Citation Nr: 22018259 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-56 292 DATE: March 28, 2022 REMANDED Service connection for vascular insufficiency with right leg amputation is remanded. Service connection for right knee injury is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1979 to November 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing with a Veterans Law Judge, but has withdrawn his request. Upon review of the claims file, the evidence and argument reflect that the scope of the claim includes a claim for service connection for a right knee injury. The issues have been amended, accordingly. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Service connection for vascular insufficiency with right leg amputation 2. Service connection for right knee injury The Veteran contends that his right leg amputation is related to an injury to the right knee during service. His ex-wife asserts that the Veteran injured his right knee while on barracks duty on or about July 1980. He was on crutches due to the injury and placed on light duty. However, during treatment in March 2006, the Veteran reported increasing discomfort after jogging, noting a history of a left knee injury. In July 2007, the Veteran reported to his treating physician that he was hospitalized for a knee injury while playing football in July 1980. Another record in July 2007 noted a history of left knee dislocation playing football on the beach in 1980. His treatment records note left knee x-ray findings in March 2006 and ongoing treatment for chronic left knee pain. Thus, there is conflicting statements regarding which leg was allegedly injured during service. The Veteran's service treatment records are illegible and/or unavailable. In September 2015, the Veteran reported that he noticed his right great toe "turning black" the next morning, after pulling toenail out. A November 2015 emergency room visit shows a diagnosis of peripheral arterial occlusive disease, peripheral vascular disease and computed tomography angiography (CTA) with evidence of bilateral superficial femoral artery (SFA) occlusion with distal reconstitution with dry gangrenous lesion of right great toe and left great toe. In January 2016, the Veteran consented to a below knee amputation of the right leg. Subsequently, he underwent an above knee amputation on January 26, 2018. In December 2021, a private orthopedic surgeon, Dr. F.G., opined that the Veteran has degenerative osteoarthritis of the right knee with history of ligamentous injuries occurring during active military service and that vascular insufficiencies with popliteal artery occlusion have a causal nexus to military service and that led to the first amputation. Dr. F. G. opined that it is more likely than not that arterial insufficiency by reason of arteriosclerotic vascular disease was beginning during military service. As the opinions are conclusory and based on mischaracterization of the March 2006 knee x-ray as being of the right knee, when it was of the left knee, a VA medical opinion in needed to address the claim. As noted above, the Veteran claimed that he suffered a right knee injury during service that eventually led to his right leg amputation. The opinion from Dr. F.G. did not provide a link between the alleged knee injury and the amputation, but he did suggest the arthritis in the right knee was related to service. The RO did not specifically adjudicate a claim for right knee injury. Such should be accomplished on remand. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The matters are REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who treated him for a right knee disability. After securing any necessary releases, request any relevant records identified. In addition, obtain outstanding VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After records development is completed, obtain an opinion to address the right leg service connection claims. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. After review of the claims file, the examiner should address the following: (a.) Whether it is at least as likely as not (an approximate balance) that the Veteran's vascular insufficiency arose during service or is otherwise related to his military service, to include as a result of an alleged injury to the right knee during service. The examiner should explain why or why not, to include addressing Dr. F.G.'s December 2021 opinion that the vascular insufficiency began during service because metabolic syndrome and an A1C of 6.1 suggests early onset of arterial sclerotic plaques and popliteal vascular occlusion developing at an early age leading to the Veteran's knee amputation. (b.) Whether it is at least as likely as not that the arthritis noted in the Veteran's right knee (during the period of the claim prior to the above knee amputation) is related to an alleged injury to right knee during service. The examiner should explain why or why not, to include addressing Dr. F. G.'s December 2021 opinion. 3. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.