Citation Nr: 21066565 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 20-18 001 DATE: November 1, 2021 REMANDED Entitlement to a disability rating in excess of 20 percent for peripheral vascular disease of the left lower extremity is remanded. Entitlement to a disability rating in excess of 20 percent for peripheral vascular disease of the right lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1975 to January 1978. This case comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of September 2018 issued by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to a disability rating in excess of 20 percent for bilateral peripheral vascular disease of the lower extremities. The Veteran's peripheral vascular disease is rated as 20 percent disabling for each of the lower extremities under Diagnostic Code (DC) 7114. See August 2020 Rating Codesheet at 1. The applicable rating criteria provide that a disability rating in excess of 20 percent is not assigned unless there is claudication on walking between 25 and 100 yards on a level grade at 2 miles per hour, as well as trophic changes (such as thin skin, an absence of hair, or dystrophic nails) or an ankle/brachial index of 0.7 or less. See 38 C.F.R. § 4.104, DC 7114. The Board notes that "claudication" in this context refers to pain, aches, or cramps experienced while walking. See "Peripheral Arterial Disease (PAD)," Centers for Disease Control and Prevention (obtained via https://www.cdc.gov/heartdisease/PAD.htm); see also 38 C.F.R. § 4.104, DC 7114, Note (1) (defining the ankle/brachial index as "the ratio of the systolic blood pressure at the ankle (determined by Doppler study) divided by the simultaneous brachial artery systolic blood pressure"). The Veteran asserts that "I experience pain in both legs when I walk up a flight of stairs... [and] when I walk a block[,]" and that "[my] [legs] are shiny and without hair." See April 2020 VA Form 9 at 2 (emphasis added); see also id. (asserting that "[my] toenail turned black on [my] great toe and [the] podiatrist easily removed it"); see also April 2020 Correspondence (supporting statement from the Veteran's spouse asserting in pertinent part that he experiences leg pain after climbing stairs). Because the rating criteria discussed above specifically provide that claudication is assessed "[while] walking... on a level grade," the Veteran's assertion regarding climbing stairs is not relevant to this adjudication. However, the Veteran's other assertions directly address several of the rating criteria applicable to a 40 percent disability rating as discussed above. The Veteran has undergone two previous VA examinations addressing these issues. The Board now finds now finds that these examinations are inadequate to sustain adjudication. Accordingly, remand for an addendum opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (providing that "once the [VA] undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, [it] must provide an adequate one"). A VA examination of August 2018 noted February 2017 ankle/brachial index testing results of 1.12 bilaterally. See August 2018 VA Examination Report at 3. However, this examination did not address evidence of claudication in the Veteran's private medical treatment records. See id.; cf. June 2018 Medical Treatment Records at 42 (noting claudication during same February 2017 private treatment). A subsequent VA examination of February 2020 noted the Veteran's assertions of leg pain with walking. See February 2020 VA Examination Report at 2. This examiner found that the Veteran experienced bilateral claudication on walking more than 100 yards. See also id. at 3. However, the reasoning supporting the conclusion that the Veteran can walk up to 100 yards without claudication is not apparent from the examination report. "[Most] of the probative value of a medical opinion comes from its reasoning. Neither a VA medical examination report nor a private medical opinion is entitled to any weight... if it contains only data and conclusions." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, neither examiner appears to have addressed whether trophic changes are in fact present. The Board notes that the format of each examination report requests that the VA examiner identify "[the] severity of current signs and symptoms" by "check[ing] all that apply[.]" See February 2020 VA Examination Report at 3 (emphasis added); see also August 2018 VA Examination Report at 2. It is therefore unclear to the Board whether the VA examiners looked for, but did not find, trophic changes among the Veteran's symptoms, or whether such examinations were not conducted. Remand for clarification on this point is therefore warranted. Nieves-Rodriguez, 22 Vet. App. at 304. Likewise, the February 2020 VA examiner indicated that ankle/brachial index testing was not performed. See February 2020 VA Examination Report at 4. It is unclear to the Board how rapidly ankle/brachial index test results may be expected to change, or whether test results of February 2017 remain adequate to support adjudication more than four years later. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (providing that the Board is not qualified to make its own medical determinations and must rely on independent and qualified medical expertise). Remand for clarification on this point is therefore also warranted. These matters are therefore REMANDED for the following action: Return the Veteran's claims file to the February 2020 VA examiner. If the February 2020 VA examiner is unavailable, provide the Veteran's claims file to an appropriately-qualified examiner. The examiner shall review the claims file, including a copy of this remand, and address the following questions regarding the symptoms of the Veteran's bilateral peripheral vascular disease of the lower extremities: 1. Is claudication present on walking between 25 and 100 yards on a level grade at 2 miles per hour? 2. Are trophic changes present? 3. Does the Veteran have an ankle/brachial index of 0.7 or less? The examiner shall describe any reasoning or medical evidence, including tests administered or physical examination results, which support their conclusions. If the examiner is unable to answer any of these questions without conducting additional testing or in-person examination, schedule the Veteran for such an examination. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Blore, 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.