Citation Nr: 21020852 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 14-28 835 DATE: April 8, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left leg disability (to include bilateral varicose veins, peripheral vascular disease, venous stasis, ulceration, and cellulitis) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to June 1976. These matters are on appeal to the Board of Veterans’ Appeals (Board) from an August 2011 rating decision. The Veteran was initially denied service connection for these claims in December 1999. October 2007 and August 2011 rating decisions again denied the claims for lack of new and material evidence. A hearing was held with the undersigned Veterans Law Judge in October 2017. In March 2018, the Board found that new and material evidence had been received, reopened the claims, and remanded to obtain updated records and VA examinations. In January 2020, the Board remanded the claims as it found the July 2019 VA examinations inadequate for adjudication purposes. While the Board regrets the additional delay, remand is once again necessary. 1. Entitlement to service connection for a left knee disability The Veteran contends his left knee disability is related to in-service injuries, to include a motor vehicle accident and/or trampoline accident, and it has progressively worsened since service. A VA opinion was rendered in February 2020. The examiner opined the Veteran’s left knee disability is less likely than not related to service. He reasoned that “while the Veteran had knee injuries as per his records, which could have started this process and in 07-17-1972, he complained of left knee slipping, there is no evidence of knee problems at the time of discharge from the military.” He continued that given the Veteran’s age and comorbidities, his arthritis and left knee replacement are less likely related to service. The Board finds this opinion internally inconsistent, as the examiner appeared to acknowledge that the Veteran’s in-service knee injuries could have started the process but ultimately finds his disability to be less likely than not related to service. Thus, remand is necessary to clarify whether the Veteran’s current knee disability is related to the knee injuries and complaints in service. 2. Entitlement to service connection for a left leg disability The Veteran contends his left leg disability has existed since service. In his hearing, he explained that he sought treatment for blisters post-service and learned he was allergic to the socks he had been wearing for 20 years. A VA opinion was rendered in February 2020. The examiner opined the Veteran’s left leg disabilities are less likely than not related to service. The examiner stated that as for the Veteran’s varicose veins, venous stasis, and peripheral vascular disease he could not pinpoint an issue from the military that could cause these conditions, and the other conditions are due to a poor vascular system, which would be exacerbated by his underlying health conditions and age. The Veteran has multiple comorbidities, to include diabetes and metabolic syndrome, which would be the more likely cause. The examiner also opined that the Veteran’s knee disability is separate from his leg disabilities. He stated that osteoarthritis would not cause his venous problems. His venous problems are more likely due to his age and underlying medical issues, and his arthritis is caused by degenerative changes in his knee over time. The Board finds clarification is necessary to ensure a fully informed decision can be made. In his brief, the Veteran contends the examiner did not consider cellulitis and ulcerations as directed in the January 2020 remand. While the examiner does not expressly address cellulitis and ulcerations, he does more broadly state “other conditions” and “venous problems.” However, as there are several different diagnoses regarding the left lower extremity, a clarified opinion regarding each separate diagnosis and the etiology thereof is necessary. Moreover, the Veteran has contended that his leg disabilities are related to an allergy to socks he wore “for most of his life,” which, while described in the medical history of the examination report, should be addressed in the examiner’s rationale in reaching his conclusion. The Veteran also stated in his October 2017 hearing that he had “itching problems” with his left leg in service. Upon remand, the examiner must consider whether the Veteran’s in-service symptoms are related to his left leg disabilities diagnosed after service. The matters are REMANDED for the following action: Obtain VA addendum opinions for the Veteran’s left knee and left leg disabilities. (a) As for the left knee, the examiner is asked to clarify his previous opinion that the Veteran’s in-service treatment for a left knee injury could have started the process for his current disability. (b) As for the left leg, the examiner is asked to identify and define each diagnosis involving the left lower extremity (including each listed on the first page of this decision) and explain the etiology of each to the extent it is known and accepted in the medical field. First, the examiner is asked to address the Veteran’s contention that his leg problems stem from an allergy to nylon socks and explain the merits of that contention based on the examiner’s medical knowledge and expertise. The examiner may need to clarify with the Veteran when he began wearing nylon socks, and, additionally, why he began wearing them, as the report states he wore them for “most of his life” for venous insufficiency, yet also states he learned of his venous insufficiency in 2018. Second, the examiner is asked to consider and address the medical significance, if any, to the Veteran’s statements in his hearing regarding “itching problems” of the left leg in service and his use of calamine lotion and subsequent development of blisters. Again, the examiner may need to communicate with the Veteran as necessary. The examiner must again opine whether any disability involving his left knee and left leg is at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) related to an in-service injury, event, or disease, including the documented in-service incidents. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Carroll, 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.