Citation Nr: 18146770 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 16-34 923 DATE: November 1, 2018 REMANDED Entitlement to service connection for a bodily infection due to herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1967 to August 1969, which included service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge Entitlement to service connection for a bodily infection due to herbicide agent exposure is remanded. The Veteran seeks service connection for a bodily infection that he maintains is due to herbicide agent exposure in Vietnam. Specifically, he asserts that he was exposed to Agent Orange while bringing supplies to the troops as he navigated through field and swamp areas and came into contact with wet soil. See February 2017 Board Hearing Transcript at 6. He asserts that experienced issues prior to a 2007 diagnosis of thoracoabdominal actinomycosis and that his bodily infection affects the soft tissues in his body and is recurring. Id at 3. A July 2007 private treatment record notes a diagnosis of thoracoabdominal actinomycosis (recurrence noted in January 2014 and August 2014 VA treatment records), a February 2014 VA treatment record reflects helicobacter pylori (H. pylori), and a February 2016 VA treatment record indicates neutropenia. Although thoracoabdominal actinomycosis, H. pylori, and neutropenia are not disabilities subject to presumptive service connection based on herbicide agent exposure under 38 C.F.R. § 3.309(e), that fact alone does not automatically mean that the Veteran’s bodily infections are not related to his presumed exposure to herbicide agents in Vietnam. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). To this end, the evidence of record shows a history of various bodily infections, including actinomycosis or chest infections; losing a kidney due to a sugar infection; elevated total protein with beta-gamma bridging on serum protein electrophoresis (SPEP), which is usually associated with chronic inflammation like cirrhosis, chronic infection, connective tissue disease, and malignancy; sores in his mouth due to fungal infections; and a bacterial infection of the left forehead. See November 2010, January 2014, February 2014, March 2014, August 2014, and September 2014 VA treatment records. Given the Veteran’s statements, the concession of in-service exposure to Agent Orange, and the presence of a current disability, the Board finds that a VA examination and medical nexus opinion on direct service connection is warranted and should be obtained on remand. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Any outstanding treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding private treatment records. 3. Then schedule the Veteran for a VA examination to determine the nature and etiology of any current bodily infection. To the extent possible, the Veteran should be scheduled for the examination during an active period of flare of his asserted disability. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. All indicated tests and studies should be conducted, and all findings reported in detail. For each bodily infection diagnosed since January 2014, to include but not limited to thoracoabdominal actinomycosis, H. pylori, and neutropenia, the examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that such disability had its onset in service or is otherwise related to service, to include as a result of walking through field and swamp areas and coming into contact with wet soil and/or conceded herbicide agent exposure in Vietnam. In addressing this question, the examiner is advised that the fact that a given disability is not one for which service connection can be presumptively awarded cannot be used as the sole basis for a negative opinion. A complete rationale must be provided for each opinion expressed. In the event the examiner is unable to provide a medical opinion, he or she must provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel