Citation Nr: 18145846 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-37 790 DATE: October 30, 2018 REMANDED Entitlement to service connection for chronic b-cell leukemia, including chronic lymphocytic leukemia (CLL) is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as due to service-connected disability is remanded. Entitlement to service connection for tinnitus, to include as due to service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to October 1967. 1. Entitlement to service connection for chronic b-cell leukemia, including chronic lymphocytic leukemia (CLL) is remanded. Although the Board regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). The Veteran’s service record shows he was present in the Republic of Vietnam during the applicable period and is presumed exposed to an herbicide agent. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). For veterans who served in the Republic of Vietnam during the period starting on January 9, 1962, and ending on May 7, 1975, service connection may be granted for specific disabilities associated with exposure to herbicide agents, including chronic B-cell leukemias. These disabilities will be considered to have been incurred in or aggravated by service despite any lack of evidence of such disease during service unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a). VA is obliged to provide an examination or obtain a medical opinion in a claim of service connection when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds that a VA examination is required in this case. Although the record contains clinical data regarding the Veteran’s claimed disability in that these records indicate the presence of a blood disorder, the Veteran has not been afforded a VA examination to determine if he manifests a chronic B-cell leukemia. See January 2016 VA Medical Record. The Board finds VA examination and opinion are warranted to determine the nature and etiology of his claimed disability. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (VA may only consider independent medical evidence to support its findings and is not permitted to base decisions on its own unsubstantiated medical conclusions). 2. Entitlement to service connection for an acquired psychiatric disorder, to include as due to service-connected disability is remanded. The Veteran contends he has an acquired psychiatric disorder that is due to service or service-connected disability. A January 2016 VA examination shows the Veteran manifests a current disability, depressive disorder. The Board notes a January VA examination and addendum opinion do not indicate a link between his service and his depressive disorder. See January 2016 VA Examination; see also January 2016 Opinion. However, this examination and opinion did not consider whether a service-connected disability caused or aggravated his depressive disorder. In light of the development regarding the Veteran’s claimed leukemia disability, the Board finds the claim for psychiatric disability is inextricably intertwined with this issue and the appeal must remanded to be readjudicated. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (providing that two or more issues are inextricably intertwined if one claim could have significant impact on the other); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). 3. Entitlement to service connection for tinnitus, to include as due to service-connected disability is remanded. The Veteran contends he has tinnitus that is due to leukemia or treatment for leukemia. See February 2015 Statement. The Board notes the Veteran does not report in-service tinnitus and a VA examination did not find a link between his service and claimed tinnitus. However, this examination did not consider the whether his tinnitus is secondary to leukemia or treatment for leukemia. See April 2015 VA examination. In light of the development regarding the Veteran’s claimed leukemia disability, the Board finds the claim for tinnitus is inextricably intertwined with this issue and the appeal is remanded. Harris, 1 Vet. App. at 183 (1991). Finally, the Veteran’s VA medical records should be obtained on remand. Those VA treatment records are constructively of record, and must be secured to allow for a fully informed appellate review. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. The AOJ should secure any outstanding, relevant VA medical records. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any current leukemia. All indicated tests and studies shall be conducted. The claims folder, including a copy of this remand and any relevant records contained in VBMS and the Virtual VA system, along with any records obtained pursuant to this remand, must be sent to the examiner for review. (a) Has the Veteran been diagnosed with a chronic B-cell leukemia at any time since December 2013? (b) IF NOT: Does the Veteran manifest another blood disorder? (c) IF THE ANSWER TO b) IS YES: Is it at least as likely as not (50 percent probability or more) that another blood disorder had its clinical onset in service, had its onset in the year immediately following service, is related to herbicide exposure in service (if this is established by the additional evidence), or is otherwise related to military service? If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 3. Conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. • For example, the AOJ should consider whether a VA medical opinion regarding the claim for service connection for depressive disorder as caused or aggravated by leukemia is warranted. • The AOJ should also consider whether a VA medical opinion regarding the claim for service connection for tinnitus as caused or aggravated by leukemia or treatment for leukemia is warranted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Trickey, Jonathan