Citation Nr: 20028061 Decision Date: 04/22/20 Archive Date: 04/22/20 DOCKET NO. 13-33 891A DATE: April 22, 2020 REMANDED Entitlement to service connection for a respiratory disorder, to include bronchial asthma and sinusitis, is remanded. Entitlement to service connection for hypertension, to include as due to exposure to an herbicide agent or secondary to service-connected adjustment disorder, is remanded REASONS FOR REMAND The Veteran had active service from June 1966 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was remanded by the Board to the Agency of Original Jurisdiction (AOJ) for further development in September 2017. Unfortunately, the Board regrets the additional delay and finds another remand is necessary. REASONS FOR REMAND 1. Entitlement to service connection for a respiratory disorder, to include bronchial asthma and sinusitis, is remanded. In this post-remand case, the Veteran contends he is entitled to service connection for bronchial asthma claimed as chronic respiratory problems. In July 2011, the Veteran filed a claim for service connection that was subsequently denied in a July 2012 rating decision. The Veteran was afforded a VA examination in February 2015. The examiner offered a negative nexus opinion stating the Veteran’s asthma was less likely than not incurred in, or caused by the claimed in-service injury, event, or illness. The rationale provided was that there is documented evidence in the STRs of childhood asthma, however, the diagnosis precedes the Veteran’s time of service, and his separation exam in 1970 documented a normal lung exam. The examiner concluded there is no documented evidence that supported a permanent residual or chronic disability. In a September 2017 decision, the Board concluded the medical opinion was of little probative value given the irreconcilable propositions that the Veteran was both treated for asthma during service and that he has been asymptomatic since childhood. Therefore, a remand was necessary to determine whether the presumption of soundness could be rebutted in this case. The requested development was completed, and an addendum opinion was obtained in November 2017. The examiner opined that the Veteran’s asthma did not pre-exist service and it is at least as likely as not (greater than 50 percent probability) the Veteran does not currently have a respiratory condition. However, in a lay statement provided by the Veteran in January 2020, the Veteran maintains he “never had or have now bronchial asthma. What I do have since Vietnam is chronic sinusitis.” The Veteran in his lay statement contends there are outstanding private and VA records corroborating his diagnosis and treatment of sinusitis. Therefore, the Board finds the issue shall be remanded to obtain any outstanding private medical treatment records and expand the Veteran’s claim to include all his respiratory conditions including his claim for asthma and chronic sinusitis. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (holding that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s description of the claim, reported symptoms, and the other information of record). 2. Entitlement to service connection for hypertension, to include as due to exposure to an herbicide agent or secondary to service-connected adjustment disorder is remanded. The Veteran additionally contends he is entitled to service connection for hypertension due to exposure to an herbicide agent or secondary to his service-connected adjustment disorder. The Board previously addressed and remanded this issue for further development in a September 2017 decision. First, the Veteran submitted private treatment records and was diagnosed with hypertension in April 2011. The Veteran’s STRs do not indicate elevated blood pressure readings or a diagnosis of hypertension while in service. The Veteran’s exposure to Agent Orange is conceded. He is currently service connected for coronary artery disease as a result of exposure. The Veteran was afforded a VA examination in February 2015. The examiner provided a negative nexus opinion and determined the Veteran’s hypertension is less likely than not proximately due to, or the result of, a service-connected disability. The examiner provided a single sentence rationale, “There is a lack of objective medical evidence... that the Veteran’s hypertension was the result of his service-connected adjustment disorder and CAD.” The Board determined this opinion was inadequate and the issue was remanded for a nexus opinion supported by rationale. The Board notes hypertension is not a disease listed under 38 C.F.R. § 3.309(e) for which a presumption of service connection based on herbicide exposure applies. However, the Board determined that, absent a medical opinion as to the likelihood that the Veteran’s hypertension was actually caused by his presumed herbicide exposure, the record was insufficient in order to adjudicate the Veteran’s claim. The Veteran was afforded a subsequent VA examination in November 2017. The examiner opined it is less likely than not (less than 50 percent probability) the Veteran’s hypertension was caused or aggravated by his active duty service. The examiner reviewed the Veteran’s STRs and stated his record revealed normal blood pressure readings throughout his period of service. The examiner noted the Veteran’s blood pressure reading upon entrance in March 1966 of 134/84, an undated blood pressure reading of 122/76, a 120/65 reading in a June 1969 note while the Veteran was serving in Vietnam, and blood pressure of 126/88 at the time of his separation. The examiner stated at the time of the Veteran’s diagnosis of chronic undifferentiated schizophrenia when he was evacuated from RVN, his blood pressure was recorded as 132/82. A July 1969 note indicates the examiner’s impression was schizoaffective reaction resolving with medications and a return to the United States. The examiner notes this diagnosis was made by a psychiatrist and it remains unknown who made the diagnosis of schizophrenia while in RVN. The examiner also noted at the new patient VA examination performed in October 2015 that there was no history or diagnosis of schizophrenia and opined the Veteran was “never truly schizophrenic” because schizophrenia is a chronic disease. However, the Board finds the medical opinion to be inadequate. Hypertension is not a disease listed under 38 C.F.R. § 3.309(e) for which a presumption of service connection based on herbicide exposure applies and medical opinion states hypertension was not shown to be aggravated during service but it fails to explain why the Veteran could not have developed hypertension in 1987 as a result of his exposure to Agent Orange while serving in Vietnam. Additionally, the opinion is inadequate because it does not explain why his hypertension cannot be related to his schizophrenia or explain why it was not caused oy aggravated by his service-connected adjustment disorder. Lastly, the opinion does not explain why his hypertension could not have been caused or aggravated by his heart disorder. Therefore, the Board finds a remand necessary in order for an addendum opinion to be obtained. The matters are REMANDED for the following actions: 1. Efforts shall be made to obtain any outstanding private medical treatment records as identified by the Veteran to include records from Dr. Westmoreland at New Century Medical Associates and Carolina Health Specialists in Myrtle Beach, South Carolina. 2. Provide the Veteran an additional VA examination and etiological opinion to determine whether he has any respiratory conditions, to include asthma and chronic sinusitis, that are at least as likely as not (greater than 50 percent probability) related to his active duty service. 3. Obtain an addendum opinion from the November 2017 VA examiner or another qualified VA examiner if the previous examiner is unavailable. The examiner shall provide an opinion as to the following: (a.) Opine as to whether the Veteran’s diagnosed hypertension may have developed in 1987 as a result of his exposure to Agent Orange in Vietnam. (b.) Opine as to whether his hypertension was caused or aggravated by his service-connected adjustment disorder. (c.) Opine as to whether his hypertension was caused or aggravated by his service-connected coronary artery disease. The examiner discussed the different types of hypertension but did not provide an explanation as to how this would preclude a connection to heart disease since the Veteran has been diagnosed with hypertension since 1987. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. DeBoer, 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.