Citation Nr: 20009922 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 17-04 272 DATE: February 5, 2020 REMANDED Entitlement to service connection for melanoma is remanded. Entitlement to service connection for a prostrate disorder is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for arthritis, to include rheumatoid arthritis, is remanded. Entitlement to service connection for a gastrointestinal disorder, to include gastroesophageal reflux disease (GERD), is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for cancer of the lymph nodes, to include non-Hodgkin's lymphoma, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from February 1969 to November 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal of March 2013 and June 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The March 2013 RO decision determined that new and material evidence had not been received to reopen a claim for entitlement to service connection for melanoma (listed as melanoma skin cancer on the back). The June 2014 RO reopened and denied the Veteran’s claim for entitlement to service connection for melanoma (listed as melanoma skin cancer on the back) on a de novo basis. By this decision, the RO also denied service connection for a prostate disorder (listed as benign prostatic hypertrophy); hypertension; arthritis, to include rheumatoid arthritis (listed as degenerative arthritis); a gastrointestinal disorder, to include GERD (listed as GERD); erectile dysfunction; and for cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. The Board observes that the June 2014 RO decision (noted above) reopened and denied the Veteran’s claim for entitlement to service connection for melanoma (listed as melanoma skin cancer on the back) on a de novo basis. The Board notes, however, that service connection for melanoma (listed as melanoma skin cancer on the back) was previously denied in a final March 2003 RO decision. Thus, the Board must address whether new and material evidence has been received to reopen the Veteran’s claim for entitlement to service connection for melanoma. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). In September 2019, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. On July 1, 2019, the Secretary of Veterans Affairs directed the Board of Veterans’ Appeals (Board) to stay adjudication of all cases which may be affected by the Blue Water Navy Vietnam Veterans Act of 2019 (the Act), until the effective date of the Act, January 1, 2020. The Act creates new statutory requirements for the adjudications of certain claims based on veterans’ herbicide agent exposure in the offshore waters of the Republic of Vietnam during the period from January 9, 1962, to May 7, 1975, in or near the Korean Demilitarized Zone during the period from September 1, 1967, to August 31, 1971, and in Thailand during the period from January 9, 1962, to May 7, 1975. The stay has now been lifted. As discussed above, the Board observes that service connection for a melanoma was previously denied in a final March 2003 RO decision. The Board finds, however, that new and material evidence has been received to reopen that claim pursuant to 38 C.F.R. § 3.156 (a). Therefore, this decision will address the merits of the underlying service connection claim for melanoma. In December 2019, the Board remanded the issues of entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD); entitlement to an initial higher (compensable) rating for bilateral hearing loss; and entitlement to a total disability rating based on unemployability (TDIU), for further development. The Board notes, however, that the issues of entitlement to service connection for a psychiatric disorder, to include PTSD; entitlement to an initial higher (compensable) rating for bilateral hearing loss; and entitlement to a TDIU, have not yet been recertified to the Board. Additionally, it appears that the RO is in the process of developing evidence in regard to those issues. Thus, the RO should complete development of those issues and recertify those issues to the Board. The Veteran contends that he has melanoma; a prostate disorder; hypertension; arthritis, to include rheumatoid arthritis; a gastrointestinal disorder, to include GERD; erectile dysfunction; and cancer of the lymph nodes, to include non-Hodgkins lymphoma, that are all related to service, to include as due to Agent Orange exposure. He specifically maintains that he was exposed to Agent Orange while serving aboard the USS Saint Paul. He reports that the USS Saint Paul docked in Da Nang harbor in the Republic of Vietnam, while he served on that ship from February 1969 to November 1970. The Veteran also indicates that he served aboard the USS Saint Paul in the Gulf of Tonkin. The Veteran further indicates that he was exposed to the sun and that he had sunburns during service, which he believes may have led to his development of melanoma. He states that he may have developed hypertension due to distress he suffered while serving on the USS Saint Paul. The Veteran states that when he was lying down in a tower taking a nap, an artillery gun went off unexpectantly, and he was startled. He further asserts that he has erectile dysfunction as a result of the chemotherapy for his cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. The Veteran maintains that his arthritis, to include rheumatoid arthritis, began during service with back pain due to going up and down stairs. He also states that he had right and left shoulder problems during service. The Veteran served on active duty in the Navy from February 1969 to November 1970. His DD Form 214 indicates that he had one year, eight months, and twenty-seven days of foreign and/or sea service. He received decorations including the Vietnam Service Medal and the Vietnam Campaign Medal. The Veteran’s service personnel records show that he served aboard the USS Saint Paul from February 1969 to November 1970. Based on a review of the record, the record shows that the Veteran was presumably exposed to Agent Orange while in service. See March 2018 RO formal finding. The Veteran’s service treatment records do not show treatment for melanoma; prostate problems; hypertension; arthritis, to include rheumatoid arthritis; a gastrointestinal disorder, to include GERD; erectile dysfunction; or for cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. Such records do show that the Veteran was treated for a rash on several occasions, and that he was treated for vomiting on one occasion. Post-service private and VA treatment records show treatment for melanoma; history of metastatic melanoma, with retroperitoneal adenopathy, status post resection of the primary lesion and systemic chemotherapy; benign prostatic hypertrophy; hypertension; GERD; impotence; erectile dysfunction; lymphoma; stage IV diffuse large B-cell lymphoma, status post six cycles of “R-CHOP” chemotherapy; and non-Hodgkin’s lymphoma. Such records also show treatment for numerous joint problems, including of the back, shoulders, and knees, as well as diagnoses such as degenerative joint disease of multiple joints, and arthritis, degenerative. The Board observes that the Veteran has not been afforded VA examinations, as to his claimed melanoma; prostate disorder; hypertension; arthritis, to include rheumatoid arthritis; gastrointestinal disorder, to include GERD; erectile dysfunction; and cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. As to the Veteran’s claim for service connection for cancer of the lymph nodes, to include non-Hodgkin’s lymphoma, the Board notes that there are multiple diagnoses of record, including lymphoma; stage IV diffuse large B-cell lymphoma, status post six cycles of “R-CHOP” chemotherapy; and non-Hodgkin’s lymphoma. The Board observes that therefore, the Veteran’s current diagnosis is somewhat unclear from the record. As to the Veteran’s claim for service connection for hypertension, the Board notes that an article in the November 2016 Journal of Occupational and Environmental Medicine entitled Herbicide Exposure, Vietnam Service, and Hypertension Risk in Army Chemical Corps Veterans suggests that herbicide exposure history and Vietnam service status were significantly associated with hypertension risk. See https://www.publichealth.va.gov/epidemiology/studies/vietnam-army-chemical-corps.asp. Additionally, in November 2018, the National Academy of Sciences upgraded hypertension to the “sufficient” category from “limited or suggestive,” indicating that “there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. In light of the above, the Board finds that the Veteran must be afforded VA examinations with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for melanoma; a prostate disorder; hypertension; arthritis, to include rheumatoid arthritis; a gastrointestinal disorder, to include GERD; erectile dysfunction; and for cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for melanoma; prostate problems; hypertension; arthritis, to include rheumatoid arthritis; a gastrointestinal disorder, to include GERD; erectile dysfunction; and for cancer of the lymph nodes, to include non-Hodgkin’s lymphoma, since October 2017. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptoms regarding his claimed melanoma; prostate disorder; hypertension; arthritis, to include rheumatoid arthritis; gastrointestinal disorder, to include GERD; erectile dysfunction; and cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination to determine the onset and etiology of his claimed melanoma. The entire claims file must be reviewed by the examiner. The examiner must specifically indicate if the Veteran has currently diagnosed melanoma and/or residuals of melanoma. The examiner must opine as to whether it is as at least as likely as not that any currently diagnosed melanoma and/or residuals of melanoma, are related to and/or had their onset during his period of service, to include presumed exposure to Agent Orange during service. The examiner must also specifically acknowledge and discuss the Veteran’s reports of exposure to the sun, with sunburns during service, and any reports of symptoms he thought were due to melanoma during or since service. 4. Schedule the Veteran for a VA examination to determine the onset and etiology of his claimed prostate disorder; hypertension; gastrointestinal disorder, to include GERD; erectile dysfunction; and cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. The entire claims file must be reviewed by the examiner. The examiner must diagnose all current prostate disorders; gastrointestinal disorders, to include GERD; and cancer of the lymph nodes, to include non-Hodgkin’s lymphoma. The examiner must specifically indicate if the Veteran has currently diagnosed hypertension and erectile dysfunction. The examiner must opine as to whether it is as at least as likely as not that any currently diagnosed prostate disorders; hypertension; gastrointestinal disorders, to include GERD; erectile dysfunction; and cancer of the lymph nodes, to include non-Hodgkin’s lymphoma, are related to and/or had their onset during his period of service, to include presumed exposure to Agent Orange during service. The examiner must also specifically acknowledge any reports by the Veteran of symptoms he thought were due to his claimed disorders, during or since service. The examiner’s opinion must include consideration that the National Academy of Sciences has upgraded hypertension to the “sufficient” category from “limited or suggestive,” indicating that “there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. Additionally, the opinion must also include consideration that in a study among U.S. Army Chemical Corps Veterans, VA researchers, found an association between both hypertension risk and exposure to herbicides, and hypertension risk and military service in Vietnam. 5. Schedule the Veteran for a VA examination to determine the onset and etiology of his claimed arthritis, to include rheumatoid arthritis. The entire claims file must be reviewed by the examiner. The examiner must diagnose all arthritis of the joints, and specifically indicate if the Veteran has currently diagnosed rheumatoid arthritis The examiner must opine as to whether it is as at least as likely as not that any currently diagnosed arthritis of the joints, to include rheumatoid arthritis, is related to and/or had its onset during his period of service, to include presumed exposure to Agent Orange during service. The examiner must also specifically acknowledge and discuss the Veteran’s reports of joint problems during and since service. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. D. Regan, 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.