Citation Nr: 18160210 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 15-23 475 DATE: December 27, 2018 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for the diabetic retinopathy is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for prostate cancer is remanded. Entitlement to service connection for diabetes is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1972 to January 1973. This matter is before the Board of Veterans Appeals (Board) on appeal from a March 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. 1. Entitlement to service connection for a back disability is remanded. The Board finds that further development of the record is necessary to meet VA’s duty to assist the Veteran in developing evidence to substantiate his claim. See 38 C.F.R. § 3.159. The Board cannot make a fully-informed decision on the claim at this time because the record does not include an examination or opinion about the Veteran’s chronic lower back pain disability. A November 2011 lay statement indicates that the Veteran was in a severe motor vehicle accident while in service which caused back injuries. As such, a VA examination is now required to determine the nature and cause of any current back disabilities. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 2. Service connection for diabetes is remanded. The Board finds that further development of the record is necessary to meet VA’s duty to assist the Veteran in developing evidence to substantiate his claims. See 38 C.F.R. § 3.159. The Board cannot make a fully-informed decision on the claim at this time because the record does not include an examination or opinion about the Veteran’s diabetes. The Veteran’s STRs indicate that he complained about eye pain and lay statements from the Veteran suggest that he may have had diabetes long before his post-service diagnosis. Further, as mentioned above, the Veteran may have been exposed to herbicides or toxic chemicals which could be related to his diabetes diagnosis. As such, a VA examination is now required to determine the nature and cause of any current back disabilities. 3. Entitlement to service connection for diabetic retinopathy is remanded. Because a decision on the remanded issue of entitlement to service connection for diabetes could significantly impact a decision on the issue of service connection for diabetic retinopathy, the issues are inextricably intertwined. Accordingly, a remand of this claim is also required. 4. Entitlement to service connection for coronary artery disease is remanded. The Board finds that further development of the record is necessary to meet VA’s duty to assist the Veteran in developing evidence to substantiate his claims. See 38 C.F.R. § 3.159. The Board cannot make fully-informed decisions on the claims at this time because the record does not include examinations or opinions about the Veteran’s coronary artery disease. The Veteran’s STRs indicate that he complained of shortness of breath in-service, which may be related to his current coronary artery disease diagnosis. As such, a VA examination is now required to determine the nature and cause of his coronary artery disease. 4. Entitlement to service connection for prostate cancer is remanded. The Board finds that further development of the record is necessary to meet VA’s duty to assist the Veteran in developing evidence to substantiate his claim. See 38 C.F.R. § 3.159. The Board cannot make a fully-informed decision on the claim at this time because the record does not include an examinations or opinion about the Veteran’s prostate cancer. Evidence was submitted that indicates that the Veteran was stationed at various areas where herbicide agents and other toxic chemicals were stored while performing his duties for the Army and the Army National Guard. As such, a VA examination is now required to determine the nature and cause of his prostate cancer. The matters are REMANDED for the following action: 1. Send a letter to the Veteran requesting that he identify any relevant outstanding private treatment records and any other relevant evidence pertaining to his claims of entitlement to service connection for a back disability, diabetic retinopathy, coronary artery disease, prostate cancer and diabetes. He should be invited to submit this evidence himself or to request that VA to obtain it on his behalf. Authorized release forms (VA Form 21-4142) should be provided for this purpose. If the Veteran properly fills out and returns any authorized release forms for private records identified by him, reasonable efforts should be made to obtain such records and associate them with the claims file. At least two such efforts should be made unless it is clear from the private provider’s response to the first request that a second effort would be futile. If attempts to obtain any records identified by the Veteran are not successful, he MUST be notified of this fact and all efforts to obtain them must be documented and associated with the claims file. 2. After completion of directive one, schedule the Veteran for an examination by an appropriate clinician to determine the nature and cause of the Veteran’s back disability. Based on the factual evidence of record and the examination, the examiner must provide an opinion that responds to the following: (a.) Please identify the Veteran’s back condition(s) by diagnosis(es). (b.) For EACH of the diagnosed back condition(s), is it at least as likely as not (defined as a 50% or better probability) that it was incurred in or is otherwise related to the Veteran’s service? 3. After completion of the above directives OR concurrent with directive two (if they are the same provider), schedule the Veteran for an examination by an appropriate clinician to determine the nature and cause of the Veteran’s diabetic retinopathy. Based on the factual evidence of record and the examination, the examiner must provide an opinion that responds to the following: (a.) Is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s diabetic retinopathy was in incurred in or is otherwise related to his service? (b) If there is a positive nexus opinion for the Veteran’s diabetes, it at least as likely as not (defined as a 50% or better probability) that the Veteran’s diabetic retinopathy was proximately caused by or aggravated by the Veteran’s diabetes? 4. After completion of the above directives OR concurrent with directives two and three (if they are the same provider), schedule the Veteran for an examination by an appropriate clinician to determine the nature and cause of the Veteran’s coronary artery disease. Based on the factual evidence of record and the examination, the examiner must provide an opinion that responds to the following: (a) Is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s coronary artery disease was incurred in or is otherwise related to his service? 5. After completion of the above directives, schedule the Veteran for an examination by an appropriate clinician to determine the nature and cause of the Veteran’s prostate cancer. Based on the factual evidence of record and the examination, the examiner must provide an opinion that responds to the following: (a) Is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s prostate cancer was incurred in or is otherwise related to his service? 6. After completion of the above directives, schedule the Veteran for an examination by an appropriate clinician to determine the nature and cause of the Veteran’s diabetes. Based on the factual evidence of record and the examination, the examiner must provide an opinion that responds to the following: (a) Is it at least as likely as not (defined as a 50% or better probability) that the Veteran’s diabetes was incurred in or is otherwise related to his service? In forming any opinions, the Board emphasizes that the Veteran is competent to report what his symptoms are and when they began. If the Veteran’s statements are inconsistent with the medical evidence, the examiner must provide a comprehensive report including a complete explanation (rationale) for all opinions and conclusions reached, citing the objective medical findings or other evidence leading to the conclusion that his statements are inconsistent with the medical evidence. Detailed rationale and reasoning for all opinions and conclusions provided is required BY LAW. Providing an opinion without a thorough explanation will delay processing of the claim and may result in a clarification being requested. Additionally, the examiner’s attention is drawn to the following pieces of evidence, which must be considered and addressed in the rationale (this does not substitute for the requirement that the examiner review the Veteran’s entire claim’s file): *December 1972 STRs where the Veteran reported “eye trouble” and “shortness of breath” *November 2011 lay/buddy statements that discuss an in-service head injury and motor vehicle accident *November 2011 Statement in Support of Claim where the Veteran reported that his doctor informed him that he has had diabetes “for a very long time” *November 2011 Third Party Correspondence that includes documents indicating where toxic chemicals and herbicides were stored in Mississippi and Kentucky—areas where the Veteran spent time while in the Army and Army National Guard. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. McKone, Law Clerk