Citation Nr: 18140336 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 18-36 003 DATE: October 2, 2018 ISSUES 1. Entitlement to service connection for right eye retina disability. 2. Entitlement to service connection for bilateral hearing loss (BHL) disability. 3. Entitlement to service connection for chronic obstructive pulmonary disease (COPD). 4. Entitlement to service connection for sleep apnea. 5. Entitlement to service connection for implanted cardiac pacemaker, claimed as heart condition. 6. Entitlement to service connection for high blood pressure. 7. Entitlement to service connection for constipation. 8. Entitlement to service connection for posttraumatic stress disorder (PTSD). 9. Entitlement to service connection for gastroesophageal reflux disease (GERD). 10. Entitlement to service connection for erectile dysfunction (ED). 11. Entitlement to service connection for prostate failure. REMANDED Entitlement to service connection for right eye retina disability is remanded. Entitlement to service connection for BHL disability is remanded. Entitlement to service connection for COPD is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for implanted cardiac pacemaker, claimed as heart condition is remanded. Entitlement to service connection for high blood pressure is remanded. Entitlement to service connection for constipation is remanded. Entitlement to service connection for PTSD is remanded. Entitlement to service connection for GERD is remanded. Entitlement to service connection for ED is remanded. Entitlement to service connection for prostate failure is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1964 to February 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2017 rating decision by the Department of Veterans Affairs (VA) Veterans Benefits Administration. Jurisdiction is with the VA Regional Office (RO) in San Juan, Puerto Rico. The Board finds that additional evidentiary development is required before the issues on appeal are decided. At the outset, the Board notes that the Veteran reported during VA examination that he is in receipt of Social Security Administration (SSA) benefits. VA has a duty to obtain SSA records when it has actual notice that the Veteran is receiving SSA benefits. Murincsak v. Derwinski, 2 Vet. App. 363 (1992); see also 38 U.S.C. § 5103A (c)(3); 38 C.F.R. § 3.159 (c)(2); Diorio v. Nicholson, 20 Vet. App. 193, 199-200 (2006); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). As these records may include information pertinent to the claims on appeal, these records should be requested on remand, and associated with the Veteran’s electronic claims file. The Veteran contends that service connection is warranted for the disabilities on appeal as due to exposure to an herbicide agent. The Veteran’s service personnel records document service in the Republic of Vietnam from March 14, 1966, to February 9, 1967; therefore, exposure to an herbicide agent is conceded. The Veteran has not been afforded VA examinations for the claimed right eye retina disability, COPD, sleep apnea, high blood pressure, constipation, GERD, ED, and prostate failure; the Board finds that remand for VA examinations and opinions is warranted. See McLendon v Nicholson, 20 Vet. App. 79 at 83 (2006). With respect to the claimed heart condition, the Board notes that presumptive service connection based on exposure to herbicide agents is available for the following pertinent diseases: ischemic heart disease including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina. For purposes of this section, the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309(e). The Veteran was afforded a VA examination for his claimed heart condition in July 2017 in which his cardiac pacemaker was noted as well as a diagnosis of bradycardia. The examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated that available service treatment records did not show evidence of a heart condition; the Veteran served in Vietnam but no current ischemia, coronary artery disease, or ischemic heart disease was reported by him or noted in available documents. (The Board notes that these are some of the herbicide exposure presumptive disabilities.) The Board finds that clarification is required from the July 2017 VA examiner before this issue is decided. Namely, the examiner relied in large part on the absence of documented treatment in service to provide a negative etiological opinion. However, the Board notes that the absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Moreover, this opinion does not address the pertinent etiological questions before the Board of whether a heart condition was incurred in or is otherwise related to service, to include conceded Agent Orange exposure. Finally, clarification is required from the VA examiner to fully address all the herbicide exposure presumptive disabilities. Accordingly, the matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding medical records pertaining to post-service treatment or examination of the Veteran for his claimed disabilities on appeal, to specifically include VA treatment records. 2. Obtain, directly from the SSA, complete copies of any determination on a claim for disability benefits from that agency as well as the records, including medical records, considered in adjudicating the claim. 3. Provide access to the electronic claims file to the July 2017 VA examiner, or appropriate substitute if required, to provide an addendum opinion regarding the Veteran’s claimed heart condition, to specifically include cardiac pacemaker and bradycardia. An examination should be performed if deemed necessary by the examiner providing the requested opinions. Following review of the electronic claims file, the examiner should provide an opinion regarding: a) Whether the Veteran has a diagnosis of any of the following: ischemic heart disease including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina. b) Is it at least as likely as not (50 percent or higher degree of probability) that any heart condition, to specifically include cardiac pacemaker and bradycardia diagnosed during the pendency of this appeal was incurred in or is otherwise related to service, to include conceded Agent Orange exposure? A rationale should be provided for all opinions expressed. In rendering the above opinion, the examiner is advised that the mere absence of in-service evidence of a disability during service is not fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). 4. Schedule the Veteran for VA examination(s) to determine the nature and etiology of the claimed right eye retina, COPD, sleep apnea, high blood pressure, constipation, GERD, ED, and prostate failure. Following review of the electronic claims file and examination of the Veteran, the examiner(s) should provide an opinion regarding: a) Is it at least as likely as not (50 percent or higher degree of probability) that the Veteran had high blood pressure which manifested within one year after the date of last exposure to Agent Orange during military service in Vietnam? b) Is it at least as likely as not (50 percent or higher degree of probability) that any right eye retina, COPD, sleep apnea, high blood pressure, constipation, GERD, ED, and prostate failure diagnosed during the pendency of this appeal was incurred in or is otherwise related to service, to include conceded Agent Orange exposure? A rationale should be provided for all opinions expressed. 5. Upon completion of the VA examinations and opinions ordered above, review the reports to ensure that they address the questions presented. Any inadequacies should be addressed prior to recertification to the Board. 6. Readjudicate the Veteran’s claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case and afforded an appropriate period of time to respond. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.M.K., Counsel