Citation Nr: 21061383 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 19-02 804A DATE: October 1, 2021 REMANDED Entitlement to service connection for residuals of rectal cancer is remanded. Entitlement to service connection for residuals of lung cancer is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy is remanded. Entitlement to service connection for residuals of nephrostomy is remanded. Entitlement to service connection for colostomy is remanded. Entitlement to service connection for scar status post nephrostomy is remanded. Entitlement to service connection for scar status post lung cancer is remanded. Entitlement to service connection for scar status post colostomy is remanded. Entitlement to service connection for scar status post rectal cancer is remanded. Entitlement to service connection for urinary incontinence is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1966 to April 1967. The Veteran had a hearing before the Board in July 2021 and the transcript is of record. 1. 6. Entitlement to service connection for residuals of rectal cancer; residuals of lung cancer; right upper extremity peripheral neuropathy; left upper extremity peripheral neuropathy; right lower extremity peripheral neuropathy; and left lower extremity peripheral neuropathy are remanded. The claims are remanded to obtain outstanding treatment records. Limited treatment records have been associated with the record. The most recent private treatment records are dated in September 2014. The Veteran identified treatment as Cleveland Clinic Indian River, Behavioral Health Center, in July 2021. See July 2021 VA Form 21-8940. Those records must be obtained on remand. To date, the Agency of Original Jurisdiction (AOJ) has not undertaken development of the Veteran's claim that he was exposed to chemicals in service. He submitted literature regarding chemicals at Fort McClellan. All indicated development should be conducted on remand. After obtaining records and information with regard to possible chemical exposures, medical opinions should be obtained. The Veteran has submitted a private medical opinion; however, the opinion is not adequate because it specifically notes a lack of pertinent information. The private opinion provider found that the Veteran's diagnoses of rectal, skin, and lung cancer were at least as likely as not secondary to his exposure to PCBs and that the colostomy and neuropathy were secondary to his chemotherapy for rectal cancer. Although the opinion provider identified medical records and discussed literature, the opinion provider also said none of the factors were "elucidated" in the Veteran's case, including the duration and level of exposure, the route of exposure, and the individual susceptibility factors. Given that lack of information, the opinion provider said the Veteran's malignancy prone history has one risk factor which is the highest factor to cause his cancer, PCBs. 7. 15. Entitlement to service connection for residuals of nephrostomy; colostomy; scar status post nephrostomy; scar status post lung cancer; scar status post colostomy; scar status post rectal cancer; urinary incontinence; and erectile dysfunction; and entitlement to a TDIU are remanded. Finally, these claims are remanded because all are intertwined with the issues being remanded. Development and ajudication of those claims will impact these claims. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all relevant outstanding treatment records. Thereafter, after obtaining any necessary authorization, attempt to obtain and associate with the claims file all identified treatment records, including from Cleveland Clinic Indian River. 2. Take all appropriate action to develop the Veteran's claim of chemical exposure in service. 3. After completion of the above, forward copies of all pertinent records to a VA clinician to obtain a medical opinion regarding the nature and etiology of the Veteran's residuals of rectal cancer; residuals of lung cancer; right upper extremity peripheral neuropathy; left upper extremity peripheral neuropathy; right lower extremity peripheral neuropathy; and left lower extremity peripheral neuropathy. If examination is deemed necessary to respond to the questions presented, one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). Copies of all pertinent records must be provided to the examiner, included any determination made by the AOJ as to possible chemical exposures during service. The examiner must answer the following questions: Is it at least as likely as not that the Veteran's residuals of rectal cancer; residuals of lung cancer; right upper extremity peripheral neuropathy; left upper extremity peripheral neuropathy; right lower extremity peripheral neuropathy; and left lower extremity peripheral neuropathy are related to exposure to toxins and/or chemicals in service? In rendering the opinion, the examiner must specifically discuss the information provided by the AOJ as to chemical exposures in service and the private medical opinion and the medical literature identified. A complete rationale must be provided for any opinions offered. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues. M.E. LARKIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert J. Burriesci, 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.