Citation Nr: 21009512 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-04 241A DATE: February 22, 2021 REMANDED Entitlement to service connection for a disability manifested by swelling of the left lower extremity, to include venous insufficiency and lymphedema, is remanded. Entitlement to service connection for a disability manifested by swelling of the right lower extremity, to include venous insufficiency and lymphedema, is remanded. Entitlement to service connection for a left foot disability, (other than a disability manifested by swelling), is remanded. Entitlement to service connection for a right foot disability, (other than a disability manifested by swelling), is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1969 to June 1973. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded these matters for additional development in October 2018 and they have been returned to the Board for review. In January 2015, the Veteran filed an informal Motion to Advance on the Docket due to severe financial hardship. The Board granted the motion and the appeal has been advanced on the Board’s docket. See 38 U.S.C.§7107 (a) (2); 38 C.F.R.§20.902 (c). 1. Entitlement to service connection for a disability manifested by swelling of the left lower extremity, to include venous insufficiency and lymphedema, is remanded. 2. Entitlement to service connection for a disability manifested by swelling of the right lower extremity, to include venous insufficiency and lymphedema is remanded. The Veteran contends that his bilateral lower extremity disabilities are due to an infectious disease he contracted while serving in Vietnam. Specifically, he contends that such disabilities are due to in-service mosquito bites by mosquitos infected with wucheria bancrofti nematodes, while stationed in Vietnam, which caused “massive” blisters and boils which continue to this day, resulting in left and right lower extremity lymphedema. Alternatively, he contends that such disabilities are due to in-service exposure to ionizing radiation from x-ray machines he used to x-ray thousands of packages when he worked in the mail room. Additionally, he contends that such disabilities are due to exposure to Agent Orange during his service in Vietnam. See generally articles and lay statements submitted by the Veteran in 2012, 2013 and 2015. The Veteran’s VA treatment records show diagnoses of bilateral lower extremity venous insufficiency and lymphedema of the left and right lower extremities, thus present bilateral lower extremity disabilities are established. The Veteran’s service treatment records show multiple complaints of and treatment, including hospitalization, for persistent lower level extremity lesions, abscesses and boils, which did not respond to therapy. Two of the Veteran’s performance reports show that he was a mail processing technician at the Saigon aerial mail terminal in Saigon, Vietnam from September 1970 to September 1971, which is during the Vietnam era. Thus, the Veteran is presumed to have been exposed to herbicides. Additionally, the Board finds that the Veteran was exposed to ionizing radiation from an x-ray machine. Pursuant to the October 2018 Board Remand, the Veteran was provided with a VA examination. The Board finds that the September 2020 examination does not fully address the Veteran’s contentions, or the evidence discussed above, pertaining to the Veteran’s bilateral lower extremity disabilities. Thus, the Board finds that there has not been substantial compliance with the Board’s remand directives and the appeals must be remanded for a new examination. See Stegall v. West, 11 Vet. App. 268 (1998). 3. Entitlement to service connection for a left foot disability, (other than a disability manifested by swelling), is remanded. 4. Entitlement to service connection for a right foot disability (other than a disability manifested by swelling), is remanded. The Veteran contends that he has left and right foot pain that is the result of prolonged standing in the mail room during service. See Statement in Support of Claim, received July 2010. In the October 2018 Board Remand, the RO was asked to obtain a medical examination which addressed all currently diagnosed foot disabilities in the appeal period (to include DJD and calcaneal spurs). The Veteran had a VA examination in September 2020, but the examiner did not address the DJD and calcaneal spurs diagnoses of record during the appeal period. Thus, the Board finds that there has not been substantial compliance with the Board’s remand directives and the appeals must be remanded for addendum opinions. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Schedule a medical examination with a different examiner(s) than the examiners who performed the November 2010 and September 2020 examinations for the Veteran’s left and right lower extremity swelling disabilities. The examiner(s) must review the entire claims file as well as a copy of this Remand. Regarding the Veteran’s left and right swelling of the lower extremities, to include venous insufficiency and lymphedema, the examiner is asked to identify any additional disabilities associated with swelling of the Veteran’s left and right lower extremities. a) For each disability of record associated with swelling of the left and right lower extremities, including venous insufficiency and lymphedema, is it at least as likely as not (50 percent probability or greater) that such disability is related to in-service treatment for the same symptomatology? The examiner should specifically address the Veteran’s in-service treatment for persistent lower level extremity lesions, abscesses and boils, which did not respond to therapy. The examiner should also consider the contention regarding the disability being caused by mosquito bites which became infected. Any opinion must be supported by a complete rationale. b) For each disability associated with swelling of the left and right lower extremities, including venous insufficiency and lymphedema, is it at least as likely as not that any such disability is related to exposure to an herbicide agent, including Agent Orange? Any opinion must be supported by a complete rationale. c) For each disability associated with swelling of the left and right lower extremities, including venous insufficiency and lymphedema, is it at least as likely as not that any such disability is related to in-service exposure to ionizing radiation from sending mail through an x-ray machine? Any opinion must be supported by a complete rationale. The Veteran should be considered credible for the limited purpose of the examination requested herein. 3. Schedule a medical examination with a different examiner(s) than the examiners who performed the November 2010 and September 2020 examinations for the Veteran’s foot disabilities. The examiner(s) must review the entire claims file as well as a copy of this Remand. a) Please list all currently diagnosed bilateral foot disabilities (to include DJD and calcaneal spurs). If the Veteran does not have any foot disabilities, the examiner must opine whether the Veteran has foot or ankle pain resulting in functional impairment. b) For each disability diagnosed during the relevant period, or if no disability is diagnosed, for any pain with functional impairment, is it at least as likely as not (50 percent or greater probability) that such disability or pain began in service or is causally and etiologically related to service? The examiner must address the August 1970 STR and the November 2010 X-ray findings. The examiner must also address the Veteran’s lay statement that he developed a foot disability due to prolonged standing in the mailroom during service, as well as his lay statements regarding symptomatology both during and since active service. Any opinion must be supported by a complete rationale. The Veteran should be considered credible for the limited purpose of the examination requested herein. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Susan Leary, 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.