Citation Nr: 18156191 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 14-38 256A DATE: December 7, 2018 ORDER New and material evidence to reopen the claims of entitlement to service connection for coronary artery disease (CAD) has been received, to this extent, the appeal is granted. REMANDED Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicide agents, and/or other chemicals and/or toxins. Entitlement to service connection for a bilateral vision disability, to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to service connection for a left arm disability (neuropathy), to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to service connection for a right arm disability (neuropathy), to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to service connection for a left leg disability (neuropathy), to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to service connection for a right leg disability (neuropathy), to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to service connection for coronary artery disease, to include due to exposure to herbicide agents, and/or other chemicals and/or toxins and as secondary to diabetes mellitus. Entitlement to an initial compensable rating for chronic epididymitis. FINDINGS OF FACT 1. In an unappealed decision, dated in October 2004, the RO denied claims for service connection for CAD. 2. The evidence received since the RO’s October 2004 decision, which denied a claim for service connection for CAD, which was not previously of record, and which is not cumulative of other evidence of record, raises a reasonable possibility of substantiating the claim. CONCLUSION OF LAW [New and material evidence has been received since the RO’s October 2004 decision; the claim for service connection for CAD is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1974 to October 1978. These matters are on appeal from July 2012 and December 2012 rating decisions. In May 2018, the Veteran testified before the undersigned Veterans Law Judge at a Video Conference hearing. A transcript of the hearing is of record. New and Material Evidence Claim The Veteran most recently filed a request to reopen his claims for entitlement to service connection for CAD in June 2011. At the time of his last final denial, evidence of record included service treatment records, service personnel records, and VA and private treatment records. Since the last final denial, evidence added to the record includes additional VA treatment records, a May 2018 hearing transcript, and an October 2018 private medical opinion. Based on a review of this new evidence, and the low standard for reopening claims, the Board finds that the new and material criteria under 38 C.F.R. § 3.156 (a) have been satisfied, and the claim for service connection for CAD is reopened. REASONS FOR REMAND 1. Service connection claims The Veteran contends that he has diabetes mellitus related to exposure to herbicide agents and/or toxic chemicals during his service. Specifically, he contends that during service he was in contact with different models of aircrafts which transported and/or sprayed various chemicals including Agent Orange. See July 2014 DRO Conference Brief. Alternatively, he contends that he has CAD, bilateral arm, leg, and vision disabilities secondary to his diabetes mellitus. In an October 2018 private medical opinion, Dr. M.F. opined that there is a high likelihood that the Veteran’s in-service exposures to TCE, JP4, JP5 and AVGS while performing aircraft maintenance during service contributed to his current medical condition. In a February 2012 memorandum, the RO Joint Services Records Research Coordinator (JSRRC) issued a formal finding of a lack of information regarding Agent Orange exposure during the Veteran’s service as a tactical aircraft maintenance specialist. However, the Board finds that further development is needed regarding the Veteran’s claimed exposure to TCE, JP4, JP5, and AVSG, while stationed at Rhein Main AB. The RO should attempt to verify the alleged exposure to hazardous materials following the procedures provided in the Veterans Benefits Administration (VBA) Adjudication Procedure Manual, which development should include findings as to the Veteran's possible exposures while stationed at Rhein Main AB. If the requested development indicates the Veteran was exposed to hazardous materials and/or herbicide agents during active service, relevant VA examinations and medical opinions regarding whether the Veteran’s claimed disabilities are related to his service should be obtained. 2. Increased rating claim During the May 2018 hearing, the Veteran testified that his chronic epididymitis has worsened since the August 2012 VA examination. Accordingly, the Veteran's rating claim should be remanded for a new VA examination. See Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993). VAOPGCPREC 11-95 (1995). The matters are REMANDED for the following actions: 1. Obtain all outstanding VA medical records related to the Veteran’s diabetes mellitus; coronary artery disease; and bilateral arm, leg, and vision disabilities, dated from December 2010. All records and/or responses received should be associated with the claims file (the Veteran himself can also submit all records he believes to be pertinent). 2. Attempt to verify the Veteran's claimed exposure to hazardous chemicals, including exposure to herbicide agents, while stationed at Rhein Main AB following the procedures set forth in the VBA Adjudication Procedure Manual. All requests and responses received should be associated with the claims file. 3. If the above development indicates that the Veteran was exposed to hazardous chemicals and/or herbicide agents during active service, then schedule the appropriate VA examination(s) related to such exposure(s). The claims file should be made available to the examiner. A review of this remand is requested. All indicated studies and tests should be performed. The claims file, including a copy of this remand, must be made available to the examiner for review who should indicate that the claims file was reviewed. Regarding diabetes mellitus Is it at least as likely as not (50 percent or more probability) that any current diabetes mellitus disability, had its onset in or is etiologically-related to the Veteran's active duty service, including exposure to hazardous chemicals and/or herbicide agents? Regarding coronary artery disease, bilateral arm disability, bilateral leg disability, and bilateral vision disability (a) Is it at least as likely as not (50 percent or more probability) that any current coronary artery disease, bilateral arm disability, bilateral leg disability, and/or bilateral vision disability, had its onset in or is etiologically-related to the Veteran’s active duty service, including exposure to hazardous chemicals and/or herbicide agents? (b) If the answer to part (a) above is “no,” for any disability and the Veteran’s diabetes mellitus has been related to his service, is it at least as likely as not (50 percent probability or more) that any currently-diagnosed coronary artery disease, bilateral leg disability, bilateral arm disability, and/or bilateral vision disability is (a) proximately due to or the result of the Veteran’s service-connected diabetes mellitus, or (b) aggravated or permanently worsened by his service-connected diabetes mellitus? If it is determined that the coronary artery disease, bilateral arm, bilateral leg, and/or bilateral vision disability is related to service-connected diabetes mellitus, to the extent possible, the examiner should indicate the approximate degree of disability or baseline before the onset. The report(s) of examination should include the complete rationale for all opinions expressed. The examiner(s) should address, as appropriate, the evidence, which includes the Veteran’s articles regarding exposure to hazardous chemicals and/or herbicide agents, the May 2018 private medical opinion, July 2014 DRO Conference Report, and May 2018 hearing transcript. The phrase “at least as likely as not” does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. The phrase “aggravated” in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. The requested opinions on aggravation should be premised on the baseline level of severity of the disorder before the onset of aggravation, or by the earliest medical evidence created at any time between the onset of aggravation and the examiner’s current findings. If an opinion cannot be rendered without resorting to speculation, the physician should explain why it would be speculative to respond. (Continued on the next page)   4. Schedule the Veteran for a VA examination, to ascertain and evaluate the current level of severity of his chronic epididymitis. All indicated studies and tests should be performed. The claims folder should be made available to the examiner for review of pertinent documents. The examination report should reflect that such a review was conducted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Adams, Counsel