Citation Nr: 18144203 Decision Date: 10/24/18 Archive Date: 10/23/18 DOCKET NO. 18-25 499 DATE: October 24, 2018 REMANDED Entitlement to service connection for gout as a result of exposure to herbicides is remanded. Entitlement to service connection for left leg condition (claimed as swelling bilateral legs) as a result of exposure to herbicides is remanded. Entitlement to service connection for right leg condition (claimed as swelling bilateral legs) as a result of exposure to herbicides is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a respiratory condition (claimed as shortness of breath), including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for obstructive sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for hypertension, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for erectile dysfunction, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for prostate cancer as a result of exposure to herbicides is remanded. Entitlement to service connection for a bladder disorder (also claimed as incontinence) as a result of exposure to herbicides is remanded. Entitlement to service connection for migraines, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for peripheral neuropathy of the left foot as a result of exposure to herbicides is remanded. Entitlement to service connection for peripheral neuropathy of the right foot as a result of exposure to herbicides is remanded. Entitlement to service connection for restless leg syndrome of the left leg is remanded. Entitlement to service connection for restless leg syndrome of the right leg is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1964 to September 1966, to include service in Vietnam, and with additional service in the National Guard and Army Reserve through 1989. Records Development In a March 2017 statement , the Veteran identified relevant outstanding private treatment records. See VA Treatment Record dated March 16, 2017. Because VA oupatient treatment records do not idenify current disabilities for all issues on appeal, a remand is required to allow VA to obtain authorization and request these records. The file does contain some records of Reserve and National Guard service but not records of participation in active duty for training or inactive duty training. One record contains orders dated in September 1966 that were issued by a personnel command at Fort Dix but not that the Veteran was serving there as it is relevant to the Veteran’s contentions of disease caused by exposure to hazards at this location. Therefore a request to the Veteran for dates and length of service at Fort Dix is necessary to determine the extend and nature of the contended exposure. Examinations The Board finds an addendum opinion is required for the issue of entitlement to service connection tinnitus. The Veteran was afforded a VA audiological examination in October 2017. At that time, the examiner noted that the Veteran had intermittent tinnitus when exposed to loud noises. The examiner ultimately opined that the Veteran’s tinnitus was not related to his period of service. However, the clinician did not elicit historical information as to when tinnitus was onset and whether it continued since service. The examiner also did not discuss whether the Veteran’s tinnitus was caused or aggravated by his bilateral hearing loss. Given these facts, the Board finds that another examination and addendum opinion is required in order to accurately ascertain the nature and etiology of the Veteran’s tinnitus disability. As for the remaining claims, the Board finds that for each established diagnosis, the Veteran should be afforded a VA examination to determine the nature and etiology of each disability. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for physicians from whom he has received treatment and facilities in which he has received treatment for the disabilities on appeal. Make two requests for the authorized records from the named physicians and facilities, unless it is clear after the first request that a second request would be futile. 2. Request that the Veteran provide the dates and length of service at Fort Dix, New Jersey. If identified, request any additional personnel records necessary to confirm the service. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any tinnitus. The examiner should elicit history from the Veteran regarding onset date and continuity of tinnitus. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including conceded noise exposure while serving in the infantry in Vietnam or in the National Guard. The examiner should also determine whether tinnitus is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. The examiner should provide a complete rationale for any opinions provided. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed bladder disability and/or prostate cancer. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease, including in-service herbicide agent exposure or confirmed exposure to hazards at Fort Dix. The examiner should provide a complete rationale for any opinions provided. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed gout. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease, including in-service herbicide agent exposure or to confirmed exposure to hazards at Fort Dix. The examiner should provide a complete rationale for any opinions provided. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed disability of the bilateral legs, to include swelling and restless leg syndrome. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease, including in-service herbicide agent exposure or hazards at Fort Dix. The examiner should provide a complete rationale for any opinions provided. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed peripheral neuropathy of the bilateral feet. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease, including in-service herbicide agent exposure or to confirmed exposure to hazards at Fort Dix. The examiner should determine whether peripheral neuropathy 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. The examiner should provide a complete rationale for any opinions provided. 8. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any erectile dysfunction. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease, including in-service herbicide agent exposure or confirmed exposure to hazards at Fort Dix. The examiner should also determine whether erectile dysfunction is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability, to include PTSD. The examiner should provide a complete rationale for any opinions provided and note whether the medical articles submitted by the Veteran are relevant and probative in his case. 9. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hypertension. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease. The examiner should also determine whether hypertension 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. The examiner should also determine whether hypertension is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability, to include PTSD. The examiner should provide a complete rationale for any opinions provided note whether the medical articles submitted by the Veteran are relevant and probative in his case. 10. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any migraines. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease. The examiner should also determine whether migraines are at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability, to include PTSD. The examiner should provide a complete rationale for any opinions provided note whether the medical articles submitted by the Veteran are relevant and probative in his case. 11. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any obstructive sleep apnea. The examiner must opine whether it is at least as likely as not caused by an in-service injury or disease. The examiner should also determine whether sleep apnea is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability, to include PTSD. The examiner should provide a complete rationale for any opinions provided note whether the medical articles submitted by the Veteran are relevant and probative in his case. 12. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any respiratory disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner should also determine whether any respiratory disability is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability, to include PTSD. The examiner should provide a complete rationale for any opinions provided note whether the medical articles submitted by the Veteran are relevant and probative in his case. 13. Readjudicate the claims on appeal. If the claims are not granted to the Veteran’s satisfaction, provide him and his representative a Supplemental Statement of the Case and allow them the appropriate time to respond before returning the appeal to the Board. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Orie, Associate Counsel