Citation Nr: 20005353 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 17-53 355 DATE: January 23, 2020 REMANDED The issue of service connection for an abdominal disorder, to include inguinal hernia, is remanded. The issue of service connection for a prostate disorder is remanded. The issue of service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1966 to November 1967. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified at a Board videoconference hearing. A transcript of the hearing has been associated with the virtual file and reviewed 1. The issue of service connection for an abdominal disorder, to include inguinal hernia. The Veteran contends that strenuous lifting during the military as a cook caused his inguinal hernia. Specifically, the Veteran stated he was responsible for feeding 780 people while in the military, had to load and distribute rations, as well as set up and lift heavy bulk boxed canned goods and milk crates on and off a one-and-a-half-ton truck. The Veteran further contends he drove a truck after discharge from service and did not participate in any physical activity that required strenuous lifting. See September 2019, Hearing transcript. Service treatment records (STRs) indicate the Veteran had abdominal issues during service. The Veteran’s entrance examination indicated his abdomen and viscera were normal, and negative medical history of a hernia or rupture was noted. In April 1966, the Veteran complained of pain in the left inguinal area on two separate occasions. Additionally, the Veteran indicated a positive medical history of a hernia or rupture on his separation examination. See September 1965, Entrance examination; April 1966, STRs; November 1967, Separation examination. Post-service treatment records indicate the Veteran had a left hernia in 2008 and underwent surgical repair of same. In 2014, the Veteran complained of abdominal pain and a CT scan revealed a small inguinal hernia. See VA treatment records dated June 2014 and December 2017. The AOJ should schedule a VA examination to determine the nature and etiology of any current disorders of the Veteran’s abdomen, to include an inguinal hernia. 2. The issue of service connection for a prostate disorder. The Veteran contends his prostate disorder was caused by Agent Orange exposure or is otherwise related to military service as he does not have a family history of prostate issues. See September 2019, Hearing transcript. The Veteran has a current diagnosis of benign prostate hyperplasia and uses a self-catheter. See VA treatment records dated October 2007 to September 2018. The Veteran’s service-connected disabilities include diabetes due to herbicide exposure; thus, herbicide exposure is conceded. The Board recognizes that the Veteran’s current prostate disorder is not on the presumptive list, but the list is not an exhaustive one. The Board further notes that the Veteran was not afforded a VA examination. The AOJ should therefore obtain a VA examination regarding the nature and etiology of the Veteran’s prostate disorder, to include whether his prostate disorder was caused by in-service herbicide exposure. 3. The issue of service connection for hypertension. The Veteran contends high blood pressure is related to active service. See September 2019, Hearing transcript. The Veteran is service-connected for diabetes resulting from in-service herbicide exposure; thus, herbicide exposure is conceded. VA treatment records indicate hypertension was diagnosed in June 2008 and diabetes mellitus was diagnosed in October 2013. See VA treatment records dated June 2008 and October 2013. From 2007 to 2013, prior to the diabetes diagnosis, the Veteran had A1c levels ranging from 6.0 to 6.4 percent. See VA treatment records from October 2007 to January 2012. After diabetes was diagnosed, the Veteran began taking 5 mg of Lisinopril to manage hypertension with increased dosage of 10 mg in October 2016. See VA treatment records dated July 2014 through September 2018. The AOJ should therefore obtain an opinion regarding the nature and etiology of the Veteran’s hypertension, to include as due to herbicide exposure and whether hypertension was proximately due to or aggravated by his service-connected diabetes. The claims file has VA treatment record up to January 2019. On remand, any previously unobtained ongoing relevant medical records should be procured and associated with the Veteran’s claims file. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records of the Veteran since January 2019. 2. After completing directive #1, obtain an opinion from an appropriate VA clinician regarding the nature and etiology of any current abdominal disorders, to include an inguinal hernia. The clinician should review the virtual file and a copy of this Remand, then address the following: (a.) Identify all abdominal disorders, to include inguinal hernias, that are currently present (or present any time from January 2017 to the present). Even if there is no diagnosed disorder, pain resulting in functional impairment may constitute a disability for service-connection purposes. If present, describe any functional impairment; if not, state why. If the examiner disagrees with a diagnosis already established in the medical records, he or she should so state and explain why. (b.) Whether it is at least as likely as not that a current abdominal disorder, to include inguinal hernia, was incurred in, caused by, or etiologically related to his service, including as due to herbicide exposure. The examiner should consider the April 1966 STRs indicating abdominal pain and the separation examination notating a hernia/rupture. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. 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 completing directive #1, obtain an opinion from an appropriate VA clinician regarding the nature and etiology the Veteran’s prostate disorder, including due to herbicide exposure. The clinician should review the virtual file and a copy of this Remand, then address the following: (a.) Whether it is at least as likely as not that the Veteran’s prostate disorder was incurred in, caused by, or etiologically related to his service, including as due to herbicide exposure. The examiner is advised that the Board is cognizant that the NAS National Research Council has not included benign prostate hyperplasia as one of the diseases potentially associated with in-service herbicide exposure; however, this list is not exclusive. The examiner is further advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. 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). 4. After completing directive #1, obtain an opinion from an appropriate VA clinician regarding the nature and etiology of hypertension, to include in-service herbicide exposure. The clinician should review the virtual file and a copy of this Remand, then address the following: (a.) Whether it is at least as likely as not that the Veteran’s hypertension was incurred in, caused by, or etiologically related to his service, including as due to herbicide exposure. (b.) Whether it is at least as likely as not (50 percent or greater probability) that hypertension is proximately due to service-connected diabetes. (c.) Whether it is as least as likely as not (50 percent or greater probability) that hypertension has been aggravated (i.e., worsened beyond the normal progression of that disease) by service-connected diabetes. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. 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). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Straughn, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.