Citation Nr: 1552570 Decision Date: 12/16/15 Archive Date: 12/23/15 DOCKET NO. 12-01 205 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New York, New York THE ISSUES 1. Entitlement to service connection for peripheral neuropathy, to include as due to exposure to herbicides. 2. Entitlement to service connection for lipomas. 3. Entitlement to service connection for hypertension. 4. Entitlement to service connection for hepatitis C. 5. Entitlement to service connection to gastroesophageal reflux disease (GERD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD B. Rideout, Associate Counsel INTRODUCTION The Veteran had active duty service from July 1966 to July 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. This appeal was processed using Virtual VA and the Veterans Benefits Management System paperless claims processing system. Accordingly, any future consideration of this Veteran's 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 The November 2011 statement (SOC) indicates that the RO reviewed the Veteran's VA medical records dated from March 2010 to February 2011. However, additional VA medical records have since been associated with the file, to include VA medical records in Virtual VA file dated from September 2001 to August 2012 and from May 2007 to April 2011. Additional VA medical records were also associated with the VBMS file after November 2011. In October 2015, the Board offered the Veteran an opportunity to submit a waiver allowing the Board's initial review of this new evidence. However, the Veteran did not respond to that request. As such, this case must be remanded to the AOJ for its initial consideration of the additional evidence. In addition, the Board notes that the Veteran has not been afforded a VA examination in connection with his claim for peripheral neuropathy. The Veteran served in the Republic of Vietnam during the Vietnam era, and he is therefore presumed to have been exposed during such service to certain herbicide agents, including Agent Orange. The Veteran and his wife also reported in an October 2009 letter that he had been diagnosed with peripheral neuropathy earlier that year by his primary care doctor. Therefore, the Board finds that a VA examination and medical opinion are needed to determine the nature and etiology of any peripheral neuropathy that may be present. 38 C.F.R. §§ 3.303(d), 3.309(e); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Board also notes that the Veteran has not been afforded a VA examination in connection with his claim for service connection for hepatitis C. He has claimed that he developed the disorder as a result of air gun injections in service. His post-service medical records also show that he has been diagnosed with hepatitis C. Therefore, a VA examination and medical opinion are needed. Accordingly, the case is REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for peripheral neuropathy, lipomas, hypertensions, hepatitis C, and GERD. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding, relevant VA medical records should also be obtained and associated with the claims file. 2. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any peripheral neuropathy that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is presumed to have been exposed to certain herbicide agents, including Agent Orange, during his military service. The examiner should also note that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has peripheral neuropathy that is causally or etiologically related to his military service, to include whether any diagnosed disorder is related to the Veteran's exposure to herbicides. In so doing, the examiner should address whether the Veteran has early-onset peripheral neuropathy that manifested within one year of his exposure to herbicides. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. The Veteran should be afforded a VA examination to determine the nature and etiology of any hepatitis C that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran' has hepatitis C that is related to his military service, to include any air gun injections therein. In so doing, the examiner should discuss the Veteran's possible risk factors. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it). A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important "that each disability be viewed in relation to its history [,]" 38 C.F.R. § 4.1, copies of all pertinent records in the appellant's claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After completing the above actions and any other development as necessary, the case should be reviewed by the AOJ on the basis of all additional evidence received since the last statement of the case. If the benefits sought are not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The appellant has the right to submit additional evidence and argument on the 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). _________________________________________________ J.W. ZISSIMOS 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) (2015).