Citation Nr: 21023041 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 15-23 960 DATE: April 20, 2021 REMANDED Service connection for right leg venous thrombosis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to February 1969, with service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Board remanded this issue for further development. Service connection for right leg venous thrombosis is remanded. The Veteran contends that he was accepted into service with a right leg/foot disorder that was aggravated by his duties in active service. He also asserts that he was hospitalized for a blood clot while in Vietnam. The Veteran’s service treatment records show no evidence of treatment for any right leg condition, to include the claimed hospitalization. His physical condition was noted as normal on clinical evaluation, on his February 1969 separation physical examination. However, as noted in the 2019 Board remand, there might be unavailable treatment records stemming from treatment in a combat zone. A November 2019 VA examiner diagnosed the Veteran with a hereditary hypercoagulable disorder of protein S deficiency. It was noted that the disorder was likely the cause of his venous thrombosis in the right leg. The examiner opined that it was less likely his disorder was incurred in or caused by his service. It was explained that protein S deficiency is a hereditary condition that affects blood clotting and increased the risk of developing abnormal blood clots. While the Veteran reported his first blood clot in Vietnam, the examiner could not confirm a diagnosis or treatment from the available service records. However, even though it was possible that his disorder manifested during active service with a blood clot in 1969, it is a hereditary condition that would not have been caused by service. A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by service. 38 U.S.C. §1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). The July 1967 entrance examination and an accompanying letter from his treating doctor noted that he had a deep laceration in his left foot prior to service. As such, the Veteran’s disorder was not noted on acceptance into service. The presumption of soundness does not, however, apply to congenital or developmental defects because such defects are not "diseases or injuries" within the meaning of 38 U.S.C. §§ 1110 and 1111. Nevertheless, service connection may be granted due to aggravation of a congenital or developmental defect by a superimposed disease or injury. See VAOPGCPREC 82-90 (July 18, 1990); see also Carpenter v. Brown, 8 Vet. App. 240 (1995). Likewise, service connection may be granted for diseases (but not defects) of congenital, developmental, or familial (hereditary) origin if the condition was incurred in or aggravated during service beyond its natural progression. In this case, the VA examiner’s diagnosis as well as the treatment records indicating that he has a hereditary hypercoagulable disorder of protein S deficiency raises the possibility that the Veteran had a disorder that pre-existed active service. Accordingly, on remand, an inquiry must be made as to whether there is clear and unmistakable evidence that the Veteran had such a condition prior to service. Based on the above, an opinion regarding whether the Veteran’s disorder pre-existed active service and, if so, whether it was aggravated by service is necessary in order for the Board to make a fully informed decision. This matter is REMANDED for the following action: Schedule the Veteran for a VA examination for to determine the nature and etiology of his hereditary hypercoagulable disorder of protein S deficiency. The examiner must review the claims file. --First, please describe the medical nature of hypercoagulable disorder of protein S deficiency. If medical literature is used, please provide a copy or a full citation to the material. Then, the examiner is asked to provide a response to the following: a) Did the hypercoagulable disorder of protein S deficiency clearly and unmistakably (i.e., undebatably) pre-exist the Veteran’s active service? b) If the examiner finds hypercoagulable disorder of protein S deficiency did clearly and unmistakably pre-exist service, was it clearly and unmistakably NOT aggravated by service? --Please explain why or why not for the answers to questions in a) and/or b), to include references to the record and/or medical literature.   c) If the examiner finds that hypercoagulable disorder of protein S deficiency either did not clearly and unmistakably preexist service, or was NOT clearly and unmistakably aggravated by service, then the examiner must opine whether it is at least as likely as not related to service. **In answering the questions above, please address the Veteran’s assertion of being hospitalized for a blood clot in the right leg in Vietnam, to include being taken to a MASH hospital. He also stated that discoloration continued after his military service. See 6/22/2015 VA Form 9.** (CONTINUED ON THE NEXT PAGE)   A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cruz, 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.