Citation Nr: 21027666 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 19-03 495 DATE: May 6, 2021 REMANDED Entitlement to an initial compensable disability evaluation for left lower extremity arteriosclerosis obliterans peripheral vascular disease under 38 U.S.C. § 1151 is remanded. Entitlement to a total disability evaluation due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1971 to May 1986. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to an initial compensable disability evaluation for left lower extremity arteriosclerosis obliterans peripheral vascular disease under 38 U.S.C. § 1151 is remanded. In this case, the RO has not assigned an evaluation for the Veteran's arteriosclerosis obliterans vascular disease. See January 2020 Rating Decision. The record show the Veteran has appealed this evaluation, rather than the evaluation for his surgical scars. See February 2019 Appellate Brief. The RO has only assigned an evaluation for the peripheral vascular disease surgical scars and has not evaluated the Veteran's vascular disease, even though August 2017 VA examination results contain data to evaluate this disease and contain an opinion linking his vascular disease with VA care that did not meet clinical standards of post-operative treatment. See August 2017 Opinion; see also August 2017 VA Examination. The Veteran testified before the undersigned Veterans Law Judge and reported worsening symptoms of vascular dysfunction, including loss of blood flow to his left toes. See February 2021 Hearing Transcript. The Veteran also reported he left his employment as a manual laborer due to inability to work due left leg pain and weakness. The August 2017 examiner noted functional impairment from his left lower extremity vascular disability would preclude walking, standing, crouching, or any weight-bearing. The Veteran's claim for TDIU is associated with his claim for an increased evaluation for vascular disease. Medical records from August 2019 show the Veteran underwent additional surgery for left lower extremity vascular disease. See August 2019 Medical Record. Given the Veteran's reports of worsening symptoms of left lower extremity vascular disease and evidence of additional surgery since he was last examined, the Board finds a current examination is warranted. See Snuffer v. Gober, 10 Vet. App. 400 (1997) (holding that a claimant is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination). Further, VA treatment records from November 2019 are outstanding. Those VA treatment records are constructively of record and must be secured to allow for a fully informed appellate review. Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to a total disability evaluation due to individual unemployability (TDIU) is remanded. Because a decision on the remanded issue could significantly impact a decision on the issue of TDIU based the Veteran's service-connected disabilities, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. The matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records. 2. Schedule a VA examination, if possible, to determine the current severity of his peripheral vascular disease of the right and left lower extremities. The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner. After a thorough review of the claims file and examination of the Veteran (if possible), the examiner is asked to respond to the following: (a) Identify all symptoms and manifestations of peripheral vascular disease for each lower extremity. (b) Provide an ankle/brachial index (ABI) for each lower extremity based on current testing. If an ABI test cannot be performed, the examiner should estimate an ABI for each lower extremity. If it is not possible to estimate an ABI, the examiner should explain why. (c) Comment on the presence of any claudication on walking. If present, at what distance in yards does it occur? (Continued on the next page) 3. The RO should readjudicate the claim for an increased evaluation for arteriosclerosis obliterans under the appropriate diagnostic code. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Trickey 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.