Citation Nr: 21066888 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 20-17 375 DATE: November 2, 2021 REMANDED Issue of entitlement to service connection for Cushing's syndrome, to include as a result of exposure to herbicide agents, is remanded. Issue of entitlement to service connection for hyperaldosteronism (also claimed as aldosteronoma, Conn's syndrome, and adrenalectomy), to include as a result of exposure to herbicide agents, is remanded. Issue of entitlement to service connection for pheochromocytoma (claimed as benign and malignant) as secondary to hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to January 1963. This appeal to the Board of Veterans' Appeals (Board) arose from a July 2016 rating decision issued by the Department of Veterans Affairs (VA). See July 2017 Notice of Disagreement (NOD); March 2020 Statement of the Case (SOC); April 2020 Substantive Appeal (VA Form 9). The Veteran testified before the undersigned Veterans Law Judge in a November 2020 hearing. See November 2020 Hearing transcript. The Board notes that the Veteran did not perfect his appeal for his claims of entitlement to service connection for acromegaly or Addison's disease. See April 2020 VA Form 9. The Board also notes that the Veteran's claim of entitlement to service connection for obstructive sleep apnea was granted in a March 2020 rating decision, which is considered a full grant of the benefit sought on appeal. These claims are, thus, no longer in appellate status or before the Board. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(a)(2). 1. Issue of entitlement to service connection for Cushing's syndrome, to include as a result of exposure to herbicide agents, is remanded. 2. Issue of entitlement to service connection for hyperaldosteronism (also claimed as aldosteronoma, Conn's syndrome, and adrenalectomy), to include as a result of exposure to herbicide agents is remanded. Unfortunately, the Board cannot make a fully informed decision on the issues of entitlement to service connection for Cushing's syndrome or for hyperaldosteronism because an opinion from a VA examiner is needed. The Veteran asserts that his Cushing's syndrome and hyperaldosteronism are due to his in-service exposure to herbicide agents. As an initial matter, the Board finds that the evidence supports the Veteran had in service exposure to herbicide agents. The Veteran has not had the requisite service for the presumption of exposure to herbicide agents as the evidence does not support that he served in the Republic of Vietnam during the Vietnam Era, that he was with a unit that operated in or near the Korean DMZ between April 1, 1968, and August 31, 1971, or that he operated, maintained, or served onboard a C-123 aircraft known to have been used to spray an herbicide agent. 38 C.F.R. § 3.307(a)(6)(iii)-(v). However, VA has determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for bases security purposes as evidence in the "Project CHECO Southeast Asia Report: Base Defense in Thailand." See Compensation & Pension Service Bulletin: Herbicide Related Claims from Veteran with Thailand Service, pp. 3-4 (May 2010). The Compensation and Pension Service has determined that a special consideration on herbicide exposure on a factual basis should be extended to those veterans whose duties placed then on or near the perimeters of Thailand military bases. Id. This special consideration provides that herbicide exposure may be conceded on a direct, facts-found basis if the Veteran served in the United States Air Force in Thailand during the Vietnam Era at one of the RTAFBs at U Tapao, Ubon, Nakhon Phanom, Udon, Takhli, Korat, or Don Muang, and served as an Air Force security policeman, security control dog handler, member of the security police squadron, or otherwise served near the air base perimeters as shown by evidence of military occupational specialty (MOS), daily work duties, performance evaluation reports, or other credible evidence. Id. This consideration only applies during the Vietnam Era from February 28, 1961, to May 7, 1975. Id. In this case, the evidence shows the Veteran served at U-Tapao Air Force Base, Thailand from around August 1971 to August 1972. January 1972 Military Personnel Record; November 2020 Hearing Transcript. The Veteran testified that his duties as an inventory management specialist would routinely bring him near the base perimeter to deliver parts to the flight line. November 2020 Hearing Transcript. The Board finds the testimony to be probative as evidence of his in service exposure to herbicide agents on a facts-found basis. As the evidence supports that the Veteran had in-service exposure to herbicide agents, the Board finds that he should be afforded a VA examination to determine if his Cushing's syndrome or hyperaldosteronism was due to service. In addition, the Veteran testified that his blood pressure had gone up and down during service and at separation, which he testified was later found as a symptom of his left adrenal gland lesion and led to his Cushing's disease and hyperaldosteronism conditions. See November 2020 Hearing Transcript. An opinion from a VA examiner is also needed for this theory of entitlement to service connection. 3. Issue of entitlement to service connection for pheochromocytoma (claimed as benign and malignant) as secondary to hypertension is remanded. The Board finds that a remand is needed to obtain an opinion from a VA examiner as to whether the Veteran's has a current disability of pheochromocytoma and, if so, whether it is proximately due to, the result of, or aggravated by his service connected hypertension. The Veteran asserts that his pheochromocytoma is related to his hypertension and adrenal gland problems. See November 2020 Hearing Transcript. The Veteran is currently service connected for hypertension and the medical treatment evidence shows that the Veteran was treated for a mass on his left adrenal gland and diagnosed with left adrenal adenoma. See April 2003 VA treatment records; November 2006 Military Medical Center treatment records. The Board finds that an opinion from VA examiner is needed to determine if the Veteran has as current disability of pheochromocytoma and, if so, whether it is was incurred in or otherwise related to service, to include as secondary to his service-connected hypertension. The matters are REMANDED for the following action: 1. Ask the Veteran to identify the provider(s) of any evaluations and/or treatment received for Cushing's disease, hyperaldosteronism, and pheochromocytoma, and provide authorizations for VA to obtain records of any such private treatment. Specifically ask the Veteran to identify any treatment dates at the Grafton VA Medical Center, which he mentioned during the November 2020 Board hearing. Attempt to obtain any identified records. 2. Schedule the Veteran for a VA examination to determine the nature and cause of his Cushing's disease and hyperaldosteronism. The medical professional should respond to the following: (a) Is the Veteran's Cushing's disease or hyperaldosteronism at least as likely as not related to his in service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the Cushing's disease or hyperaldosteronism is not on the list of diseases that are presumptively associated with exposure to herbicide agents. (b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's Cushing's disease or hyperaldosteronism began in or is otherwise related to the Veteran's military service? The examiner should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms, including that his blood pressure was up and down during service and this was later found as a symptom of his left adrenal gland lesion and led to his Cushing's disease and hyperaldosteronism. A rationale is needed for any opinion given. 3. Obtain an opinion as to the Veteran's pheochromocytoma, to include a physical examination if the examiner deems it necessary. The examiner is asked to provide a response to the following questions. A rationale is needed for an opinion given. (a) Does the Veteran have a current disability of pheochromocytoma? The examiner should specifically consider and discuss the April 2003 VA treatment evidence showing a lesion on his left adrenal gland and a November 2006 diagnosis of left adrenal adenoma. The VA examiner should discuss what is pheochromocytoma and if there is evidence the Veteran has or has had pheochromocytoma since around the time of his May 2016 claim. (b) If pheochromocytoma is a current disability, is it at least as likely as not (a 50 percent or greater probability) that it began in or is otherwise related to the Veteran's military service? (c) If pheochromocytoma is a current disability and not found to have been incurred during service, is it at least as likely as not proximately due to or the result of his service connected hypertension? If not proximately due to or the result of his service-connected hypertension, is it at least as likely as not (50 percent or greater probability) aggravated, i.e., worsened beyond its natural progression, by his service-connected hypertension? R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.