Citation Nr: 21009559 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 16-10 289 DATE: February 22, 2021 REMANDED Entitlement to service connection for left lower extremity peripheral vascular disease (PVD) as secondary to the service-connected disability for coronary artery disease (CAD) is remanded. Entitlement to service connection for right lower extremity PVD as secondary to the service-connected disability for CAD is remanded. REASONS FOR REMAND The Veteran served honorably in the Army from March 1964 to November 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). An October 2019 Board decision remanded this matter as an opinion regarding aggravation was not provided in the October 2014 VA examination (VAX). The Board determined that a medical opinion addressing the issue of secondary service connection is inadequate where it fails to adequately encompass the question of aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 141 (2013).   The Veteran was afforded another VAX in November 2020. However, an opinion regarding aggravation was not provided. As the November 2020 VAX does not comply with the Board’s remand directives another remand is necessary to obtain an addendum opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding a veteran whose case is remanded by the Board has the right to VA’s compliance with the remand order). The matters are REMANDED for the following action: Obtain an addendum opinion to determine the nature and etiology of the Veteran’s PVD. The entire claims file along with this remand must be made available to and be reviewed by the examiner. The examiner must address whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left lower extremity PVD and right lower extremity PVD underwent any incremental increase in disability, regardless of its permanence, due to a service-connected CAD. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. In addressing the above opinions, the examiner must address the clinical significance, if any, that the diagnosis of the Veteran’s CAD predated his PVD as well as the Fact Sheet from St. Mary Medical Center indicating that CAD can increase a patient’s chance of developing PVD. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Smith, 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.