Citation Nr: 21064874 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 05-00 220 DATE: October 21, 2021 REMANDED Service connection for a vein disability to include lupus anticoagulant, deep vein thrombosis, or post-phlebitic syndrome is remanded. Service connection for a seizure disability is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from June 1983 to August 1993. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) made in April 2004 and April 2007. These matters are being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in December 2015, and a transcript of the hearing is of record. These matters were previously before the Board, and, in July 2015 and in December 2017, the Board remanded these matters for further development. The Board notes that the issue of entitlement to service connection for multiple sclerosis and an acquired psychiatric disorder were previously remanded for further development. Service connection for multiple sclerosis and an acquired psychiatric disorder were granted in June 2021 and February 2020 respectively. This is considered a full grant of the Veteran's requested prayer of relief, and these issues are no longer on appeal. The Board notes that in an August 2021 appellant brief the Veteran raised the possibility of being granted multiple disability ratings under different psychiatric diagnoses. The practice of providing multiple disability ratings under different diagnoses for duplicative or overlapping symptomology, also known as pyramiding, is to be avoided, and the Veteran has not alleged any psychiatric symptoms that are not currently being compensated for under the current disability rating for an acquired psychiatric disorder. 38 C.F.R. § 4.14. 1. Service connection for a vein disability to include lupus anticoagulant, deep vein thrombosis, or post-phlebitic syndrome is remanded. At issue is whether the Veteran is entitled to service connection for lupus anticoagulant. The Veteran underwent a VA examination in April 2021. The examiner diagnosed that the Veteran lupus anticoagulant and indicated that a medical nexus did not exist between lupus anticoagulant and an in-service incurrence. Nevertheless, the examiner also diagnosed the Veteran also diagnosed the Veteran with deep vein thrombosis and post-phlebitic syndrome, but the examiner did not opine on whether or not medical nexuses existed between these disabilities. The Veteran's deep vein thrombosis and post-phlebitic syndrome are within the scope of his claim for service connection for lupus anticoagulant. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Once VA undertakes the effort to provide the Veteran with an examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed in order to ensure that VA's evaluation of the Veteran's claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, this matter must be remanded for a new VA examination in order to address whether or not a medical nexus exists between an in-service incurrence and a current vein disability to include deep vein thrombosis or post-phlebitic syndrome. 2. Service connection for a seizure disability is remanded. At issue is whether the Veteran is entitled to service connection for a seizure disability. The Veteran underwent a VA examination in April 2021 which indicated that the Veteran's seizures were not due to an in-service incurrence, but that treatment for the Veteran's previously service-connected multiple sclerosis "hastened" the Veteran's seizures. Once VA undertakes the effort to provide the Veteran with an examination, it must provide the Veteran with an adequate one, and an adequate examination is sufficiently detailed in order to ensure that VA's evaluation of the Veteran's claim is fully formed. See Barr. Therefore, this matter must be remanded for a new VA examination in order to determine whether or not the Veteran is entitled to service connection for a seizure disability on a secondary basis. The matters are REMANDED for the following action: 1. Arrange to provide the Veteran with a VA examination in order to address the following. Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a vein disability to include lupus anticoagulant, deep vein thrombosis, or post-phlebitic syndrome? Why or why not? 2. Arrange to provide the Veteran with a VA examination in order to address the following: (a.) Is it at least as likely as not (50 percent or more) that a seizure disability is proximately due to or aggravated by a previously service-connected disability to include multiple sclerosis? Why or why not? (b.) If the Veteran's seizures are aggravated by a previously service-connected disability, then please estimate the baseline severity of the Veteran's seizures absent any disabling effects? Why? DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David R. Seaton, 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.