Citation Nr: 21063427 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 16-15 403 DATE: October 14, 2021 REMANDED Entitlement to service connection for chronic venous insufficiency and varicose veins (claimed as bilateral ankle and calf condition), as secondary to total right knee replacement, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1963 to October 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In a November 2014 Board decision, the Board determined that the claim of entitlement to service connection for chronic venous insufficiency and varicose veins was raised by the record as secondary to claims that were filed in February 2010. The Veteran requested, and was scheduled for, a hearing with the Board in August 2021. However, he did not request postponement of the hearing, did not appear for the hearing, and did not request for the hearing to be rescheduled. As such, his hearing request is deemed withdrawn. 38 C.F.R. § 20.704 (d). The Board notes that the Veteran has been represented by a private agent, Christopher Loiacono. The agent submitted a letter on January 9, 2018, noting that he represented the Veteran and requesting written notification advising of the status of the Veteran's case. On January 24, 2018, VA responded to the representative, stating that the appeal for chronic venous insufficiency and varicose veins was pending before the Board. In a letter dated January 3, 2019, after the case was certified to the Board, the agent notified VA that he no longer represents the Veteran. The RO director sent a letter to the representative and the Veteran on April 9, 2021, stating the agent no longer represented the Veteran. A representative may not withdraw his representation of a Veteran after the certification of the appeal to the Board absent a showing of good cause on motion. 38 C.F.R. § 20.608 (b)(2). Here, the Veteran's agent did not provide a statement of good cause on motion, nor did he indicate that the Veteran was notified of the withdrawal prior to the April 2021 letter from the RO. Thus, the Board finds the representative's withdrawal was improper. Consequently, we continue to recognize the Veteran's private agent as his representative in this matter. 1. Entitlement to service connection for chronic venous insufficiency and varicose veins (claimed as bilateral ankle and calf condition), as secondary to total right knee replacement, is remanded. The Veteran seeks entitlement to chronic venous insufficiency and varicose veins as secondary to his service-connected total right knee replacement. In the November 2014 decision, the Board stated the claim was raised by the record, and referred the claim to the RO for further development. A VA medical opinion was obtained in December 2014, and the examiner determined that it was less likely as not that the Veteran's edema is proximately due to or the results of the Veteran's service-connected disability. As rationale, the examiner stated there was no indication that the Veteran's edema began directly after his knee surgeries. The Board finds this opinion is inadequate for adjudication purposes. The examiner does not consider the possibility that edema could have developed later due to the Veteran's knee surgeries, nor was an opinion provided as to whether the edema is aggravated by his service-connected disability. Additionally, the Veteran's medical records show he has diagnoses of varicose veins and lymphedema. A private treatment note from April 2000 shows the Veteran's physician noted the Veteran had significant edema and that swelling was common after knee surgeries. Another private physician stated in April 2016 that the Veteran's bilateral knee lymphedema is most likely a result of knee operations, but he did not provide any additional rationale. Remand is required to afford the Veteran a VA examination to confirm the currently diagnosed venous conditions and/or diseases associated with the bilateral lower extremities, and to obtain new medical opinions. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his chronic venous insufficiency and varicose veins. The examiner must review the claims file. 2. List all venous conditions and/or diseases associated with Veteran's bilateral lower extremities. 3. The examiner is asked to provide a response to the following for each diagnosis: (Continued on the next page) (a.) Is the condition at least as likely as not proximately due to service-connected status post total right knee replacement? (b.) Is the condition at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected status post total right knee replacement? Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Miller, 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.