Citation Nr: 21008826 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 18-31 886 DATE: February 18, 2021 REMANDED Entitlement to service connection for a disorder of the hands and feet manifested by cold sensation, claimed as peripheral arterial disease, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1984 to June 1984, January 2003 to October 2003, and from October 2003 to November 2015 and his decorations include the Parachutist Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in February 2020. In April 2020, the Board, in pertinent part, remanded the issue of entitlement to service connection for peripheral arterial disease. In light of the resultant development, the Board has recharacterized the issue. Entitlement to service connection for a disorder of the hands and feet manifested by cold sensation, claimed as peripheral arterial disease, is remanded. The Veteran seeks service connection for a disorder of the hands and feet manifested by cold, which he contends had its onset in service or is otherwise secondary to his service-connected heart disability. Service treatment records show that the Veteran was diagnosed with peripheral vascular disease in February 2014; however, in April 2015, a VA examiner opined that the Veteran did not have a current diagnosis of peripheral artery disease. The Veteran reports that he continues to experience the sensation of cold hands and feet that was diagnosed as peripheral vascular disease during service in 2014. See VA examination (April 2015). In April 2020, the Board remanded the appeal for a medical examination to (i) determine the nature and etiology of the Veteran’s hand and foot symptoms, which he has claimed as peripheral artery disease; (ii) opine as to whether it is at least as likely as not that any current diagnosis is related to an in-service injury, event, or disease; and (iii) address the fact that the Veteran was diagnosed with peripheral vascular disease during service in February 2014 and that he reports that his hand and foot symptoms have been recurrent since that time. In December 2020, based on review of the Veteran’s medical records, a VA clinician agreed with the April 2015 VA examiner’s determination that the Veteran does not have peripheral vascular disease, to include peripheral arterial disease. The clinician cited a January 8, 2020, podiatry note, showing that vascular examination was unremarkable. The clinician explained that VA diagnostic criteria for peripheral artery disease requires ankle brachial index (ABI) and/or angiography conformation, which was not present in January 2020. The clinician further reasoned that peripheral vascular disease and peripheral arterial disease are not listed the Veteran’s VA medical records. Finally, the examiner reasoned that clinical evaluation of the Veteran’s vascular system was normal upon retirement in examination in March 2014. While the December 2020 clinician ruled out peripheral vascular disease, to include peripheral arterial disease, the clinician failed to address the nature, onset and etiology of the Veteran’s current symptoms (sensation of cold hands and feet), that is, determine whether such symptoms represent a diagnosable disability or functional impairment to earning capacity. The clinician also failed to address the fact that the Veteran was diagnosed with peripheral vascular disease during service in February 2014 and that he reports that his hand and foot symptoms have been recurrent since that time. As such, the Board finds that remand is needed to ensure compliance with the directives of its April 2020 remand. The matters are REMANDED for the following action: Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature, onset and etiology of the Veteran’s hand and foot symptoms, which he has claimed as peripheral artery disease. (a.) The examiner is to identify whether the Veteran’s competent, credible reports of cold sensation of the hands and feet represent a clinical diagnosis. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. (b.) As to each current disability, the examiner is to address whether it is at least as likely as not that such is related to an in-service injury, event, or disease. The examiner is to address the fact that the Veteran was diagnosed with peripheral vascular disease during service in February 2014 and that he reports that his hand and foot symptoms have been recurrent since that time. (c.) The examiner is also to address whether it is at least as likely as not that any current diagnosis is caused or aggravated by the Veteran’s service-connected heart disability or a neurological abnormality associated with any spinal disability. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joshua R. Castillo, 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.