Citation Nr: 21063217 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 20-27 915 DATE: October 13, 2021 ORDER Entitlement to service connection for a gastrointestinal disability to include gastroesophageal reflux disease (GERD) and stomach ulcers is denied. Entitlement to service connection for muscle tears, to include as due to radiation and herbicide agent exposure, is denied. Entitlement to service connection for arthritis of all joints, to include as due to radiation and herbicide agent exposure, is denied. Entitlement to service connection for bilateral cataracts and residuals status-post surgery, to include as due to radiation and herbicide agent exposure, is denied. Entitlement to service connection for a skin disability as due to in-service sun exposure is granted. REMANDED Entitlement to service connection for migraine headaches, to include as due to radiation and herbicide agent exposure, is remanded. Entitlement to service connection for irregular heartbeat/heart murmur disability, to include as due to radiation and herbicide agent exposure, and as secondary to a service-connected heart disability is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had a gastrointestinal disability to include GERD or stomach ulcers at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence is against finding that any muscle tear, to include bilateral shoulder rotator cuff and bicep tears, is etiologically related to an in-service event, injury, or disease or caused by radiation or herbicide agent exposure. 3. The preponderance of the evidence is against finding that the Veteran's degenerative joint disease of bilateral shoulders and cervical spondylosis, is etiologically related to an in-service event, injury, or disease or caused by radiation or herbicide agent exposure. 4. The preponderance of the evidence is against finding that his bilateral cataracts and residuals status-post surgery is etiologically related to an in-service event, injury, or disease or caused by radiation or herbicide agent exposure. 5. Resolving reasonable doubt in the Veteran's favor, his skin disability is etiologically related to his in-service sun exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for a gastrointestinal disability to include GERD and stomach ulcers have not been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for muscle tears, to include as due to radiation and herbicide agent exposure, have not been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for arthritis of all joints including degenerative joint disease of bilateral shoulders and cervical spondylosis, to include as due to radiation and herbicide agent exposure, have not been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for bilateral cataracts and residuals status-post surgery, to include as due to radiation and herbicide agent exposure, have not been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a skin disability to include as due to in-service sun exposure have been met. 38 U.S.C. §§ 1112, 1113,1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Navy Reserve with active-duty service from January 1967 to October 1969. The Veteran is in receipt of a Vietnam Service Medal with one Bronze Star. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office. The Board notes the Veteran's bilateral hearing loss, tinnitus, and coronary artery disease/ischemic heart disease, not to include a heart murmur/irregular heartbeat disability, were on appeal with these issues before the Board. These claims were granted in an April 2020 rating decision and, as such, represents a full grant of the benefits sought. Thus, these claims are no longer before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107 (a)(2); 38 C.F.R. § 20.900 (c). As an initial matter, the Board has recharacterized some of the Veteran's claims. The Board finds it appropriate to recharacterize the Veteran's claim for his GERD and stomach ulcers as one for entitlement to service connection for a gastrointestinal disability to include GERD and stomach ulcers to encompass all conditions reasonably contemplated by the claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). His evidence further indicate that he has been diagnosed with multiple skin disabilities to include seborrheic keratosis, squamous cell carcinoma, basal cell carcinoma, and verruca vulgaris. As such, the Board also finds it appropriate to recharacterize his claim as being one for entitlement to service connection for a skin disability in order to encompass all conditions reasonably contemplated by the claim. Id. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131. Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Certain chronic diseases are subject to presumptive service connection if it manifests to a compensable degree within one year from separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Additionally, service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service in a veteran who had active military, naval or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam, included the waters offshore, and other locations if conditions of service involved duty of visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. Service connection for a disability attributable to exposure to ionizing radiation during service will be presumptively granted. 38 C.F.R. § 3.309 (d). Service connection can be demonstrated by three methods: (1) Under 38 C.F.R. § 3.309 (d), if the veteran is radiation-exposed and diagnosed with one of the 15 types of cancer, which are presumptively service connected; (2) under 38 C.F.R. § 3.311 (b), if the veteran is diagnosed with a radiogenic disease and certain conditions are met, or (3) by establishing the elements for direct service connection. Davis v. Brown, 10 Vet. App. 209, 211 (1997). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, the Veteran asserts his disabilities on appeal are due to exposure to radiation and herbicide agent exposure. As a result, VA made requests to determine whether he was exposed to ionizing radiation and herbicide agent exposure during his period of active duty service. In October 2019, the Naval Dosimetry Center submitted a response indicating that he did not have any occupational exposure to ionizing radiation. The response further indicated that the Exposure Registry does not maintain records for non-ionizing forms of radiation such as radar or microwave, and that such records could be found in the Veteran's medical treatment records. The Board notes his service treatment records and military personnel records have been associated with his claims file. In this regard, the Board finds that the Veteran was not exposed to ionizing radiation during his period of active duty service. Nonetheless, the Veteran may still seek service connection based on any exposure to non-ionizing radiation such as radar and microwave. With regards to herbicide agent exposure, deck logs for the USS Coral Sea and USS John Paul Jones indicated the Veteran served in close proximity to the Da Nang Harbor. As such, on March 2020, VA conceded herbicide agent exposure based on the Veteran's nautical service in the offshore eligible waters defined in the Blue Water Navy Vietnam Veteran's Act of 2019. 1. Gastrointestinal disability to include GERD and stomach ulcers The Veteran asserts that his gastrointestinal disabilities, to include GERD and ulcers, are related to exposure to radiation and herbicide agents during service. Upon review of the claims file, the Board concludes that the Veteran does not have a current diagnosis of a stomach disability, to include GERD or ulcers, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The Veteran's report of medical history at the time of his enlistment indicates that he reported having intestinal cramps four years prior to service. However, it was later noted that the condition cleared with therapy and he had no recurrences. The remainder of his STRs does not reflect treatment for any gastrointestinal condition during service. A review of the available private and VA treatment record also does not reflect he had any treatment or diagnosis of a stomach disability within a year after separation from service. Notably, throughout his VA treatment records, physical examination of his abdomen consistently shows no report of nausea, vomiting, diarrhea, or incontinence. The Board has further considered Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity." Id. at 1367-69. Aside from his assertion that his GERD is related to radiation and herbicide agent exposure during the June 2019 Decision Review Officer's hearing, there is simply no other evidence indicating that he experiences abdominal or gastrointestinal pain throughout the pendency of the claim. Therefore, the Board finds that Saunders is inapplicable with regards to his claim for service connection for a gastrointestinal disability. The Board has considered his lay assertions that he has a gastrointestinal disability. However, aside from indicating that he has stomach ulcers or GERD in his VA Form 21-526 EZ and his report of intestinal cramps in service, there is simply no competent or credible evidence of a current diagnosis of a gastrointestinal disability. Moreover, the Board finds that the Veteran is not competent to provide a diagnosis in this case as it requires specialized medical education and knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. The Board notes, however, the preponderance of the evidence is against the claim of entitlement to service connection for a stomach disability. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Muscle tears 3. Arthritis of all joints 4. Bilateral cataracts as due to radiation and herbicide agent exposure The Veteran further asserts that his muscle tears, arthritis of all joints, and cataracts and residuals status-post surgery are related to radiation exposure based on his military occupational specialty as an electrical maintenance man and herbicide agent exposure during service. Regarding the Veteran's muscle tear claim, the Board concludes that the Veteran has a current muscle tear disability. During a June 2019 Decision Review Officer hearing, he stated that he tore his rotator cuffs, bilaterally, and biceps. A review of the evidence reflects a history of a bilateral shoulder rotator cuff injuries in a March 2016 VA treatment record. As such, the Board resolves reasonable doubt in favor of the Veteran and finds that he has a current bilateral shoulder rotator cuff muscle tear disability. However, the Board finds that the evidence does not support a finding of a bicep tear. His VA and private medical treatment records are silent for any treatment or diagnosis of a bicep tear or for report of pain associated to a biceps tear. As such, the Board finds that he does not have a current muscle tear of his biceps. Moreover, to the extent that he believes he has any additional muscle tear disability aside from the bilateral shoulder rotator cuffs, the Board finds that the medical evidence of record does not reflect any additional diagnosis of a muscle tear disability of any other muscles. Regarding his claim for service connection for arthritis of all joints, his VA treatment record shows a diagnosis of cervical spondylosis and degenerative joint disease of his bilateral shoulders. As such, the Board finds that he has a current diagnosis of degenerative joint disease of his bilateral shoulders and cervical spondylosis. The Board acknowledge that his claim is one for arthritis of all joints. However, aside from arthritis of the cervical spine and bilateral shoulders, there is no evidence of any other competent diagnosis of arthritis affecting all of his joints. As such, he does not have a current diagnosis of arthritis of all joints. Regarding his claim for service connection for bilateral cataracts, his VA treatment record reflects he underwent corrective surgery for bilateral cataracts around 2011. As he was diagnosed with bilateral cataract within close proximity to the date that he filed a claim for service connection, the Board finds that he has a current bilateral cataract disability. Thus, the question remaining is whether these disabilities are etiologically related to service, to include any exposure to radiation and herbicide agents. As the Veteran asserts that his military occupational specialty as an electrical maintenance man exposed him to radiation, the Board has considered whether he is entitled to presumptive service connection based on ionizing radiation. However, as discussed above, the Naval Dosimetry Center found he was not exposed to any ionizing radiation during service based on his location and military occupational specialty. As such, presumptive service connection on the basis of exposure to ionizing radiation is not warranted. With respect to his assertion that these disabilities are also related to herbicide agent exposure, the Board has considered whether he is entitled to the presumption afforded for chronic diseases caused by such exposure. However, upon consideration of 38 C.F.R. § 3.309(e), the Board finds that his current disability of torn bilateral rotator cuff, cervical spondylosis, degenerative joint disease of the bilateral shoulders, and cataracts are not diseases known to have been caused by exposure to herbicide agents, to include Agent Orange. Thus, presumptive service connection based on diseases associated with herbicide agent exposure is not warranted. The Board notes that his diagnosis of degenerative joint disease of the bilateral shoulder and cervical spondylosis are chronic diseases contemplated under 38 C.F.R. § 3.309 (a). As such, the Board has further considered whether a presumption for chronic disease is warranted. However, upon review of the evidence, the Board finds that there is no in-service treatment for any pain or injury to his cervical spine or shoulders or a diagnosis of arthritis in service. His post-service medical treatment records also fail to show any continuous treatment for pain or injury of the shoulders or neck or that he was diagnosed with degenerative joint disease of the shoulders or cervical spondylosis within a year following separation. Rather, the earliest evidence indicating a diagnosis of degenerative joint disease of the shoulders was in March 2013. The earliest evidence indicating a diagnosis of cervical spondylosis was in June 2019. The evidence indicate that he was not diagnosed with arthritis of these two joints until more than 40 years after separation from service. As such, the Board finds that presumptive service connection on the basis of a chronic disability is not warranted for his degenerative joint disease of the shoulders or cervical spondylosis. Notwithstanding the foregoing presumptive provision, the Veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, F.3d 1039, 1042 (Fed. Cir. 1994). Unfortunately, even considering the Veteran's claims on the basis of actual direct causation, the Board finds that the preponderance of the evidence is against a finding that his torn rotator cuffs, degenerative joint disease of his bilateral shoulders, cervical spondylosis, or bilateral cataract disability is etiologically related to service, to include as due to radiation and herbicide agent exposure. As indicated above, there is no in-service event, injury, or diagnosis of a cervical spine or shoulder condition. While his service treatment records (STRs) reflects that he was seen for other ailments in service, there is no complaints or treatment for his shoulders, neck, or eyes in service. This fact weighs against the credibility of any statement that he had any of these conditions during service. AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013). If the Veteran had a then-existing condition of his shoulders, neck, or eyes, it would be expected that he report it or there be clinical findings of such at the time of discharge. The Board notes that the Veteran has not been afforded a VA examination for his muscle tear, degenerative joint disease of bilateral shoulders, cervical spondylosis, or bilateral cataracts. Under relevant VA regulations, action should be undertaken by way of obtaining a medical opinion if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: 1) contains competent evidence of diagnosed disability or symptoms of disability; 2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, which may be established by competent lay evidence; and 3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. 38 C.F.R. § 3.159 (c)(4) (2017). McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Board finds that the low threshold to trigger a VA examination has not been satisfied. The Board acknowledge that the Veteran submitted a medical literature titled, "Adverse health effects of occupational exposure to radiofrequency radiation in airport surveillance radar operators" in support of his claim. See September 2019 Correspondence. The research indicates that workers exposed to non-ionizing radiation such as radar systems, reported feeling run down and out of sort, headaches, tightness or pressure in the head, insomnia, getting edgy, and bad tempered. There was also a positive finding of radiation exposure and decreased sperm motility and viability. However, there were no findings indicating that exposure to non-ionizing radiation causes muscle strains, arthritis, or cataracts. As such, the Board finds that a VA examination is not warranted because there is no indication that these current disabilities are related to an in-service event, injury, or disease to include exposure to radiation and herbicide agent exposure. The Board has further considered the Veteran's assertion that his torn rotator cuffs, degenerative joint disease, cervical spondylosis, and bilateral cataracts is caused by radiation and herbicide agent exposure. However, he has not demonstrated any specialized knowledge or expertise to indicate he is capable of rendering a competent medical opinion in this matter. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, the etiology of his torn rotator cuffs, degenerative joint disease of his shoulders, cervical spondylosis, and bilateral cataracts and residuals status-post surgery falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Based on the foregoing, the Board finds that the preponderance of the evidence weighs against findings that the Veteran's torn rotator cuffs, degenerative joint disease of bilateral shoulders, cervical spondylosis, or bilateral cataracts are etiologically related to an in-service event, injury, or disease, to include exposure to radiation or herbicide agent exposure. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine but finds it is inapplicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Skin disability The Veteran further asserts his skin cancer is caused by his exposure to radiation while working on electrical equipment located in front of radar equipment on the USS John Paul Jones. Alternatively, he asserts it is caused by herbicide agent exposure. Upon review of the evidence, a June 2019 private treatment record shows the Veteran has a current diagnosis of a skin disability to include skin cancer. Specifically, in August 2006, he was diagnosed with basal cell carcinoma of the right neck and left shoulder and myxoid neuroma of the left mid-back. In February 2007, he was diagnosed with seborrheic keratosis of the right neck. In March 2008, he was diagnosed with squamous cell carcinoma of the left dorsal hand. In May 2008, he was diagnosed with verruca vulgaris of the left forearm and right arm. Finally, in December 2019, he was diagnosed with seborrheic keratosis of the left temple and right neck. As such, the Board concludes that the Veteran has a current skin disability. Based on his assertion that his skin disabilities are related to radiation and herbicide agent exposure in service, the Board has considered whether his skin disability is related to ionizing radiation exposure during service. However, as stated above, he has not been found to be occupationally exposed to ionizing radiation. As such, he is not entitled to a presumption on the basis of exposure to ionizing radiation. With regards to his assertion that his skin disabilities are related to herbicide agent exposure, the Board finds that his skin disabilities, to include squamous cell carcinoma and basal cell carcinoma are not diseases contemplated under 38 C.F.R. § 3.309(e). As such, he is not entitled to a presumption for chronic disease associated with herbicide agent exposure to include Agent Orange. Again, the Veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, F.3d 1039, 1042 (Fed. Cir. 1994). Here, his STR are unremarkable for any treatment, symptoms, complaints or diagnosis for a skin disability. However, the Veteran stated during the June 2019 Decision Review Officer's hearing that he was exposed to his ship's main radar while working on a piece of equipment used for launching missiles up and down. He stated he had to climb up to the mast of the ship to check on the equipment and that it was directly in front of a radar which could not be shut down. He also described excessive exposure to the sun. As there is no evidence to the contrary, the Board finds the Veteran's lay statement regarding his environmental exposures during service to be a credible statement regarding an in-service event. As to whether there is a medical nexus relating the Veteran's skin disability to include skin cancer to his service, the Board finds that the evidence of record supports a finding that his skin disability to include skin cancer is related to his sun exposure during service. In support of his claim, the Veteran submitted a private medical opinion by his dermatologist in September 2019. The dermatologist noted review of the Veteran's medical history and the circumstances of his service to include exposure to radiation and Agent Orange from 1968 to 1969. However, the dermatologist specifically states that outside of sun exposure during his military tour in Vietnam, he had no other known risk factors that may have precipitated his current condition. The dermatologist further stated that based on his experience as well as the medical literature, it is known that both types of exposure lead to systemic and cutaneous skin cancer. As such, the dermatologist concluded his skin cancer was at least as likely as not a direct result of his exposure during his military service. A VA examination was further obtained in May 2020 and the VA examiner also opined that it is at least as likely as not that the Veteran's skin disability was incurred or caused by his service. In support of the medical opinion, the VA examiner relied on the September 2019 private medical opinion specifically noting that outside of sun exposure during his military tour in Vietnam, he had no other known risks factors that could have precipitated his current condition. While the Veteran believes his skin disability is related to radiation and herbicide agent exposure, as previously discussed, his skin disability are not conditions known to have been caused by radiation or herbicide agent exposure. Nonetheless, the Board finds that both the private and VA examiner further attributes his skin disability to his sun exposure during his military tour in Vietnam. As such, the Board finds that a causal relationship between his skin disability and sun exposure in service has been established. Moreover, considering his military occupational specialty as an electrician mate and his competent lay statements that he spent hours working on equipment at the top of the ship, it is likely that he had prolonged sun exposure during service. As such, the Board finds that the Veteran's skin disability is etiologically related to his in-service sun exposure. In reaching this conclusion, the Board finds both, the VA and private, medical opinion to be competent and probative in establishing direct service connection. Specifically, the private medical opinion was rendered by the Veteran's own treating dermatologist with consideration of the Veteran's military service and exposure to radiation and herbicide agents and was supported by consideration of medical literatures. Absent evidence to the contrary, the Board finds the evidence to at least be in equipoise as to whether his current skin disability is related to sun exposure during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that direct service connection for a skin disability is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Migraine headaches to include as due to radiation and herbicide agent exposure is remanded. The Board finds that a remand is warranted for further development of the claim. With regards to his claim for migraine headaches, the Board notes that his private and VA treatment records does not show a formal diagnosis of a migraine headaches or headaches, in general. However, the Board notes that headaches are symptoms capable of lay observation and are largely clinically-diagnosed based on reported symptoms. In this regard, as he stated during the June 2019 Decision Review Officer hearing that he has migraine headaches, is sensitive to light, and has to lay down, the Board finds that his reports of currently experiencing migraine headaches are sufficient to establish the presence of a related current disability. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). The Veteran's service treatment records further reflect that he reported having frequent headaches in his November 1965 report of medical history. He was also treated for headaches in June 1968. Additionally, the Veteran asserts that his migraine headache is related to his exposure to radiation working as an electrical maintenance man and to herbicide agent exposure. As such, in September 2019, he submitted a medical article which indicated that a relationship exists between exposure to radiation and the development of headaches. Here, the Veteran has a current disability and there is evidence of an in-service occurrence. However, the Board finds that the Veteran has not yet been provided with a VA examination. As the low threshold of McClendon is satisfied, a remand is warranted to obtain a VA examination and opinion to determine the nature and etiology of the Veteran's migraine headache disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Irregular heartbeat/heart murmur to include as due to radiation and herbicide agent exposure and as secondary to a service-connected heart disability is remanded. The Board further finds that the Veteran's claim for his irregular heartbeat/heart murmur must be remanded for further development. First, the Board notes that the Veteran was afforded a VA examination in March 2020 for his heart conditions. Although the VA examiner noted he had a diagnosis of coronary artery disease, hypertension, and heart palpation, the VA examiner's medical opinion only addressed his coronary artery disease/ischemic heart disease. There was no discussion on whether his irregular heartbeat/heart murmur or heart palpation was related to any in-service event, injury, or disease to include exposure to radiation and herbicide agents. Moreover, in the March 2020 VA examination, the VA examiner's statement regarding a diagnosis of the Veteran's irregular heartbeat or heart murmur is inconsistent with the medical treatment of record. While his VA treatment record reflects a diagnosis of supraventricular tachycardia, the March 2020 VA examiner indicated he did not have a diagnosis of supraventricular tachycardia. However, the VA examiner continues to discuss the Veteran's heart palpation condition throughout the VA examination. The VA examiner also provides contradicting statement regarding the etiology of the Veteran's heart palpation. As indicated under section 2C of the VA examination, the VA examiner noted that the etiology of his heart palpations is related to "stress, exercise, or, rarely, a medication condition can trigger them." The VA examiner further noted that his heart palpation can also be caused by an underlying arrhythmia. However, in response to the question of whether there is a relationship with other heart conditions, the VA examiner noted "unknown causality." For these reasons, the Board finds that the March 2020 VA examination is incomplete and inconsistent with regards to the Veteran's heart palpation and irregular heart/heart murmur disability. As such, it is inadequate for adjudication purposes. Lastly, the Board notes that the VA examiner's statement that his heart palpation may be related to other medical condition raise the question of whether the Veteran's heart palpation or irregular heartbeat/heart murmur is secondary to any of his service-connected disabilities. As such, upon remand, a medical opinion for secondary service connection should also be obtained. Based on the foregoing reasons, the Board finds a remand is warranted to obtain an adequate VA examination to properly address the nature and etiology of the Veteran's heart palpation and irregular heartbeat/heart murmur. The matters are REMANDED for the following action: 1. Contact the Veteran to provide information necessary to obtain any private treatment records and VA treatment records related to the Veteran's migraine headaches, heart palpation, and irregular heartbeat/heart murmur and associate them with the claims file. 2. Schedule the Veteran for an examination for his migraine headache disability and heart palpation and irregular heartbeat/heart murmur. The claims file, including a copy of this remand, should be made available to the examiner, who should review it in conjunction with the prior examination and should note that review in the report. The examiner is requested to provide an opinion for the following questions: (a.) Is the Veteran's migraine headache at least as likely as not (50 percent probability or greater) related to any in-service event, injury, or disease, to include exposure to radiation as an electrical maintenance man and herbicide agent exposure. (b.) Is the Veteran's heart palpation and/or irregular heartbeat/heart murmur at least as likely as not (50 percent probability or greater) related to any in-service event, injury, or disease, to include exposure to radiation as an electrical maintenance man and herbicide agent exposure. (c) Is the Veteran's heart palpation and/or irregular heartbeat/heart murmur at least as likely as not (1) proximately caused or (2) aggravated by any of his service-connected disabilities? In rendering a medical opinion, the examiner is requested to consider the Veteran's lay statements. A complete and detailed rationale for these opinions should be provided for every opinion requested by the examiner. (Continued on the next page) 3. After, readjudicate the claim. If the benefit sought on appeal remains denied, furnish the Veteran with a supplemental statement of the case (SSOC) and provide him with an appropriate opportunity to respond. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Xiong, 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.