Citation Nr: 18143740 Decision Date: 10/23/18 Archive Date: 10/22/18 DOCKET NO. 16-11 556A DATE: October 23, 2018 REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for bilateral hearing loss, to include secondary to in-service chemical exposure, is remanded. Entitlement to service connection for coronary artery disease, to include as secondary to in-service chemical exposure and herbicide-agent exposure, is remanded. Entitlement to service connection for hypertension, to include as secondary to in-service chemical exposure and herbicide-agent exposure, is remanded. Entitlement to service connection for partial colon removal, to include as secondary to in-service chemical exposure and herbicide-agent exposure, is remanded. Entitlement to service connection for a kidney disorder, to include renal cell carcinoma and kidney stones, to include as secondary to in-service chemical exposure and herbicide-agent exposure, is remanded. Entitlement to service connection for a tremor disorder, to include as secondary to chemical exposure and herbicide-agent exposure, is remanded. Entitlement to service connection for a neurological disorder of the feet, to include as secondary to in-service chemical exposure and herbicide-agent exposure, is remanded. REASONS FOR REMAND The Veteran had active service from November 1967 to May 1969. These matters are before the Board of Veterans’ Appeals (Board) on appeal from October 2013 and August 2014 rating decisions of a Department of Veterans Affairs (VA) Regional Offices (RO). In June 2017, the Veteran and his spouse testified at a videoconference hearing held before the undersigned Veterans Law Judge and a transcript of that hearing has been associated with the electronic record. At the hearing, the Veteran’s representative asserted that all disorders except for the low back disorder and bilateral hearing loss are secondary to chemical exposure from working around aircraft, to include the jet fuel JP-4. Hearing transcript, pages 6, 11. In June 2017, the Veteran’s representative submitted medical treatise information showing that jet fuel JP-8 exposure has been shown to increase hearing damage from noise exposure in rats. Pursuant to Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000), the Board will consider whether the hearing loss is secondary to in-service exposure to chemicals other than herbicide agents. In light of the above, the issues are as stated above. VA examinations are necessary to determine whether various disorders are related to in-service exposure to chemicals other than herbicide agents. The Veteran’s separation examination report reveals that he reported having a kidney stone when he was 16. The VA examination regarding kidney stones should address whether the current kidney stone disorder preexisted active service. The Veteran asserts that he injured his back jumping off airplanes repeatedly. He is competent to report this injury, and the Board finds him credible. A VA examination is required to determine the etiology of the low back disorder. Private treatment records reflect that Dr. Chewing of Miller Clinic performed back surgery in November 1996 apparently at Presbyterian Hospital. The RO should obtain these records as well as any additional VA treatment records. A September 2013 VA examiner rendered a negative medical nexus opinion on the etiology of the bilateral hearing loss that was based in part on the hearing on separation being normal. A May 1969 separation examination report reflects that the Veteran had an elevated pure tone threshold at 6000 Hertz in the left ear. Therefore, an addendum to that examination report is necessary to address whether the current hearing loss is related to the elevated pure tone threshold on separation and exposure to chemicals other than herbicide agents. In an August 2013 statement, the Veteran reported that he worked on airplanes that transported cargo to and from Vietnam. A May 2014 VA treatment record reveals that the Veteran reported that he may have handled Agent Orange but that he was unsure. The RO should undertake development for claims based on herbicide-agent exposure in other locations. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all treatment for his low back disorder, hearing loss, coronary artery disease, hypertension, partial colon removal, kidney disorders, tremor disorder, and neurological disorder of the feet, and obtain any identified records. Obtain the Veteran’s VA treatment records from the Salisbury VA Medical Center and the Charlotte community based outpatient clinic for the period from March 2016 to the present. Ask the Veteran to complete a VA Form 21-4142 for Dr. Chewing of the Miller Clinic and Presbyterian Hospital. Make two requests for the authorized records from Dr. Chewing of the Miller Clinic and Presbyterian Hospital, unless it is clear after the first request that a second request would be futile. 2. The RO should undertake the development for claims based on herbicide-agent exposure in other locations as prescribed in M21-1, Part IV, Subpart ii, Chapter 1, Section H, topic 7. 3. After the development in 1 is competed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of hypertension, coronary artery disease, colon removal, kidney stones, kidney cancer, tremor disorder, and neurological disorder of the feet. For hypertension, coronary artery disease, colon removal, kidney cancer, any renal disorder other than kidney cancer and kidney stones, the tremor disorder, and the neurological disorder of the feet, the examiner must opine whether it is at least as likely as not that each disorder is related to an in-service injury, event, or disease, including exposure to JP-4 jet fuel, greases, oils, and lubricants while working on airplanes in service. For the kidney stones, the examiner must opine on whether it is clear and unmistakable (undebatable) that the kidney stones preexisted the Veteran’s service. If the examiner finds the kidney stones did clearly and unmistakably (undebatably) preexist service, the examiner must opine whether it is clear and unmistakable (undebatable) that the kidney stones were not aggravated by service. If the examiner finds that the kidney stones either did not clearly and unmistakably preexist service, or were not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not that the kidney stones are related to an in-service injury, event, or disease, including exposure to JP-4 jet fuel, greases, oils, and lubricants while working on airplanes in service. 4. After the development in 1 is competed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the low back disorder. The examiner must opine whether it is at least as likely as not that the low back disorder is related to an in-service injury, event, or disease, including injuring the low back from jumping off airplanes while working on them during service. 5. After the development in 1 is completed, the RO should arrange for the Veteran’s claims file to be reviewed by the September 2013 VA examiner who conducted the hearing loss examination for preparation of an addendum opinion regarding whether the Veteran’s bilateral hearing loss is at least as likely as not related to in-service noise exposure and exposure to JP-4 jet fuel, greases, oils, and lubricants while working on airplanes in service. The examiner must consider the fact that the pure tone threshold at 6000 Hertz was 30 decibels in the left ear on the May 1969 separation examination. If the examiner is unavailable, arrange for the claims file to be reviewed by an appropriate clinician. The Veteran should only be scheduled for another examination if the September 2013 VA examiner or the new clinician deems it necessary. 6. Thereafter, the RO should undertake any necessary development as required by the additional evidence of record regarding the herbicide-agent theory of entitlement. 7. Thereafter, the RO should readjudicate the issues on appeal. If any benefit is not granted, the Veteran should be furnished with a supplemental statement of the case, with a copy to his representative, and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Cherry, Counsel