Citation Nr: 18148833 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-31 850 DATE: November 8, 2018 REMANDED Entitlement to service connection for cysts, tumors, and eye disorders, to include as due to exposure to herbicides. REASONS FOR REMAND The Veteran served on active duty from September 1967 to September 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision. The claim must be remanded for a VA examination. VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4) (2018); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including credible lay evidence of continuity of symptomatology). Medical records indicate that since 1979 the Veteran has undergone multiple ocular related treatment and surgeries, including right fibrous histiocytoma excision and dacryocystorhinostomy (DCR), epidermal inclusion cyst removal from the left cheek, and right orbital tumor excision. In November 2014 a biopsy of the right lower lid showed “possible spindle cell sarcoma vs solitary fibrous tumor with MIB-1.” The Veteran asserts that residuals from these and other procedures resulted from his exposure to herbicides during his active service in Vietnam. In a December 2014 medical record a VA physician stated that the Veteran’s solitary fibrous tumor of the orbit was similar to soft tissue sarcoma and “could be related to agent orange exposure.” Based on the foregoing, the Board finds that remand is required to obtain a medical examination and opinion that addresses the medical matters raised by this service connection issue. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment on and after June 3, 2016. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. 3. After any additional records are associated with the claims file, provide the Veteran with the appropriate examination to determine the etiology of the claimed eye and related disorders. The claims file must be made available to and reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. a) The examiner is asked to state whether any of the Veteran's currently diagnosed eye and related disorders are among the diseases the VA Secretary has determined are related to herbicide (Agent Orange) exposure (38 C.F.R. § 3.309 (e)). b) If it is determined that any of the Veteran’s currently diagnosed eye and related disorders are not among the diseases the VA Secretary has determined are related to herbicide exposure, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that any such currently diagnosed had its onset in service or is etiologically related to the Veteran’s active service, to include presumed exposure to herbicide agents (Agent Orange) during service. In providing rationale for the medical opinion, the reviewer should not rely on the fact that the disorder is not a presumptive condition associated with herbicide exposure. 4. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K.A. KENNERLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David Nelson