Citation Nr: 21003429 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 13-09 443A DATE: January 21, 2021 REMANDED 1. Entitlement to service connection for myasthenia gravis, to include as due to exposure to Agent Orange, is remanded. 2. Entitlement to service connection for a respiratory disability, to include as due to exposure to Agent Orange, is remanded. 3. Entitlement to service connection for tricuspid regurgitation, to include as due to exposure to Agent Orange, is remanded. 4. Entitlement to service connection for fibromuscular dysplasia, to include as due to exposure to Agent Orange, is remanded. 5. Entitlement to service connection for a skin condition, to include as due to exposure to Agent Orange, is remanded. REASONS FOR REMAND The appellant is the surviving spouse of a Veteran who served on active duty (including in combat in Vietnam) from December 1965 to January 1968. These matters are before the Board of Veterans’ Appeals (Board) on appeal from November 2009 and July 2012 rating decisions. In July 2015 a videoconference hearing was held before the undersigned, a transcript is in the record. In December 2015 the matters were remanded for further development. The Veteran died in January 2017; and the appellant is his surviving spouse who has been substituted for him as the appellant. In November 2018 and June 2020, these matters were again remanded for additional development. 1. 2. 3. 4. 5. Entitlement to service connection for myasthenia gravis (on de novo consideration), a respiratory disability, tricuspid regurgitation, fibromuscular dysplasia, and a skin disability, all to include as due to exposure to Agent Orange is remanded. The Board finds that there has not yet been substantial compliance with previous remand directives, and that corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The June 2020 Board remand directed the AOJ to obtain medical records from the Greater LA VAMC. It was noted that VA is required to make as many requests as necessary to obtain relevant records from a Federal department or agency (including medical and other records from VA medical facilities), and that VA will end its efforts to obtain records from a Federal department or agency only [emphasis added] if it is concluded that the records sought do not exist or that further efforts to obtain those records would be futile. See 38 C.F.R. § 3.159 (c)(2). The record following the June 2020 Board remand does not contain documentation of any efforts to obtain records from the Greater LA VAMC. As was noted on the June 2020 remand, the current records obtained from other VA facilities do not contain the positive opinions that the Veteran asserted exist in his testimony at the July 2015 videoconference hearing. Any such existing Greater LA VAMC records that are outstanding remain particularly critical evidence, for which an exhaustive development is required. Consequently, the duty to assist requires a remand for additional development to attempt to obtain outstanding Greater LA VAMC records in accordance with the requirements in 38 C.F.R. § 3.159 (c)(2). The matters are REMANDED for the following: 1. Arrange for exhaustive development to secure for the record complete clinical records of any VA treatment the Veteran received at the Greater LA VAMC since he received a diagnosis of myasthenia gravis. Efforts to secure such records must continue until it is reasonably certain that such records do not exist or that further effort to obtain them would be futile (upon a negative response from the Greater LA VAMC and any record storage facility where they may have been retired). The scope of the search and all responses must be documented in the record. If any records that were reported to have been created cannot be located, make a formal finding of unavailability for the claims file. The appellant must be notified of the result of the development. 2. Then review any additional records from the Greater LA VAMC received (searching thoroughly for a medical opinion by a VA provider relating any of the claimed disabilities here at issue to the Veteran’s service and exposure to Agent Orange therein), and arrange for any further development suggested by information found. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Staskowski, 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.