

1. Obtain the names and addresses of all medical care providers who treated the Veteran for any deep vein thrombosis or pulmonary embolism complaints since May 2012 not already associated with the record.  After securing the necessary release, take all appropriate action to obtain these records, including any VA treatment records since July 2021.

2. After the completion of the above, obtain an addendum opinion from the VA examiner who provided July 2021 VA opinion, (or another appropriate provider if the July 2021 examiner is unavailable) to determine the nature and etiology of the Veteran's right leg DVT and bilateral pulmonary embolism.  Copies of all pertinent records, including this remand, must be made available to the examiner for review.  Based on the review of the record (and examination if needed), the examiner should answer the following:

Is it at least as likely as not that the Veteran's right leg DVT which developed into a bilateral pulmonary embolism is (i) caused by or (ii) aggravated by (defined as any increase in disability) the Veteran's service-connected right knee strain?  Why or why not?   

The examiner should specifically consider and discuss as necessary the development of deep vein thrombosis in June 2014 following the Veteran's knee surgery. 

The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate.  If an opinion cannot be provided, the examiner should indicate why.   

3. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Eric Struening

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.