Citation Nr: 21012849 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 13-24 756 DATE: March 5, 2021 REMANDED Entitlement to service connection for left below the knee amputation residuals is remanded. Entitlement to service connection for a right knee disorder to include total knee replacement residuals is remanded. Entitlement to service connection for a right lower extremity disorder to include muscle and tendon injury is remanded. Entitlement to service connection for a right lower extremity neurological disorder to include right foot peripheral neuropathy is remanded. Entitlement to service connection for a left lower extremity neurological disorder to include peripheral neuropathy is remanded. REASONS FOR REMAND The Veteran had active service from October 1954 to September 1956. The Veteran’s spouse is the Appellant in the instant appeal. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a December 2012 rating decision of the Seattle, Washington, Regional Office (RO). The Board remanded this case in August 2016, June 2017 and December 2020. 1. Service connection for left below the knee amputation residuals The case was remanded in December 2020 for medical opinion regarding whether the left below the knee amputation was aggravated by his service-connected disabilities. The examiner concluded that none of the service-connected skin disabilities affected the below the knee amputation stump. In providing the rationale, the examiner pointed out that tinea manum affected the hands and eczema affected the ears. Further, onychomycosis (tinea unguium) of the toenails and dermatophytosis pedis were no longer present following amputation. However, this explanation is not complete. The examiner does not refer to or explain a June 9, 2015, VA outpatient report showing treatment for a skin fungal infection of the stump similar to an unidentified skin disorder that the Veteran indicated that he had received prior treatment. It is not clear if this fungal infection was systemically or otherwise medically related to his service-connected skin conditions although the previous sites of infection were absent. Especially since the Veteran suggested (and possibly prescribed) the same medication as previously prescribed for skin conditions. Supplemental statements are needed. 2. Service connection for a right knee disorder to include total knee replacement residuals 3. Service connection for a right lower extremity disorder to include muscle and tendon injury 4. Service connection for a right lower extremity neurological disorder to include right foot peripheral neuropathy 5. Service connection for a left lower extremity neurological disorder to include peripheral neuropathy The Board finds that the issues of service connection for the claimed bilateral lower extremity disorders are inextricably intertwined with the claim for service connection for left below the knee amputation residuals, and thus must be deferred pending resolution of that claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together). The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate medical professional to obtain a VA medical opinion to determine the nature and etiology of the Veteran’s left below the knee amputation and its relationship, if any, to service connected disorders. Following a review of the claims file, to include a copy of this remand, the examiner is asked to provide an opinion as to the following: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the infection which necessitated the Veteran’s left below the knee amputation had its onset during active service or was related to any incident of service? b) Whether it is at least as likely as not (a 50 percent or greater probability) that the infection which necessitated the Veteran’s left below the knee amputation was due to a service-connected disability? c) Whether it is at least as likely as not (a 50 percent or greater probability) that the infection which necessitated the Veteran’s left below the knee amputation was aggravated beyond normal progression by a service-connected disability? The examiner is asked to address the May 2017 submitted medical treatise regarding bacteremia as well as the June 2015 treatment for a fungal infection of the BKA stump. During the Veteran’s lifetime, service connection was in effect for nerve damage of the right hand, a right wrist disability, and a skin disability. The Appellant contends that the Veteran’s left below the knee amputation was secondary to his service-connected eczema with tinea manum, onychomycosis, tinea unguium, and dermatophytosis pedis. Specifically, she contends that his service-connected disabilities caused a cutaneous infection in his left leg, which in turn resulted in the amputation of the left leg below the knee. A complete rationale must be provided for all opinions expressed. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.D. Jackson, 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.