Citation Nr: 18150555 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-40 331 DATE: November 15, 2018 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for gastrointestinal stromal tumor (GIST), also claimed as soft tissue sarcoma, is remanded. Entitlement to service connection for pheochromocytoma status post left adrenalectomy (claimed as lymphoma and adrenal gland tumor) is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from February 1966 to January 1968, to include service in the Republic of Vietnam. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In his August 2016 substantive appeal, the Veteran requested a Board hearing; however, correspondence dated in May 2017 reflects that he later withdrew the request. 38 C.F.R. § 20.704(e) (2018). 1. Entitlement to service connection for hypertension The Veteran asserts that his hypertension is related to his active service. The Board notes that the Veteran has a diagnosis of hypertension during the appeal period, and that treatment notes dating back to 2000 indicate that the Veteran had elevated blood pressure readings. To date, no VA medical opinion has been obtained with regard to the Veteran’s claimed hypertension. As noted above, the Veteran served in the United States Army from February 1966 to January 1968. During this time, the Veteran served in the Republic of Vietnam, and is thus presumed to have been exposed to herbicides. Although hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e), the National Academy of Sciences Institute of Medicine (NAS) has concluded that there is “limited or suggestive evidence of an association” between herbicide exposure and hypertension. See 77 Fed. Reg. 47924, 47926-927 (Aug. 10, 2012). Given the foregoing, the Board finds an examination and opinion is required to determine the nature and etiology of the Veteran’s hypertension, to include whether the Veteran’s hypertension is related to his conceded herbicide exposure during service in the Republic of Vietnam. See 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. §§ 3.159(c)(4), 3.303 (2018). Therefore, the Board finds the Veteran should be afforded a VA examination to determine the nature and etiology of his diagnosed hypertension. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection for GIST The Veteran asserts his GIST is related to his active service. The Board notes that the Veteran had a diagnosis of GIST during the pendency of the appeal. Moreover, an April 2012 VA treatment note indicates that the Veteran had a small bowel mass surgically removed, which was postoperatively diagnosed as GIST. The Veteran contends that numerous VA physicians have reported to him that his GIST may be related to his in-service herbicide exposure. To date, no VA medical opinion has been obtained on the Veteran’s GIST. Therefore, the Board finds the Veteran should be afforded a VA examination to determine the nature and etiology of his GIST. McLendon, 20 Vet. App. at 81. 3. Entitlement to service connection for pheochromocytoma status post left adrenalectomy The Veteran asserts that his pheochromocytoma is related to his active service. An April 2012 VA treatment note indicates that the Veteran had a symptomatic pheochromocytoma resected from his left adrenal gland in November 2011. An April 2015 VA treatment note indicates that the Veteran has a newly diagnosed pheochromocytoma status post left adrenalectomy. The Veteran contends that numerous VA physicians have reported to the Veteran that his pheochromocytoma may be related to his in-service herbicide exposure. To date, no VA medical opinion has been obtained on the Veteran’s pheochromocytoma status post left adrenalectomy. Therefore, the Board finds the Veteran should be afforded a VA examination to determine the nature and etiology of his pheochromocytoma status post left adrenalectomy. McLendon, 20 Vet. App. at 81. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file any outstanding VA treatment records dated since February 2016. If these records cannot be located, it must specifically document the attempts that were made to locate them and the Veteran must be notified. 2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran’s hypertension. The entire claims file and a copy of this remand must be made available to, and reviewed by, the examiner. Any indicated studies should be performed. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: The National Academy of Sciences excerpt indicating a limited or suggestive association between herbicide exposure and hypertension. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s hypertension (i) had its onset during service or (ii) manifested to a compensable degree within one year after active service, or (iii) is otherwise etiologically related to his active service, to include herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The examiner should specifically consider the Veteran’s reported continuity of symptoms since service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran’s GIST. The entire claims file and a copy of this remand must be made available to, and reviewed by, the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s GIST (i) began during active service, or (ii) is etiologically related to his active service, to include herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The examiner should specifically consider the Veteran’s lay statements regarding the onset and continuity of his symptoms. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 4. Schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of the Veteran’s pheochromocytoma status post left adrenalectomy. The entire claims file and a copy of this remand must be made available to, and reviewed by, the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s pheochromocytoma status post left adrenalectomy (i) began during active service, or (ii) is etiologically related to his active service, to include herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The examiner should specifically consider the Veteran’s lay statements regarding the onset and continuity of his symptoms. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. Then, confirm that the VA examination reports and all opinions provided comport with this remand and undertake any other development determined to be warranted. 6. Then, readjudicate the issues on appeal. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. T. Blake Carter Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. O’Donnell, Associate Counsel