Citation Nr: 1532344 Decision Date: 07/29/15 Archive Date: 08/05/15 DOCKET NO. 12-11 727 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to exposure to herbicides. 2. Entitlement to service connection for peripheral neuropathy of the left foot, to include as secondary to exposure to herbicides. 3. Entitlement to service connection for ischemic heart disease, to include as secondary to exposure to herbicides. REPRESENTATION Appellant represented by: Kenneth S. Kabb, Attorney WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD A. Roggenkamp, Associate Counsel INTRODUCTION The Veteran had active service from April 1968 to February 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The case was remanded by the Board in April 2013 in order to afford the Veteran a hearing. The Veteran testified at a travel board hearing in June 2014 before the undersigned. A copy of the transcript has been associated with the Veteran's electronic claims file. The Veteran submitted a waiver of his right to have the RO review newly submitted evidence and allowing the Board to proceed with an appeal. This appeal was partially processed using the Veterans Benefits Management System (VBMS) paperless claims processing system. Accordingly, any future consideration of this case should take into consideration the existence of this electronic record. The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the appellant if further action is required. REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claims, so that he is afforded every possible consideration. The Veteran's claims file puts forth evidence supporting a possible other source for the Veteran's conditions: contamination of the soil and groundwater at the camp at which the Veteran was stationed in Korea, including by leakage of oil and heavy metals. The Board finds it necessary to order VA examinations in order to pursue this potential nexus. Accordingly, the case is REMANDED for the following action: 1. The RO must provide the Veteran's claims file to an examiner who is qualified to give an opinion on the Veteran's ischemic heart disease, so an examination and opinion may be provided. The entire claims file (both the paper claims file and any relevant medical records contained in Virtual VA and/or VBMS) and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. a) The examiner must take a detailed history from the Veteran. If there is any clinical or medical basis for corroborating or discounting the reliability of the history provided by the Veteran, the examiner must so state, with a complete explanation in support of such a finding. b) Although an independent review of the claims file is required, the Board calls the examiner's attention to the February 2006 Stars and Stripes article included in the claims file which discusses the levels of contamination in the camp where the Veteran was stationed, and the lay statements of the Veteran's fellow service members regarding the condition of the camp. c) The examiner must provide an opinion including specific findings as to the following: i) Whether it is at least as likely as not (50 percent or greater possibility) that exposure to contaminants like oil and heavy metals could cause ischemic heart disease. ii) Whether it is at least as likely as not that the Veteran's ischemic heart disease was caused by or related to exposure to contaminants at Camp Page. iii) Regardless of contamination at Camp Page, whether it is at least as likely as not that the Veteran's ischemic heart disease began during active service or is related to any incident of service, or manifested within a year of service. d) As part of the opinion, the examiner must address the Veteran's competent lay statements regarding onset in his or her rationale, as well as any relevant statements from treatment records. e) The examiner must provide a complete explanation for his or her opinion(s), based on his or her clinical experience, medical expertise, and established medical principles. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and specifically explain whether there is any potentially available information that, if obtained, would allow for a non-speculative opinion to be provided. 2. The RO must provide the Veteran's claims file to an examiner who is qualified to give an opinion on the Veteran's diabetes mellitus, type II, so an examination and opinion may be provided. The entire claims file (both the paper claims file and any relevant medical records contained in Virtual VA and/or VBMS) and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. a) The examiner must take a detailed history from the Veteran. If there is any clinical or medical basis for corroborating or discounting the reliability of the history provided by the Veteran, the examiner must so state, with a complete explanation in support of such a finding. b) Although an independent review of the claims file is required, the Board calls the examiner's attention to the February 2006 Stars and Stripes article included in the claims file which discusses the levels of contamination in the camp where the Veteran was stationed, and the lay statements of the Veteran's fellow service members regarding the condition of the camp. c) The examiner must provide an opinion including specific findings as to the following: i) Whether it is at least as likely as not (50 percent or greater possibility) that exposure to contaminants like oil and heavy metals could cause diabetes mellitus, type II. ii) Whether it is at least as likely as not that the Veteran's diabetes mellitus, type II was caused by or related to exposure to contaminants at Camp Page. iii) Regardless of contamination at Camp Page, whether it is at least as likely as not that the Veteran's diabetes mellitus, type II began during active service or is related to any incident of service, or manifested within a year of service. d) As part of the opinion, the examiner must address the Veteran's competent lay statements regarding onset in his or her rationale, as well as any relevant statements from treatment records. e) The examiner must provide a complete explanation for his or her opinion(s), based on his or her clinical experience, medical expertise, and established medical principles. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and specifically explain whether there is any potentially available information that, if obtained, would allow for a non-speculative opinion to be provided. 3. The RO must provide the Veteran's claims file to an examiner who is qualified to give an opinion on the Veteran's peripheral neuropathy of the left foot, so an examination and opinion may be provided. The entire claims file (both the paper claims file and any relevant medical records contained in Virtual VA and/or VBMS) and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. a) The examiner must take a detailed history from the Veteran. If there is any clinical or medical basis for corroborating or discounting the reliability of the history provided by the Veteran, the examiner must so state, with a complete explanation in support of such a finding. b) The examiner must provide an opinion including specific findings as to the following: i) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy was proximately due to or the result of his diabetes mellitus, type II. ii) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy was aggravated beyond its natural progression by his diabetes mellitus, type II. iii) IF AND ONLY IF the above questions are both answered negatively, determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy began during active service, or is related to any incident of service. c) As part of the opinion, the examiner must address the Veteran's competent lay statements regarding onset in his or her rationale, as well as any relevant statements from treatment records. d) The examiner must provide a complete explanation for his or her opinion(s), based on his or her clinical experience, medical expertise, and established medical principles. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and specifically explain whether there is any potentially available information that, if obtained, would allow for a non-speculative opinion to be provided. 4. After the above has been completed, the RO must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. 5. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issues on appeal. If the benefits sought on appeal remain denied, in whole or in part, the Veteran must be provided with a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West 2014). _________________________________________________ K. PARAKKAL Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2014), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2014).