Citation Nr: 18123992
Decision Date: 08/06/18	Archive Date: 08/03/18

DOCKET NO. 15-20 784
DATE:	August 6, 2018
Entitlement to a higher rating for varicose veins along with lipodermasclerosis, right lower extremity, currently evaluated as 40 percent disabling is remanded.
Entitlement to a higher rating for varicose veins along with lipodermasclerosis, left lower extremity, currently evaluated as 40 percent disabling is remanded.
Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
The Veteran served on active duty from February 1965 to August 1968.
1. Entitlement to higher ratings for varicose veins along with lipodermasclerosis, of the right and left lower extremities, each currently evaluated as 40 percent disabling are remanded.
The Veteran was afforded a Board hearing in June 2016.  She testified that her varicose disability had worsened since her November 2013 VA examination.  She reported having blood clots in her legs since 2013, and that she had an ulceration that needed drainage in approximately April 2018.  She reported discoloration of her legs and the use of a support hose for treatment.  The Veteran’s spouse testified that the Veteran “does not move around like she use to,” sits down frequently, and has redness, swelling, and ulcerations.  While the mere passage of time is not grounds for a new examination, a new examination is appropriate when there is an assertion (and indication) of an increase in severity since the last examination.  See 38 C.F.R. § 3.159; see also Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997).  In light of the hearing testimony, and March 2016 VA treatment records documenting significant varicosities bilaterally with right knee small effusion, the Veteran should be afforded a new examination to determine the current severity of her varicose disability and related symptoms.   
At the hearing, the Veteran reported receiving private treatment for her conditions.  Records from Atlantic Medical Center dated through August 2013 are associated with the claims file, however, the Veteran subsequently submitted records from the same provider dated April 2016.  As the Veteran receives ongoing treatment for her varicose disability from this provider and there may be outstanding records, on remand the RO should contact the Veteran to obtain appropriate authorization to obtain any outstanding private treatment records. 
The Board notes that a statement of the case (SOC) adjudicating the claims was issued in April 2015.  However, the RO subsequently associated VA treatment records dated through September 2015 with the claims file.  As it was VA that added VA records to the claims file, not the Veteran that submitted evidence, the waiver provisions of 38 C.F.R. § 20.1304(c) (2017) are not for application.  The claims must be remanded for issuance of a supplemental SOC (SSOC).
Lastly, any outstanding VA treatment records should be obtained on remand to address the nature of the Veteran’s varicose disability.
2. Entitlement to a total disability rating based on TDIU is remanded.
The Board finds that the Veteran’s claim for TDIU is inextricably intertwined with her claims on appeal for higher ratings. Therefore, the appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim.  Harris v. Derwinski, 1 Vet. App. 180 (1991).
The matters are REMANDED for the following action:
1. Obtain and associate with the claims file any outstanding VA treatment records.
2. Send a letter to the Veteran requesting that she identify all records of ongoing private treatment and provide releases authorizing VA to obtain all records of private treatment, including treatment from Atlantic Medical Center, since August 2013.
If the Veteran fails to complete necessary authorizations, tell her that she may obtain and submit the records herself.
If any records cannot be obtained after attempting to do so, inform the Veteran of this fact, tell her what efforts were made to obtain the records, and advise her of any additional development that will be undertaken
3. Then, schedule the Veteran for a VA artery and vein conditions examination to determine the current nature and severity of her varicose disability. 
The claims file must be made available to the examiner for review, and the examination report should reflect that such review was completed. The examiner is requested to identify the nature, frequency, and severity of all current manifestations of varicose.  The examiner must also comment on any functional impairment caused by the Veteran’s varicose disability.  A rationale for all opinions expressed must be provided.

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Amanda Baker, Associate Counsel

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