Citation Nr: 18141069 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-20 593 DATE: October 9, 2018 REMANDED Entitlement to a compensable disability rating for bilateral hearing loss is remanded. Entitlement to service connection for diabetes mellitus type II is remanded. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus type II, is remanded. Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for cirrhosis of liver, to include as secondary to hepatitis C, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from September 1968 to September 1972. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested to appear at a hearing before the Board in his February 2016 VA Form 9, Appeal to Board of Veterans’ Appeals. The Veteran withdrew his request for a hearing in February 2017. As such, his hearing request is considered withdrawn. 1. Entitlement to a compensable disability rating for bilateral hearing loss is remanded In his Substantive Appeal filed in February 2016, the Veteran asserted that the July 2013 VA audiological examination was inadequate as the testing was inconsistent and did not reflect the current level of his disability. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of his bilateral hearing loss disability. 2. Entitlement to service connection for diabetes mellitus type II is remanded The Veteran contends that he was exposed to herbicide agents while serving at Kadena Air Force Base (AFB) on the island of Okinawa, and he argues that this exposure has caused his diabetes mellitus type II. The Veteran’s service personnel records reflect that the Veteran was stationed at Kadena AFB from January 1970 to August 1971. In August 2016, in response to a RO inquiry regarding whether herbicide agents were used in Okinawa, staff at the Veterans Benefits Administration’s central office directed the RO to send the Veteran’s claim to the Joint Services Records Research Center (JSRRC) for an inquiry about the Veteran’s claimed exposure to herbicide agents. The RO did not comply with this instruction. The Board notes that the VA Adjudication Procedures Manual, M21-1MR, Part IV, Subpart ii, Chapter 1, Section H.7.a, addresses the verification of exposure to herbicide agents in locations other than Vietnam or Korea. The RO should request an herbicide agent exposure verification from the JSRRC for the time the Veteran was stationed at Okinawa. In this case, no request has been made to the JSRRC, and a remand is warranted for additional development. 3. Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus type II, is remanded The Veteran has alleged that his hypertension is secondary to his diabetes. Because a decision on the remanded issue of service connection for diabetes mellitus type II could significantly impact a decision on the issue of service connection for hypertension, the issues are inextricably intertwined. Remand of the inextricably intertwined hypertension claim is therefore required as well. 4. Entitlement to service connection for hepatitis C is remanded A January 2016 VA opinion concluded that it was less likely than not that the Veteran’s hepatitis C was caused by the Veteran’s service. In reaching this conclusion, the VA physician cited reports from a Dr. Boyd at the University of South Florida College of Medicine Gastroenterology Clinic (March 2003) and at the USF Physicians Group (December 2004) which indicate that the Veteran was an intravenous drug user at the age of 13. These reports are not part of the record and they seem to be inconsistent with the Veteran’s reported history and other evidence of record. For example, a letter received in June 2015 from the Veteran’s treating physician Dr. Eisner indicates that the Veteran has no obvious risk factors for hepatitis C. An October 2012 private treatment record indicates that the Veteran’s use of illicit drugs was limited to the use of marijuana in his teens and 20s. Notably, in his February 2016 VA Form 9, the Veteran also expressed surprise at the opinion’s report of him using IV drugs at the age of 13 and denied such use. Further, in VA Forms 21-4142, Authorization and Consent to Release Information to VA, the Veteran has not indicated receiving treatment from a Dr. Boyd. Thus, it appears that the opinion provided in January 2016 may have been based on inaccurate factual premises. A remand is necessary in order to determine whether the Veteran has ever received treatment from a Dr. Boyd, the University of South Florida College of Medicine Medical Clinics, or USF Physicians Group, and if so to obtain those records, and to perform a new VA examination. 5. Entitlement to service connection for cirrhosis of liver, to include as secondary to hepatitis C, is remanded Because a decision on the remanded issue of service connection for hepatitis C could significantly impact a decision on the issue of service connection for cirrhosis of the liver, the issues are inextricably intertwined. Remand of the inextricably intertwined cirrhosis claim is therefore required as well. The matters are REMANDED for the following actions: 1. Attempt to verify the Veteran’s asserted in-service exposure to herbicide agents by sending a request to JSRRC regarding herbicide agent usage and storage in Okinawa while the Veteran was stationed there from January 1970 to August 1971. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. Boyd, University of South Florida College of Medicine Gastroenterology Clinic, and the USF Physicians Group, if he has received treatment from these providers, and for any other treatment he has received for the claimed disabilities that has not already been associated with the record. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 3. After completing (2) above, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s hepatitis C. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including vaccine inoculation by air gun. If the information contained in the January 2016 VA opinion regarding the Veteran using intravenous drugs is not corroborated by any additional records obtained, then such information should not be considered in providing an opinion. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. After completing (2) above, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral hearing loss. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Dean, Associate Counsel