Citation Nr: 18142458 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-24 119 DATE: October 15, 2018 REMANDED The issue of entitlement to service connection for heart condition is remanded. The issue of entitlement to service connection for bladder cancer is remanded. The issue of entitlement to service connection for prostate cancer is remanded. REASONS FOR REMAND 1. Heart Condition The Veteran’s service treatment records note several complaints of chest pain between 1974 and 1981. In August 2010, the Veteran was brought to an emergency room at Seven Rivers Regional Medical Center with a complaint of dyspnea, and at that time, he reported that he had myocardial infarction, discovered by an EKG while having his stress test, in 2002. Laboratory testing conducted during this August 2010 visit led to a diagnosis of atrioseptal aneurysm and patent foramen ovale. More recently, in November 2016, the Veteran was admitted to Seven Rivers Regional Medical Center for chest pain, and he was diagnosed with myocardial infarction. The Veteran underwent a VA examination in April 2012. The examiner noted the 2010 diagnosis of patent foramen ovale and provided an opinion that the Veteran’s patent foramina ovale is not related to his active military service. The rationale was that symptoms of patent foramen ovale are hypoxia and paradoxical emboli/stroke, but not usually chest pain. Notably, the examiner did not evaluate whether the Veteran’s recurrent myocardial infarction is related to his service. Provided that the Veteran had another episode of myocardial infarction after the April 2012 VA examination, an addendum opinion must be obtained to ascertain etiology of myocardial infarction. 2. Bladder Cancer 3. Prostate Cancer The service treatment records reveal that he reported to the clinic for various problems with penis and he had bilateral vasectomy in October 1972. The Veteran asserted at one point that his cancer is related to exposure to chemicals such as ozone and carbon while he worked as oceanographic specialist with SOSUS system. See April 2012 Veteran’s statement. The medical evidence of record indicates that the Veteran underwent prostatectomy to remove prostate cancer in 2007 with subsequent chemotherapy to treat recurrent cancer and that he had a diagnosis of bladder cancer in 1990’s, which was removed twice in the past. It appears that the Veteran underwent a colovesical fistula repair in January 2013. In his August 2017 statement, the Veteran reports that the colovesical fistula resulted from bladder cancer; the radiation treatment applied to the area made it weak, causing gas to expel from the penis. He also reported in the August 2017 statement that he developed a problem with controlling urine after the 2007 prostatectomy and the procedure also caused erectile dysfunction. The RO attempted to obtain the Veteran’s records for his bladder cancer from Dr. Tejero, the doctor who removed malignant tumors from bladder and also from Dr. Rabinowitz, the urologist who followed up the Veteran after the surgery, but Dr. Tejero’s records were no longer available and there was no response from Dr. Rabinowitz even after repeated requests from the RO. In light of the evidence of record summarized above and the proximity of the location of bladder and that of prostate, the Board finds that a medical examination must be conducted to ascertain the current state of his prostate and bladder disabilities and the etiology of prostate cancer and bladder cancer. A medical opinion concerning whether these disabilities are related to service, to include in-service vasectomy and exposure to chemicals from SOSUS system is also requested. The matters are REMANDED for the following action: 1. Obtain any outstanding treatment record for the Veteran’s heart condition, bladder cancer, and prostate cancer. 2. Obtain an addendum opinion from an appropriate clinician on the nature and etiology of any heart condition. The examiner must opine: A) whether any heart condition, to include myocardial infarction, is at least as likely as not related to an in-service injury, event, or disease, including in-service chest pain; and B) whether any heart condition, to include myocardial infarction, at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. All opinions must be supported by a clear rationale, and a discussion of the facts and medical principles involved. In rendering the opinion, the examiner should not resort to mere speculation. If it is not possible to provide the requested opinion without resort to speculation, the examiner should state why speculation would be required in this case. If there are insufficient facts or data within the claims file, the examiner should identify the relevant testing, specialist’s opinion, or other information needed to provide the requested opinion. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of prostate cancer and bladder cancer. The examiner must opine: A) whether prostate cancer and bladder cancer are at least as likely as not related to an in-service injury, event, or disease, including in-service vasectomy and claimed exposure to chemicals from SOSUS system; and B) whether prostate cancer and bladder cancer at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) were noted during service with continuity of the same symptomatology since service. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. All opinions must be supported by a clear rationale, and a discussion of the facts and medical principles involved. In rendering the opinion, the examiner should not resort to mere speculation. If it is not possible to provide the requested opinion without resort to speculation, the examiner should state why speculation would be required in this case. If there are insufficient facts or data within the claims file, the examiner should identify the relevant testing, specialist’s opinion, or other information needed to provide the requested opinion. 4. Then, the AOJ should readjudicate the claims on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case, allow the appropriate time for a response, and then return the case to the Board for further appellate action. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Y. Taylor, Associate Counsel