Citation Nr: 21061803 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-46 964 DATE: October 5, 2021 ORDER Entitlement to service connection for post-phlebitic syndrome and venous stasis, as secondary to deep vein thrombosis (DVT), is granted. REMANDED Entitlement to an initial rating in excess of 40 percent for residuals of right lower extremity DVT is remanded. FINDING OF FACT The Veteran's post-phlebitic syndrome and venous stasis are residuals of his service-connected DVT. CONCLUSION OF LAW The criteria for entitlement to service connection for post-phlebitic syndrome and venous stasis, as secondary to DVT, are met. 38 U.S.C. §§1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from April 1986 to February 1992, from April 1996 to July 1996 and from September 2001 to October 2001, with additional National Guard service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In this regard, the Veteran submitted new and material evidence within one year of the December 2014 rating decision, and thus that decision never became final. See January 2015 VA Form 21-4138; 38 C.F.R. § 3.156(b). When the claim was re-adjudicated in March 2017, he timely perfected this appeal. In December 2020, the Veteran testified at a virtual hearing before the undersigned. In March 2021, the Board granted entitlement to service connection for left lower extremity DVT and remanded the issue of entitlement to a rating in excess of 40 percent for right lower extremity DVT. The issue of entitlement to secondary service connection has been raised by the record and is part and parcel of the Veteran's claim seeking an increased rating. See Morgan v. Wilkie, 31 Vet. App. 162, 164 (2019) (the Board may need to explore schedular rating tools, including secondary service connection, prior to considering an extraschedular rating as part of an increased rating claim). 1. Entitlement to service connection for post-phlebitic syndrome and venous stasis, as secondary to DVT, is granted. The Board directed that the Veteran be afforded a new examination and requested that the examiner identify additional residuals of his service-connected DVT. See March 2021 Board Remand at 4-6. The Veteran was afforded the directed examination in April 2021. The examiner noted additional diagnoses that are directly due to service-connected DVT, specifically post-phlebitic syndrome and venous stasis. See April 2021 Examination Report at 2, 10-11. The examiner also noted varicose veins that are unrelated to his DVT. See id. Secondary service connection may be granted for a disability that is proximately due to or aggravated by a service-connected disability. See 38 C.F.R. § 3.310. Here, the evidence shows that post-phlebitic syndrome and venous stasis are directly due to the Veteran's service-connected DVT. Accordingly, secondary service connection for these residuals is warranted. REASONS FOR REMAND 2. Entitlement to an initial rating in excess of 40 percent for residuals of right lower extremity DVT is remanded. The Board regrets the delay, but remand is necessary to achieve substantial compliance with the March 2021 Board remand directives. Specifically, the Board directed the examiner to discuss the Veteran's report of ulcerations and open wounds, especially during warm weather in Florida, and opine as to whether the reported history of ulceration is medically consistent, medically inconsistent, or neither consistent nor inconsistent with examination findings. See March 2021 Board Remand at 5. However, this has not been achieved. On remand, this deficiency should be addressed. Additionally, the rationale provided for the examiner's opinion that the Veteran's right groin swelling is unrelated to his DVT is not clear. On remand, an addendum opinion should be obtained that includes a clear rationale. Updated VA treatment records should also be secured. Finally, the Board notes that the AOJ did not attempt development of outstanding relevant private treatment records. On remand, this deficiency should be addressed. The matters are REMANDED for the following action: 1. Secure the Veteran's complete VA treatment records. 2. With any necessary assistance from the Veteran, secure any outstanding relevant private treatment records. 3. Refer the claims file to an examiner, preferably the examiner who conducted the April 2021 Vein Condition examination, for preparation of an addendum opinion. No additional examination of the Veteran is necessary unless the examiner deems otherwise. After a review of the claims file, the examiner should respond to the following: (a) Describe the Veteran's flare-ups of his DVT condition, including in hot weather. If there are no flare-ups, please so state. (b) The Veteran has reported a history of ulceration and open wounds, especially during warm weather in Florida. Persistent ulceration was not noted on the April 2021 examination. Please state whether the Veteran's reported history of ulceration is medically consistent, medically inconsistent, or neither consistent nor inconsistent with examination findings. (c) Please opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's swollen lymph gland of the right groin area is proximately due to his DVT residuals. (d) Please opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's swollen lymph gland of the right groin area has been aggravated (worsened beyond natural progression) by his DVT residuals. In addressing questions (c) and (d), the Board acknowledges the medical opinion provided in June 2021. The examiner is requested to provide a detailed rationale for the determination that the Veteran's swollen lymph node of the right groin area is not etiologically related to his DVT, as the rationale provided in June 2021 is not adequate for Board purposes. In this regard, the examiner's statement that the node manifested after the Veteran's diagnosis of DVT is not, standing alone, sufficient. A complete rationale must be provided for all opinions. If the requested opinion cannot be provided without resorting to speculation, the examiner should so state and explain why an opinion would be speculative (beyond the realm of medical knowledge, beyond the examiner's knowledge, etc.). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.