Citation Nr: 21075547 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 15-00 303A DATE: December 20, 2021 REMANDED Entitlement to service connection for venous ulcer and leg cellulitis with scars of the right lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1977 to June 1986. The Veteran appealed an April 2010 rating decision by the Agency of Original Jurisdiction (AOJ). A Board of Veterans' Appeals (Board) hearing was held in June 2018 before a Veterans Law Judge (VLJ) who has since retired from the Board. A transcript is of record. In November 2021, the Department of Veterans Affairs (VA) sent the Veteran a letter offering a new hearing. The Veteran has not since requested a new hearing. The Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The September 2019 Board decision remanded the issue for a new etiology opinion. The Veteran contends that her right leg ulcer condition is due to either in-service pregnancies that caused a blood clot, or secondary to her service-connected right ankle condition that caused swelling and decreased blood flow. See August 2019 informal hearing presentation (IHP). However, as noted in the October 2021 IHP, the February 2020 opinion did not address the Veteran's pregnancy contention. Furthermore, the opinion noted there was no permanent aggravation by the Veteran's right ankle condition. However, permanent aggravation is not necessary for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). The Board finds remand is required for another etiology opinion that properly addresses all contentions and theories of entitlement. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for her right lower extremity ulcer condition that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and her representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's right lower extremity ulcer condition. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran's right lower extremity ulcer condition was incurred in, or otherwise related, to her time on active service, to include in-service pregnancies and any in-service right leg injuries? Is it at least as likely as not that the Veteran's right lower extremity ulcer condition was CAUSED by her service-connected right ankle condition? Is it at least as likely as not that the Veteran's right lower extremity ulcer condition was AGGRAVATED by her service-connected right ankle condition? In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report her symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and her representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.