Citation Nr: 18123748 Decision Date: 08/02/18 Archive Date: 08/02/18 DOCKET NO. 17-38 422 DATE: August 2, 2018 REMANDED Service connection for ischemic heart disease is remanded. Service connection for tonsil cancer residuals is remanded. REASONS FOR REMAND The Veteran served in the United States Army from March 1961 to February 1964. The Veteran requested and was scheduled for a videoconference hearing before the Board. In June 2016, the Veteran’s representative reported the Veteran was unable to attend the hearing. She requested the hearing request be withdrawn and submitted an informal hearing presentation (IHP) brief on the Veteran’s behalf. See July 2018 brief. The Veteran’s hearing request is deemed withdrawn. 1. Service connection for ischemic heart disease is remanded. 2. Service connection for tonsil cancer residuals is remanded. In a July 2018 brief, the Veteran’s representative requested the Veteran be provided a VA examination opinion to determine the etiology of his heart condition and tonsil cancer. The brief referenced a report showing non-tactical chemicals and insecticides were used in the Panama Canal Zone during the Veteran’s service. The Board finds a medical opinion is necessary to adjudicate the claim. See McLendon v. Nicholson, 20 Vet. App.79 (2006). In addition, the Veteran has contended his heart condition and tonsil cancer are related to working as a radio operator in proximity to Hawk missiles in service. See March 2017 Radiation Risk Activity form and May 2017 NOD. The Board will request the examiner opine on the likelihood non-ionizing radiation exposure during service caused the Veteran’s heart condition or tonsil cancer. Lastly, VA treatment records indicate there may be relevant private treatment records missing from the claims file. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. Swank in Roanoke, Virginia; Dr. Proctor in Lewisburg, West Virginia; or any other treatment records for tonsil cancer or heart condition not included in the claims file. See April 2017 VA treatment note. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. After the above records development is completed to the extent possible, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any tonsil cancer residuals. The examiner must: (a.) Identify any tonsil cancer residuals found in the claims file or on examination. Specifically consider the Veteran’s reported residuals of difficulty swallowing, dry mouth, neck pain, lack of smell, reduced saliva, and lack of taste. See July 2018 representative brief. (b.) Is it as likely as not (50 percent or greater) the Veteran’s tonsil cancer began in service or is etiologically related to service, to include exposure to non-tactical chemicals and insecticides used in the Panama Canal Zone during his service? The examiner must discuss the Veteran’s lay statements reporting nausea, eye-watering, and sometimes headache when he smelled the non-tactical chemicals and/or insecticides in service, reporting a sore throat in service, his wife’s report that the Veteran’s voice was raspy after discharge from service, and the medical literature stating symptoms of tonsil cancer include a hoarse voice and a sore or uncomfortable throat. See July 2018 representative brief. (c.) Is it as likely as not the Veteran’s tonsil cancer is etiologically related to non-ionizing radiation exposure working as a radio operator in proximity to Hawk missiles in service? See March 2017 Radiation Risk Activity form and May 2017 NOD. The examiner must provide a detailed rationale for any opinion expressed. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After the records development in step 1 is completed to the extent possible, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any heart condition. The examiner must: (a.) Identify any heart condition diagnoses found in the claims file or on examination. (b.) For each heart condition identified, is it as likely as not the condition began in service or is etiologically related to service, to include exposure to non-tactical chemicals and insecticides used in the Panama Canal Zone during his service? See July 2018 representative brief. (c.) For each heart condition identified, is it as likely as not the condition is etiologically related to non-ionizing radiation exposure working as a radio operator in proximity to Hawk missiles in service? See March 2017 Radiation Risk Activity form and May 2017 NOD. (Continued on the next page)   The examiner must provide a detailed rationale for any opinion expressed. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Winkler, Associate Counsel