Citation Nr: 21006896 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 15-26 972 DATE: February 5, 2021 REMANDED The claim of entitlement to service connection for poor circulation of the bilateral legs is remanded. REASONS FOR REMAND The Veteran had active service from August 1980 to September 1983. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2013 rating decision by the Agency of Original Jurisdiction (AOJ). The Veteran seeks service connection for a disability characterized by poor circulation of the bilateral legs, to include as secondary to his service-connected left ankle disability. This issue has been remanded by the Board on two occasions. In September 2018, the Board directed that an examination be conducted to determine the etiology of the claimed circulatory disorder. Specifically, the Board directed that an examiner provide an opinion regarding whether the claimed disability was caused or aggravated by the Veteran’s service-connected left ankle strain. In April 2020, the Board noted that a September 2019 VA examiner had opined that the Veteran’s poor circulation was more likely than not due to the Veteran’s history of cigarette smoking. The Board observed that in forming his conclusion, the examiner had not discussed any of the medical evidence of record, to include evidence demonstrating that the Veteran’s peripheral vascular disease was worse in his left lower extremity. The Board pointed out that on doppler study in 2014, occlusive disease was diagnosed in the bilateral lower extremities that was worse on the left, and that the Veteran had endorsed claudication and cramping in the lower extremities that was worse on the left. The Board directed that the Veteran be afforded an additional examination that addressed both direct and secondary service connection. On VA examination in September 2020, the diagnosis was peripheral vascular disease of the bilateral lower extremities with claudication. The examiner did not provide an opinion regarding whether the Veteran’s peripheral vascular disease was related to any disease or injury during service. Regarding a relationship with the Veteran’s service-connected left ankle disability, the examiner determined that the claimed condition was less likely than not proximately due to or the result of the service-connected disability. She reasoned that the medical literature did not support a relationship between ankle strain and peripheral vascular disease. She indicated that peripheral vascular disease was more likely the result of the Veteran’s smoking history, and that a nexus with ankle strain had not been established. She did not provide an opinion regarding whether peripheral vascular disease was aggravated by the service-connected left ankle strain. Considering the September 2020 examiner’s failure to provide an opinion on the matter of whether peripheral vascular disease was aggravated by the Veteran’s service-connected left ankle strain, the Board concludes that an additional examination must be conducted to address this question. Finally, the Board notes that in November 2020, the Veteran contacted the AOJ and reported that he had undergone examination on October 7, 2020. It is unclear whether an additional examination was conducted following the September 2020 examination, or whether the Veteran was otherwise provided VA treatment on the date he reported. Notably, the record contains VA outpatient records through September 2020. The AOJ should obtain any outstanding VA treatment records from that date, to include examination reports. The matters are REMANDED for the following action: 1. Obtain all relevant outstanding VA treatment and examination reports from September 15, 2020 to the present and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the etiology of his lower extremity peripheral vascular disease. The claims file must be made available to the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Following review of the record and examination of the Veteran, the examiner should provide an opinion with respect to whether it is at least as likely as not that peripheral vascular disease is related to any incident of service. The examiner should also provide an opinion with respect to whether it is at least as likely as not (50 percent or more probability) that peripheral vascular disease was caused OR aggravated (worsened beyond normal progression) by the Veteran’s service-connected left ankle disability. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner 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. The 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 examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner 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. 3. Then, readjudicate the Veteran’s claim, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Barone, 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.