Citation Nr: 21029614 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 17-47 511 DATE: May 14, 2021 REMANDED Entitlement to service connection for a left lower extremity condition, claimed as restless leg syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to May 1973. In November 2019, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ) of the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board). A transcript of that hearing has been associated with the claims file. In February 2020, the Board remanded this issue, captioned at that time as entitlement to service connection for a left lower extremity condition, to include restless leg syndrome and an ankle disorder, to the VA Regional Office (RO) for additional development. By a February 2021 rating decision, the RO granted service connection for the Veteran's left ankle disability, status-post talo-navicular fusion with posttraumatic arthritis. The remaining issue before the Board is thus entitlement to service connection for a left lower extremity condition, claimed as restless leg syndrome. 1. Entitlement to service connection for a left lower extremity condition, claimed as restless leg syndrome, is remanded. The Veteran, to date, is service-connected for a number of disabilities involving the left lower extremity, namely, left foot, residuals, internal fixation fracture with pes planus and degenerative arthritis; left ankle, status-post talo-navicular fusion with posttraumatic arthritis; and left foot, surgical scar. During the November 2019 Board hearing, the VLJ confirmed with the Veteran the scope of his current claim related to the left lower extremity, that he sought service connection for restless leg syndrome, pes planus, and a left ankle disability. As noted, service connection is in effect for left foot, residuals, internal fixation fracture with pes planus and degenerative arthritis, and left ankle, status-post talo-navicular fusion with posttraumatic arthritis; leaving restless leg syndrome the only remaining disability for which the Veteran seeks service connection. At the November 2019 Board hearing, the Veteran testified that he was currently being treated for restless leg syndrome, and that he did not know if it was related to his in-service injuries, his left ankle sprain/navicular fracture in January 1970 and/or his left ankle sprain in July 1971. In a January 2021 peripheral nerves Disability Benefits Questionnaire (DBQ), a VA examiner diagnosed the Veteran with restless leg syndrome, progressively worsening, characterized by a vague feeling of discomfort and thrashing at night. In a January 2021 opinion, the VA examiner opined that the Veteran's restless leg syndrome is not at least as likely as not related to service, that medical records support the conclusion that restless leg syndrome is not related to his in-service injuries in January 1970 or July 1971, as it is not medically established that restless leg syndrome is caused by trauma. The examiner also opined that the Veteran's restless leg syndrome is not at least as likely as not secondary to his service-connected left foot, residuals, internal fixation fracture with pes planus and degenerative arthritis, and left ankle, status-post talo-navicular fusion with posttraumatic arthritis, as there is no medical evidence that such disabilities cause restless leg syndrome. It does not appear that the examiner offered an opinion as to whether the Veteran's service-connected disabilities aggravated his restless leg syndrome. Thus, the January 2021 VA opinion is inadequate; the examiner did not render a complete etiological opinion as to the whether the Veteran's restless leg syndrome was secondary to the service-connected disabilities cited. Also, additional medical comment is required beyond that of the examiner's bare conclusion that trauma does not cause restless leg syndrome. On remand, the RO should obtain an adequate etiological opinion on this issue. The matters are REMANDED for the following action: Forward the Veteran's claims file to the VA examiner who conducted the January 2021 peripheral nerves DBQ, or a suitable substitute, for an addendum etiological opinion as to his restless leg syndrome. If any examiner determines that additional physical examination of the Veteran is required, so schedule the Veteran. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination. The examiner should respond to the following, with complete rationale: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's restless leg syndrome had its clinical onset during active service or is related to any incident of service, specifically, his in-service left ankle sprain/navicular fracture in January 1970 and/or left ankle sprain in July 1971? In this regard, the examiner should consider the Veteran's in-service and post-service symptoms and treatment and offer medical comment beyond the conclusion that trauma is not shown to cause restless leg syndrome. (b) Is it at least as likely as not that the Veteran's restless leg syndrome is either (i) caused by, or (ii) aggravated (i.e., worsened beyond the normal progression) by the Veteran's service-connected left foot, residuals, internal fixation fracture with pes planus and degenerative arthritis, and left ankle, status-post talo-navicular fusion with posttraumatic arthritis? In this regard, the examiner should consider the Veteran's symptoms, including the nerves impacted his restless leg syndrome and his service-connected disabilities, his treatment for his service-connected disabilities, including the effect of medication, and his altered gait caused by his service-connected disabilities, and offer medical comment beyond the conclusion that the service-connected disabilities are not shown to cause or aggravate restless leg syndrome. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.