Citation Nr: 21062662 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 18-26 072 DATE: October 8, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right hip condition is remanded. Entitlement to service connection for a left hip condition is remanded. Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for skeletal arthritis is remanded. Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to service connection for diabetes mellitus 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 left lower extremity peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for a bilateral eye disability is remanded. Entitlement to service connection for a lung disability is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a stomach condition is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a kidney disability is remanded. REASONS FOR REMAND Although the Board of Veterans' Appeals (Board) regrets the delay, additional development is needed as to the Veteran's appeal. At his June 2021 Board hearing, the Veteran testified that he has applied for Social Security Administration (SSA) disability benefits. When the Department of Veterans Affairs (VA) is put on notice of the existence of potentially relevant SSA records, VA must try and obtain these records before deciding the appeal as part of the duty to assist. See 38 C.F.R. § 3.159(c)(2) and (3); see also Murincsak v. Derwinski, 2 Vet. App. 363, 370- 372 (1992). On remand, those SSA records, including all adjudications and the underlying records, must be associated with the Veteran's file. Also, the Veteran testified as to ongoing, relevant treatment at the VA. The most recent VA treatment records associated with the Veteran's claims file are from November and December 2020. Prior to that, records were last uploaded as of April 2018. It is unclear if records exist from the period between April 2018 and November 2020. On remand, all records since April 2018 should be obtained and associated with the Veteran's claims file. 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right hip condition is remanded. 4. Entitlement to service connection for a left hip condition is remanded. 5. Entitlement to service connection for a back disability is remanded. 6. Entitlement to service connection for a cervical spine disability is remanded. 7. Entitlement to service connection for skeletal arthritis is remanded. The Veteran has argued that his musculoskeletal disabilities, including his bilateral knee disability, bilateral hip disability, back disability, cervical spine disability, and skeletal arthritis are causally related to his service. The Veteran testified at his Board hearing that he injured his hips and knees in service picking up heavy rounds and running. An August 1983 service treatment records notes the Veteran was seen for right leg pain starting in his right hip and radiating down to his calf. The Veteran testified that during boot camp he injured his back trying to pull a fellow servicemember up a mountain. He reported his back continued to hurt during service, but he took pain pills on his own to treat it. He reported he sought private treatment for his back in 1985 after he separated from service. On remand, the Veteran should be afforded a VA examination of his knee, hip, back, neck, and arthritis disabilities and an opinion obtained as to whether any current disability onset in or is causally related to his service. 8. Entitlement to service connection for a bilateral foot disability is remanded. The Veteran testified that he began having problems with his feet during service. He reported that he sometimes still gets a rash on his feet. A May 1982 service treatment record notes that the Veteran sought treatment for blisters on his right foot and was diagnosed with tinea pedis. A May 1984 record indicates the Veteran jammed his left great toe. In August 1984 he was seen for swollen feet. A September 1984 service treatment record notes a diagnosis of a fungal infection in his feet. On remand, the Veteran should be afforded a VA examination of his feet and an opinion obtained as to whether any current disability onset in or is causally related to his service. 9. Entitlement to service connection for diabetes mellitus is remanded. The Veteran has a current diagnosis of diabetes. At his hearing the Veteran testified that he saw people spraying brush in service, with what he believes was Agent Orange. He further testified that he believes some of his symptoms in service, such as excessive sweating, were early signs of diabetes. The Veteran submitted information suggesting that contaminants, including pesticides and other chemicals were disposed of in dump sites at Camp Pendleton, where he was stationed. On remand, the VA should undertake evidentiary development to attempt to verify the Veteran's alleged exposure to chemicals and toxins during his service at Camp Pendleton through official sources. Thereafter, a VA opinion should be obtained as to whether the Veteran's diabetes onset in or is causally related to his service. 10. Entitlement to service connection for right upper extremity peripheral neuropathy is remanded. 11. Entitlement to service connection for left upper extremity peripheral neuropathy is remanded. 12. Entitlement to service connection for left lower extremity peripheral neuropathy is remanded. 13. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. The Veteran has argued that his peripheral neuropathy is secondary to his diabetes. He also testified at his Board hearing that during service he experienced numbness in his fingers. Service treatment records reflect that in April and May 1982 the Veteran was seen for left arm numbness and weakness. As the issue of entitlement to service connection to diabetes has been remanded above, the Veteran's neuropathy claims must also be remanded as intertwined. Further, a VA opinion should be obtained as to whether the Veteran has left upper extremity peripheral neuropathy related to his in-service left arm complaint. 14. Entitlement to service connection for erectile dysfunction is remanded. At his hearing the Veteran contended that his erectile dysfunction and nerve damage is secondary to his back disability. As the Veteran's claim for entitlement to service connection for a back disability has been remanded above, the Veteran's claim for service connection for erectile dysfunction must also be remanded as intertwined. 15. Entitlement to service connection for a bilateral eye disability is remanded. At his Board hearing the Veteran testified that in service he would get debris in his eyes during artillery firing. He stated that he had "twitching eyes" and he went to a doctor immediately after service and was prescribed glasses. He testified the doctor told him he had dust particles in his eyes. On remand, the Veteran should be afforded a VA eye examination and an opinion obtained as to whether it is at least as likely as not that the Veteran has an eye disability that onset in or is causally related to his service. 16. Entitlement to service connection for a lung disability is remanded. Records reflect the Veteran has been diagnosed with chronic obstructive pulmonary disease (COPD). At his hearing, the Veteran contended that he had difficulty breathing hot air in service. On remand, the Veteran should be afforded a VA examination and an opinion obtained as to whether it is at least as likely as not that the Veteran has lung disability, to include COPD, that onset in or is causally related to his service. 17. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran testified he was exposed to loud noise during artillery firing in service and currently has hearing loss as a result. He was afforded a VA examination in June 2016 at which he reported exposure to firearm noise during bootcamp and range practice and from operating a truck that supplied artillery to a tank unit position next to it. He stated that after service he worked as a commercial truck driver. The VA examiner opined that the Veteran's hearing loss is less likely than not related to service. As a basis for the negative nexus opinion, the examiner stated the Veteran had no significant in-service threshold shift from entrance to separation from service and cited a report from the Institute of Medicine (IOM) entitled "Noise and Military Service: Implications for Hearing Loss and Tinnitus" stating that "There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one's lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur." With regards to that IOM report, the United States Court of Appeals for Veterans Claims (Court) held that the Board must address a medical text that serves as the basis for a medical opinion which contains apparent qualifiers or contradictions to explain whether those aspects of the medical text diminish the probative value of the medical opinion. See McCray v. Wilkie, 31 Vet. App. 243 (2019). On remand, the Board finds that an addendum medical opinion is needed. 18. Entitlement to service connection for a stomach condition is remanded. At his Board hearing, the Veteran indicated he had stomach problems beginning in service. He indicated that he was scheduled to undergo testing at the VA to diagnose his current stomach problems. After the Veteran's SSA and VA treatment records have been obtained, the Agency of Original Jurisdiction (AOJ) should consider whether further development of the claim, including a VA examination, is necessary. 19. Entitlement to service connection for hypertension is remanded. The Veteran testified at his Board hearing that he was diagnosed with high blood pressure after service. After the Veteran's SSA and VA treatment records have been obtained, the AOJ should consider whether further development of the claim, including a VA examination, is necessary. 20. Entitlement to service connection for a kidney disability is remanded. The Veteran has contended that his kidney disability has been contributed to by multiple causes, including his blood pressure medication, his diabetes, and his use of muscle relaxants. After the Veteran's SSA and VA treatment records have been obtained, the AOJ should consider whether further development of the claim, including a VA examination, is necessary. The matters are REMANDED for the following action: 1. Contact the Social Security Administration and obtain a complete copy of any adjudication and the records underlying any adjudication for disability benefits. All efforts to obtain Social Security records should be fully documented, and a negative response must be provided if records are not available. 2. Obtain the Veteran's VA treatment records since April 2018 and associate with his claims file. 3. After directives 1 and 2 are completed, arrange for the Veteran to undergo a VA examination of his knee, hip, back, neck, and arthritis disabilities. The following opinions should be obtained: (a.) Is it at least as likely as not that the Veteran has arthritis that onset to a compensable degree within a year of his separation from service? (b.) Is it as least as likely as not that the Veteran has a right or left knee disability that onset in or is causally related to his service? (c.) Is it as least as likely as not that the Veteran has a right or left hip disability that onset in or is causally related to his service? (d.) Is it as least as likely as not that the Veteran has a back disability that onset in or is causally related to his service? (e.) Is it as least as likely as not that the Veteran has a cervical spine disability that onset in or is causally related to his service? A full rationale should be provided for all opinions expressed. In rendering opinions, the examiner should consider the Veteran's lay statements with respect to his physical activities in service and pain experienced in service as well as an August 1983 service treatment record noting that the Veteran was seen for right leg pain starting in his right hip and radiating down to his calf. 4. After directives 1 and 2 are completed, arrange for the Veteran to undergo a VA examination of his feet. For each condition diagnosed, the examiner should opine whether it is at least as likely as not that the condition onset in or is causally related to the Veteran's service. A full rationale should be provided for all opinions expressed. In rendering opinions, the examiner should consider the Veteran's lay statements with respect to an onset of foot problems in service as well as the following service treatment records: a May 1982 record noting blisters on the right foot with a diagnosis of tinea pedis, a May 1984 record noting the Veteran jammed his left great toe, an August 1984 record noting swollen feet, and a September 1984 record diagnosing a fungal infection of the feet. 5. Contact the appropriate records repository or repositories to attempt to verify the Veteran's contention of exposure to herbicides, chemicals, and other contaminants at Camp Pendleton. 6. After directives 1, 2, and 5 are completed, arrange for the Veteran to undergo a VA examination of his diabetes and diabetic complications. The examiner should opine whether it is at least as likely as not that the Veteran's diabetes onset in service or is causally related to his service. The examiner should consider whether or not the VA verified the Veteran's chemical/herbicide exposure. However, the examiner is advised that presumptive service connection for a disability does not preclude a Veteran from establishing service connection with proof of direct causation. The examiner must provide reasons for any opinion and address all relevant medical and lay evidence. The rationale for a negative opinion must not be based solely on the lack of a relevant in-service diagnosis or clinical finding and must reflect consideration of the competent lay assertions of pertinent symptomology. 7. After directives 1 and 2 are completed, arrange for the Veteran to undergo a VA examination in connection with his claim for upper extremity peripheral neuropathy. The examiner should opine whether it is at least as likely as not that the Veteran's upper extremity neuropathy onset in or is causally related to his service. A full rationale should be provided for all opinions expressed. The examiner should consider the Veteran's lay statements or numbness in his fingers during service and 1982 service treatment records noting the Veteran was seen for left arm numbness and weakness. 8. After directives 1 and 2 are completed, arrange for the Veteran to undergo a VA eye examination. For each eye disability diagnosed, the examiner should opine whether it is at least as likely as not that the condition onset in service or is causally related to service. A full rationale should be provided for all opinions expressed. The examiner should consider the Veteran's lay statements of getting debris in his eyes during artillery firing. 9. After directives 1 and 2 are completed, arrange for the Veteran to undergo a VA respiratory examination. For each lung disability diagnosed, including COPD, the examiner should opine whether it is at least as likely as not that the condition onset in service or is causally related to service. A full rationale should be provided for all opinions expressed. The examiner should consider the Veteran's lay statements of difficulty breathing in service. 10. Obtain an VA opinion as to the etiology of the Veteran's bilateral hearing loss. The examiner should opine whether it is at least as likely as not that the Veteran's current hearing loss is causally related to his service. A full rationale should be provided for all opinions expressed. The Board notes that the absence of hearing loss during service is not, alone, a bar to service connection. If the examiner cites to the IOM study on delayed onset hearing loss, they must address any qualifying or contradictory statements relied upon in the medical text. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Christensen 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.