Citation Nr: 18145191 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-29 915 DATE: October 26, 2018 REMANDED Entitlement to service connection for acid reflux (claimed as gastroesophageal reflux disease (GERD)) as a result of exposure to herbicides, is remanded. Entitlement to service connection for Barrett’s esophagus as a result of exposure to herbicides, is remanded. Entitlement to service connection for diabetes as a result of exposure to herbicides, is remanded. Entitlement to service connection for high blood pressure (also claimed as hypertension-heart issues) as a result of exposure to herbicides, is remanded Entitlement to service connection for chronic sinusitis as a result of exposure to herbicides, is remanded. Entitlement to service connection for sleep apnea as a result of exposure to herbicides, is remanded. REASONS FOR REMAND Regarding GERD and Barrett’s esophagus, the Veteran wrote in his June 2016 VA Form 9 that he was told by his private (non-VA) doctor that his conditions “are all connected [and] inter related.” This indicates that these two conditions may be secondary to the remaining claims. Accordingly, they are interrelated and must be remanded together. Furthermore, the complete treatment records from the private doctor are not in the claims file. Remand is needed to obtain them. Regarding diabetes, the Veteran wrote in his September 2015 NOD that his “diabetes has been coming on & getting worse.” Currently, the medical records do not reflect a diagnosis of diabetes. The only indication of diabetes appears in a December 2014 VA examiner treatment note indicates “prob[able] borderline diabetes—cont[inue] diabetic diet.” His later VA medical records and the available private medical records do not reflect a diagnosis of diabetes. As mentioned, however, there are outstanding private records, which may contain the missing information. Regarding hypertension, the Veteran related in his Agent Orange (AO) registry examination that his hypertension had its onset in 1980, and he claims that it was caused by exposure to herbicides. Regarding sinusitis, the Veteran was diagnosed with chronic sinusitis in 2009. In his AO registry examination, the Veteran claimed that he has “been plagued with sinus issues” since returning from Vietnam. Regarding sleep apnea, the Veteran was diagnosed with moderate obstructive sleep apnea in July 2014. In his AO registry examination, the Veteran claimed poor sleep since 1970. Regarding hypertension, sinusitis, and sleep apnea, the Veteran has not yet been afforded a VA examination in connection with his service connection claims for any of these conditions. The Board concludes that a VA examination on his high blood pressure, sinusitis and sleep apnea claims is needed. Specifically, the Veteran has current evidence of the claimed disabilities, and his statements that the conditions have been present since his Vietnam service or shortly thereafter are sufficient to provide an indication that the disorders may be associated with his service. In the absence of evidence addressing whether these conditions were related to service on a presumptive or direct basis, the Board will remand the matter for VA medical examinations. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. Cook and any other facility or provider having relevant medical records. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain updated VA treatment notes from May 2018. 2. After the development requested in item 1 has been completed to the extent possible, schedule the Veteran for VA examinations to determine the etiology of his currently diagnosed (1) high blood pressure, (2) chronic sinusitis and (3) sleep apnea. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to each examiner and be reviewed in conjunction with these requests. Following review of the claims file and examination of the Veteran, the examiners should provide opinions discussing the following for each disability: (a.) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s hypertension was caused by or results from his in-service exposure to herbicide agents, or is otherwise related to service. Please explain why or why not. (b.) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s chronic sinusitis was caused by or results from his in-service exposure to herbicide agents, or is otherwise related to service. Please explain why or why not. (c.) whether it is at least as likely as not (50 percent probability or more) that the Veteran’s sleep apnea was caused by or results from his in-service exposure to herbicide agents, or is otherwise related to service. Please explain why or why not. The examiners should note that the Veteran’s herbicide exposure is conceded. The examiner is also asked to disregard whether the disorder is one for which a "presumption" is established and, instead, to answer whether the medical condition is a result of Agent Orange exposure even though it is not on the list of "presumptive" diseases. (Continued on the next page)   In answering these questions, the examiner is asked to consider the statements from the Veteran regarding his symptoms history. The examiner is asked to explain why his statements make it more or less likely that a condition started during service. If indicated, it should be explained whether there is a **medical** reason to believe that the Veteran’s recollection of his symptoms during and after service may be inaccurate or not medically supported as the onset or cause of his current diagnosis. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Snyder, Associate Counsel