Citation Nr: A21019262 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 211008-190982 DATE: December 3, 2021 REMANDED Entitlement to an initial compensable rating for left leg varicose veins is remanded. Entitlement to an initial compensable rating for right leg varicose veins is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1968 to February 1970. The rating decision on appeal was issued in June 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the October 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(a)(2). 1. Entitlement to an initial compensable rating for left leg varicose veins. 2. Entitlement to an initial compensable rating for right leg varicose veins. The Veteran's representative contends that the Veteran's leg ulcers are due to his varicose veins, and that a 60 percent rating is warranted under Diagnostic Code 7120. See Appellate Brief (October 2021). The issues of entitlement to initial compensable ratings for left and right leg varicose veins are remanded to correct duty to assist errors that occurred prior to the June 2021 decision on appeal. 38 C.F.R. § 20.802(a). The first error involves VA's duty to assist in obtaining private treatment records. 38 C.F.R. § 3.159(c)(1). Prior to the June 2021 rating decision on appeal, the Veteran submitted evidence which indicates that there are relevant outstanding private treatment records. A September 2018 private opinion from Dr. J.B. states that the Veteran has been a patient receiving treatment from that doctor for the last 20 years. See Medical Treatment Record - Non-Government Facility (October 2018). However, the records from that treatment have not been obtained. Additionally, a September 2018 private opinion from Dr. K.F. states that the Veteran underwent an initial evaluation in March 2018 and was treated for weeks after that evaluation. See Medical Treatment Record - Non-Government Facility (October 2018). However, the records from that evaluation and treatment have not been obtained. A remand is required to allow VA to obtain these records. The second error involves VA's duty to provide a medical examination and opinion. 38 C.F.R. § 3.159(c)(4). Although the AOJ obtained a medical opinion and addendum opinion prior to the June 2021 rating decision on appeal, where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the April 2021 VA clinician cited a medical study to support the opinion that the Veteran's symptoms are not caused by his varicose veins. However, the clinician provided no facts specific to the Veteran, such as the onset date and progression of his disabilities. Moreover, the opinion provides no meaningful discussion of the facts pertaining to the Veteran's condition and how the referenced materials are applicable to the Veteran's specific facts. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (an opinion is inadequate when based solely on general articles without a meaningful discussion of the facts pertaining to a veteran's condition or individual circumstances). Additionally, the Board finds that the June 2021 opinion is inadequate as it contains a conclusory finding supported by no analysis. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007) (an adequate medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record). The June 2021 VA clinician opined that the Veteran's varicose veins are asymptomatic, without any associated manifestations, including edema. However, the clinician provided no analysis of the evidence used to reach that determination, which prevents the Board from weighing the opinion against the conflicting evidence of record. VA treatment records also show that an attending clinician noted that the Veteran's lower extremity edema was "nonspecific." See CAPRI (May 2019). As the VA clinician in June 2021 opined that the Veteran's symptoms of ulceration, edema, and eczema (which are contemplated by a compensable rating under Diagnostic Code 7120 for varicose veins but are not contemplated by the currently assigned ratings for venous insufficiency and Raynaud's syndrome) are not manifestations of varicose veins, but provided no analysis to support the opinion, it is inadequate. Therefore, remand is required for the correction of errors in fullfilling VA's duty to assist. 38 C.F.R. § 3.159. Accordingly, the matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the records of treatment for varicose veins with Dr. J.B. and Dr. K.F. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Thereafter, schedule an examination by an appropriate clinician who has not previously examined the Veteran to determine the current severity of his service-connected left and right leg varicose veins. The examiner should report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. In doing so, the clinician must discuss and opine on whether the Veteran's symptoms of swelling, itching, stasis pigmentation, pain after prolonged standing, lower extremity ulceration, edema, and eczema are caused by service-connected (1) varicose veins, (2) venous insufficiency, or (3) Raynaud's syndrome. (Continued on the next page) To the extent possible, the examiner should identify any functional impairments due to right and left leg varicose veins alone and discuss the effect of the Veteran's right and left leg varicose veins on any occupational functioning and activities of daily living. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. A complete rationale should be provided for all opinions. If an opinion cannot be expressed without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Thaddaeus J. Cox, 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.