Citation Nr: 21068704 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 13-19 058 DATE: November 12, 2021 REMANDED Entitlement to service connection for peripheral vascular disease (PVD) of the right and left lower extremities is remanded. Entitlement to service connection for frostbite of the right and left hands is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1976 to April 1981. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for the claims on appeal. In January 2017, the Board remanded the claim to schedule the Veteran for a Board hearing per his request. In May 2017, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. In August 2017, the Board remanded the claim for further development. Thereafter, in July 2019, the Board denied both claims. The Veteran timely appealed the decision to the United States Court of Appeals for Veterans Claims (Court), and by a May 2020 Order, the Court granted a Joint Motion for Remand (JMR) that vacated and remanded both issues for further adjudication. In October 2020, the Board remanded the claim to obtain VA examinations and etiology opinions, and Social Security Administration (SSA) records. Pursuant to the Board's October 2020, SSA records were obtained and are of record. The Veteran was afforded VA examinations in February 2021, and the examination report and associated medical opinions are of record and have been reviewed. The February 2021 VA examiner opined that the Veteran's PVD was less likely than not related to service as there was no clinical evidence to suggest that the condition had any causal relationship to the Veteran's military service. The examiner stated that the Veteran's chronic and poorly controlled hypertension and diabetes in addition to being a long-time smoker and having elevated cholesterol were the likely causes of the Veteran's PVD. The examiner also opined that the claimed frostbite was less likely than not related to service as there was no chronic diagnosis of frostbite of the left or right hands and that the Veteran's symptoms were subjective only. For the reasons expressed below, the February 2021 VA medical opinions do not adequately address the directives of the October 2020 Board remand. Although the Board regrets the additional delay, remand is again necessary to ensure compliance with the Board's October 2020 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that a remand by the Court or the Board confers on the Veteran as a matter of law, the right to substantial compliance with the remand). PVD The February 2021 VA medical opinions reflect several deficiencies. First, the examiner did not address the Board's remand directive regarding whether the Veteran's lay reports of having had pain and spasms in both legs and calves during service represented symptoms of early onset of PVD and whether the duties associated with his MOS as a heavy equipment operator and the impact of running on the ground during inservice training could have been the cause of his now diagnosed PVD. See Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). Moreover, the examiner did not actually explain the medical basis for the conclusion that the Veteran's hypertension, diabetes, long-time smoker, and elevated cholesterol levels were the likely cause of the Veteran's PVD and not the in-service events. See also Nieves-Rodriguez, 22 Vet. App. 295, 304 (2008) (stating that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). Frostbite In the prior remand, the Board directed the VA examiner to address the Veteran's lay statements of numbness and tingling in both hands. The examiner did not diagnose frostbite or its residuals, noting that the Veteran's symptoms are subjective only. However, the Board notes that the Veteran is competent to report those observable symptoms. On remand, the examiner should determine whether the Veteran's competent lay reports of numbness and tingling in both hands is consistent with frostbite residuals, and if so, whether they are related to service. The matters are REMANDED for the following action: 1. Ensure that any outstanding VA treatment records are associated with the claims file. 2. Then, obtain an addendum opinion from a VA examiner other than the one who authored the February 2021 opinions, and who is a VA physician (M.D.) to help determine the likely etiology of the Veteran's PVD. The claims file and a copy of this remand must be made available to the examiner, who will acknowledge receipt and review of these materials. **The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After review of the record, the examiner is asked to respond to the following: (a) Provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that the diagnosed PVD had its onset during service or is otherwise related to it. (b) In addressing this question, the examiner must clarify: Whether the in-service leg and calf pain and spasms described by the Veteran were indications of an early onset of PVD and whether the Veteran's MOS duties contributed to the now diagnosed PVD. The standard of review is more likely than not. A complete rationale should be provided for all opinion. 3. Obtain another opinion from a VA examiner other than the one who authored the February 2021 opinions, and who is a VA physician (M.D.) to help determine the likely etiology of the Veteran's claimed frostbite or its residuals. The claims file and a copy of this remand must be made available to the examiner, who will acknowledge receipt and review of these materials. **The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After review of the record, the examiner is asked to respond to the following: (a) Indicate whether the Veteran's competent reports of numbness and tingling in both hands since service is consistent with a diagnosis of frostbite residuals. Explain why or why not. (b) Regardless of whether there is sufficient evidence to diagnose frostbite or its residuals, provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran's current hand numbness and tingling is related to claimed frostbite injuries while lifting steel equipment in the snow and only wearing wet leather gloves with a thin liner. 4. After completing any other development that may be warranted, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Beach, 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.