Citation Nr: 18140201 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 13-22 900 DATE: October 2, 2018 REMANDED Entitlement to service connection for a circulatory or vascular disability (claimed as heart and circulation problems) is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD), to include as due to herbicide exposure or as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active service from September 1966 to September 1968, to include service in the Republic of Vietnam. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2015, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video conference hearing. A transcript of his testimony is of record. These matters were previously before the Board in June 2016, when they were remanded for additional development. The Board notes that the Veteran filed a notice of disagreement (NOD) at the RO concerning the issue of entitlement to an increased rating for residuals of melanoma, as shown in the electronic claims file (VBMS). Such appeal is contained in the VACOLS appeals tracking system as an active appeal at the RO. While the Board is cognizant of the United States Court of Appeals for Veterans Claims (Court) decision in Manlincon v. West, 12 Vet. App. 238 (1999), in this case, unlike in Manlincon, the RO has fully acknowledged the NOD and is currently in the process of adjudicating the appeal. Action by the Board at this time may serve to delay the RO’s action on the appeal. As such, no action will be taken by the Board at this time, and the issue will be the subject of a later Board decision, if ultimately necessary. 1. Entitlement to service connection for a circulatory or vascular disability (claimed as heart and circulation problems) is remanded. 2. Entitlement to service connection for GERD, to include as due to herbicide exposure or as secondary to service-connected PTSD, is remanded. 3. Entitlement to a disability rating in excess of 20 percent for diabetes mellitus is remanded. The evidence indicates there may be outstanding relevant VA treatment records. VA treatment records from June 27, 2017 and May 11, 2016 indicate that the Veteran was to return for follow up appointments in early July 2016 and on July 22, 2016. VA treatment records subsequent June 28, 2016 have not been associated with the claims file. Additionally, VA treatment records from July 24, 2015, September 14, 2014, July 18, 2013, September 1, 2010, October 7, 2009, and June 7, 2007 indicate that non-VA treatment records were scanned into VistA Imaging. It does not appear that these records have been associated with the claims file. A remand to obtain the records is required. In accordance with the June 2016 remand directives, VA opinions regarding the Veteran’s GERD were obtained in August 2016 and April 2017. Nevertheless, those opinions are not fully responsive to the remand directives. Initially, the clinician co-mingled the requested opinions regarding direct and secondary service connection. Additionally, in addressing direct service connection the clinician did not address whether the Veteran’s documented in-service reports of pain or pressure in chest, nausea, and vomiting are related to his current GERD. The Veteran was provided a VA vascular examination in May 2010. The examiner opined that the Veteran did not have a heart or circulatory disability. However, a December 2013 stress test did show some abnormality, although no obvious ischemia was noted. Accordingly, a new examination is warranted. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records dated since June 28, 2016 as well as the VistA Imaging records referenced in the July 24, 2015, September 14, 2014, July 18, 2013, September 1, 2010, October 7, 2009, and June 7, 2007 VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above is completed to the extent possible, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran’s GERD. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s GERD had its onset during service or is otherwise related to service, to include his presumed herbicide exposure and in-service August 1968 report of medical history of chest pain, nausea, and vomiting. (b.) Whether it is at least as likely as not (50 percent probability or greater) that GERD was caused by his service-connected PTSD or any medication taken for those disabilities? (c.) If not caused by the service-connected diabetes mellitus or any medication taken for those disabilities, is it at least as likely as not that GERD is worsened beyond natural progression (aggravated) by his service-connected PTSD or any medication taken for those disabilities? If the clinician finds that the Veteran’s GERD was aggravated by his service-connected PTSD or any medication taken for those disabilities, the clinician should attempt to quantify the level of aggravation beyond the baseline level of GERD. A complete rationale should be provided for all opinions and conclusions expressed. 3. Schedule the Veteran for a VA cardiovascular examination. Following review of the claims file and examination of the Veteran, the clinician should respond to the following: (a.) Does the Veteran suffer from a current heart or circulatory/vascular disability? If so, please provide the diagnosis for such, and indicate whether the heart disability is a form of ischemic heart disease. In rendering this opinion, the examiner should address the December 2013 stress test showing some questionable lateral wall abnormality. (b.) For any diagnosed non-ischemic heart condition and circulatory/vascular disability, opine whether it is at least as likely as not (50 percent probability or greater) that the condition is related to service to include exposure to herbicide agents therein and the in-service August 1968 report of medical history of chest pain. (c.) If not due to service, opine whether it is at least as likely as not (50 percent probability or greater) that the any non-ischemic heart disability and circulatory/vascular disability was caused by his service-connected diabetes mellitus and/or, PTSD? (d.) If not caused by the service-connected diabetes mellitus or PTSD is it at least as likely as not that any non-ischemic heart disability or circulatory/vascular disability is worsened beyond natural progression (aggravated) by his service-connected diabetes mellitus and/or PTSD? If the clinician finds that any non-ischemic heart disability or circulatory/vascular disability was aggravated by his service-connected diabetes mellitus and/or PTSD, the clinician should attempt to quantify the level of aggravation beyond the baseline level of disability. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Anderson