Citation Nr: 21032823 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 17-21 138 DATE: May 28, 2021 REMANDED Entitlement to a rating in excess of 40 percent for right lower extremity peripheral vascular disease as secondary to diabetes mellitus, type II is remanded. Entitlement to a rating in excess of 60 percent for left lower extremity peripheral vascular disease as secondary to diabetes mellitus, type II is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1967 to April 1969. In December 2020, the Board, in relevant part, remanded the claim of entitlement to a compensable rating for peripheral vascular disease secondary to diabetes mellitus, type II. In May 2021, the RO increased the rating assigned to left lower extremity peripheral vascular disease to 60 percent and the rating assigned to right lower extremity peripheral vascular disease to 40 percent, with effective dates of August 21, 2014. As this does not represent a full grant of the benefits sought with respect to his claim for an increased rating for bilateral lower extremity peripheral vascular disease, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993) Further, the Board finds that the examination obtained in connection with the increased rating claims is inadequate as it did not include all relevant testing for rating purposes. 1. Entitlement to a rating in excess of 40 percent for right lower extremity peripheral vascular disease as secondary to diabetes mellitus, type II is remanded. 2. Entitlement to a rating in excess of 60 percent for left lower extremity peripheral vascular disease as secondary to diabetes mellitus, type II is remanded. The Veteran contends that his right and left lower extremity peripheral vascular disease is more disabling than the 40 and 60 percent ratings currently assigned. In this regard, the Veteran stated that the May 2021 examination was inadequate and did not adequately assess his disability beyond claudication on walking less than 25 yards on a level grade at two miles per hour, prior to final adjudication. Further, as noted in the May 2021 rating decision, "an at-once examination is needed [to] supplement missing information from the May 6, 2021 examination." Here, the Board agrees that another examination is warranted to assess the current severity of the Veteran's service-connected disabilities. Specifically, in the Artery and Vein Conditions DBQ, ankle/brachial index testing was not performed. The examiner did not indicate that such testing was unable to be performed. Additionally, the examiner did not determine whether the Veteran had persistent coldness of the extremity. Here, this testing is necessary to determine whether a higher rating for either lower extremity is warranted. On remand, the examiner should be afforded a new VA examination, which includes all testing, studies, and evaluations necessary to properly evaluate the claims. The matters are REMANDED for the following action: 1. Provide the Veteran an additional VA examination 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 (specifically, whether it is 0.5 or less) 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 of the following symptoms: i. Claudication on walking. If present, at what distance in yards does it occur, when walking at 2 miles an hour on a level grade? ii. Persistent coldness of the lower extremity. iii. Ischemic limb pain at rest. iv. Deep ischemic ulcers. 2. Then re-adjudicate the claim and provide the Veteran and his representative with a Supplemental Statement of the Case. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Hanson, 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.