Citation Nr: 18153792 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 17-46 271 DATE: November 28, 2018 REMANDED Entitlement to service connection for a right ear hearing loss disability is remanded. Entitlement to service connection for coronary artery disease (CAD), to include as due to herbicide agent exposure and as secondary to service-connected varicose veins, is remanded. Entitlement to service connection for a stroke, to include as secondary to service-connected varicose veins, is remanded. Entitlement to service connection for pleural plaques, to include as secondary to asbestos exposure, is remanded. Entitlement to service connection for skin cancer, to include as due to herbicide agent exposure, is remanded. Entitlement to a compensable initial rating for a left ear hearing loss disability is remanded. Entitlement to a compensable initial rating for varicose veins of the right lower extremity is remanded. Entitlement to a compensable initial rating for varicose veins of the left lower extremity is remanded. REASONS FOR REMAND The Veteran had active service from May 1963 to May 1968 and from August 1968 to July 1993. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a right ear hearing loss disability is remanded. 2. Entitlement to service connection for CAD is remanded. 3. Entitlement to service connection for a stroke is remanded. 4. Entitlement to service connection for pleural plaques is remanded. 5. Entitlement to service connection for skin cancer is remanded. 6. Entitlement to a compensable initial rating for a left ear hearing loss disability is remanded. 7. Entitlement to a compensable initial rating for varicose veins of the right lower extremity is remanded. 8. Entitlement to a compensable initial rating for varicose veins of the left lower extremity is remanded. The evidence indicates there may be outstanding relevant VA treatment records. A January 9, 2017, VA treatment record indicates that the Veteran was to return for follow up appointment in October 2017. VA treatment records subsequent September 2, 2017 have not been associated with the claims file. VA treatment records from December 5, 2013, April 9, 2014, January 8, 2015, March 26, 2015, May 7, 2015, May 13, 2015, October 3, 2015, October 10, 2015, October 16, 2016, October 17, 2015, October 21, 2015, September 7, 2016, October 19, 2016, February 7, 2017, March 4, 2017, March 24, 2017, April 25, 2017, May 11, 2017, May 30, 2017, August 1, 2017, and September 2, 2017 indicate that non-VA treatment records had been scanned into VistA Imaging. Additionally, VA records from August 23, 2013, August 29, 2013, September 13, 2013, October 4, 2013, October 15, 2013, October 31, 2013, November 25, 2013, December 11, 2013, January 7, 2014, January 8, 2014, January 21, 2014, April 9, 2014, April 24, 2014, May 19, 2014, May 23, 2014, June 6, 2014, July 17, 2014, July 21, 2014, October 7, 2014, October 24, 2014, and January 23, 2017 indicate that non-VA records from Riverside Community Hospital, Destiny Home Health, Orange County Heart Institute, and Dr. Mikhail had been received and reviewed. It is unclear whether these records are contained in VistA Imaging or were destroyed after they were reviewed by the Veteran’s VA provider. On remand, the aforementioned records should be associated with the claims file. The record indicates that there are outstanding private treatment records. In September 2017, the Veteran submitted a VA Form 21-4142 authorizing VA to obtain records from 26 private treatment providers as well as two fee basis providers. To date, it does not appear that complete records from these providers have been requested or otherwise obtained. On remand, reasonable efforts should be made to obtain them. An opinion regarding the Veteran’s right ear hearing loss disability was obtained in September 2016. Nevertheless, the audiologist’s negative opinion did not acknowledge or address the Veteran’s in-service reports of right ear pain in April 1972 and April 1989. Accordingly, an addendum opinion is warranted. Regarding the Veteran’s stroke and CAD claims, the Board notes that VA opinions were obtained in July 2014, December 2016, and June 2017. Nevertheless, the VA clinician’s rationale in support of the negative opinions only addressed causation and did not address whether the conditions had been aggravated by the Veteran’s service-connected varicose veins. Additionally, as the Veteran’s service treatment records document his reports of in-service chest pain, the addendum opinion regarding the Veteran’s CAD should also address direct service connection. Accordingly, addendum opinions are warranted. Concerning the Veteran’s claim for pleural plaques, the Board notes that in a June 2014 correspondence VA requested that the Veteran provide details regarding his claimed asbestos exposure. To date, the Veteran has not responded. As the claim must be remanded for other development, on remand the Veteran should be provided another opportunity to submit such information. Regarding the Veteran’s skin cancer claim, the Board notes that the Veteran’s service treatment records document various skin conditions, including new skin growths and pigment changes, as well as cyst and mole excisions. Accordingly, the Board cannot make a fully-informed decision on the issue because no VA examiner has opined whether the Veteran’s skin cancer is related to his military service. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified, including those identified on the September 2017 VA Form 21-4142 and associated attachment. In addition, obtain updated VA treatment records dated since September 1, 2017, the VistA Imaging records referenced in the December 5, 2013, April 9, 2014, January 8, 2015, March 26, 2015, May 7, 2015, May 13, 2015, October 3, 2015, October 10, 2015, October 16, 2016, October 17, 2015, October 21, 2015, September 7, 2016, October 19, 2016, February 7, 2017, March 4, 2017, March 24, 2017, April 25, 2017, May 11, 2017, May 30, 2017, August 1, 2017, and September 2, 2017 VA treatment records, and the non-VA records that were noted to have been received and reviewed in the August 23, 2013, August 29, 2013, September 13, 2013, October 4, 2013, October 15, 2013, October 31, 2013, November 25, 2013, December 11, 2013, January 7, 2014, January 8, 2014, January 21, 2014, April 9, 2014, April 24, 2014, May 19, 2014, May 23, 2014, June 6, 2014, July 17, 2014, July 21, 2014, October 7, 2014, October 24, 2014, and January 23, 2017 VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. All efforts to obtain additional evidence must be documented in the claims file. 2. Contact the Veteran and request that he provide information concerning the nature of any asbestos exposure before, during, and after his military service. 3. After the above is completed to the extent possible, obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right ear hearing loss disability at least as likely as not (50 percent probability or greater) arose during or is otherwise related to service, to include the Veteran’s in-service reports of right ear pain. A complete rationale for all opinions expressed should be provided. If examination of the Veteran is deemed necessary, one should be scheduled 4. Forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran’s CAD. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that CAD had its onset during service or is otherwise related to service, to include the Veteran’s December 1977 and April 1993 reports of chest pain. (b.) Whether it is at least as likely as not (50 percent probability or greater) that CAD was caused by the service-connected varicose veins? (c.) If not caused by the service-connected varicose veins, is it at least as likely as not that the Veteran’s CAD is worsened beyond natural progression (aggravated) by his service-connected varicose veins? A complete rationale should be provided for all opinions and conclusions expressed. 5. Forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran’s stroke. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s stroke was caused by the service-connected varicose veins? (b.) If not caused by the service-connected varicose veins, is it at least as likely as not that the Veteran’s stroke is worsened beyond natural progression (aggravated) by his service-connected varicose veins? A complete rationale should be provided for all opinions and conclusions expressed. 6. The Veteran should be afforded a VA skin examination to determine the nature of his skin cancer and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any skin cancer arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided. (Continued on the next page)   7. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record and readjudicate the claims on appeal. If any claim remains denied, the AOJ should issue an appropriate supplemental statement of the case, afford the Veteran and his attorney an opportunity to respond, and return the case to the Board L. Chu Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Anderson