Citation Nr: 21026991 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-28 924A DATE: May 4, 2021 REMANDED Entitlement to service connection for peripheral insufficiency of the bilateral lower extremities as secondary to the service-connected disabilities of the right and left foot is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to April 1971. This case is before the Board of Veterans' Appeals (Board) on appeal from a September 2013 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for peripheral insufficiency of the bilateral lower extremities. The Veteran's notice of disagreement (NOD) was received in October 2013. The RO issued a statement of the case (SOC) in December 2013. The Veteran's VA Form 9, substantive appeal to the Board, was received in August 2014. In April 2018, the Board remanded the case to the RO for further development and adjudicative action. In October 2019, the Board denied the claim. The Veteran appealed to the Court of Appeals for Veterans Claims (CAVC or Court). In a December 2020 Order, the Court vacated the Board's October 2019 decision and remanded the matter pursuant to a December 2020 Joint Motion for Remand (JMR). The December 2018 VA examiner provided the medical opinion that the Veteran's peripheral insufficiency of the bilateral lower extremities was less likely than not proximately due to or the result of metatarsalgia of the right foot, status post condylectomy, right third metatarsal head with degenerative changes and was less likely than not caused or aggravated by service-connected bilateral foot disabilities, or due to service. In support of this finding the examiner noted there is no significant medical research to support the Veteran stating it is due to him favoring his left leg peripheral vascular disease and there is no significant medical literature to support over use of an extremity results in a worsening of the peripheral vascular disease in that extremity. The parties in the December 2020 JMR agreed that the December 2018 VA examiner did not adequately address whether the Veteran's claimed peripheral insufficiency of the bilateral lower extremities was aggravated by his service-connected disabilities of the bilateral foot. The JMR explained that the examiner's findings that the Veteran's favoring of his left leg and overuse of an extremity did not lead to aggravation or worsening of his peripheral vascular disease does not address or otherwise render an opinion as to aggravation by the Veteran's service-connected bilateral foot disabilities on his peripheral insufficiency of the bilateral lower extremities disability. Thus, the opinion does not provide an adequate discussion of aggravation. Accordingly, a remand is necessary to obtain a new VA medical opinion that addresses whether Veteran's claimed peripheral insufficiency of the bilateral lower extremities was aggravated by his service-connected disabilities of the bilateral foot. The matters are REMANDED for the following action: Obtain a VA medical opinion by an appropriate medical specialist with respect to the Veteran's service connection claim for bilateral lower extremity peripheral insufficiency disorder. Only arrange for the Veteran to undergo a VA examination if one is deemed necessary in the judgment of the individual designated to provide the medical opinion. The claims file, including a copy of this remand, must be made available to the medical specialist for review, and the medical specialist should indicate that the claims folder was reviewed. The medical specialist is requested to provide an opinion as to whether any current disorders of the bilateral lower extremity documented in the claims folder to include peripheral insufficiency of the bilateral lower extremity is at least as likely as not (i.e., a 50 percent or more probability) either (a) caused by, or (b) aggravated (i.e., made worse and not due to the natural progress of the disease) by his service-connected disabilities of the bilateral foot and/or bilateral ankle. Both causation and aggravation must be addressed. If aggravation is found, the examiner must attempt to establish a baseline level of severity of bilateral lower extremity disorder prior to aggravation by the service-connected disability. (Continued on the next page) An explanation must be given for any opinion expressed and the foundation for all conclusions should be clearly set forth. It would be helpful if the medical specialist discussed medical treatises, articles, and/or studies as part of his or her opinion. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Berry, 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.