Citation Nr: 21067304 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-47 899 DATE: November 3, 2021 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for chronic kidney disease is granted. Entitlement to service connection for a chronic headache disability is granted. Entitlement to service connection for bladder cancer is denied. Entitlement to service connection for peripheral neuropathy of the lower extremities is denied. Entitlement to service connection for bilateral pes planus is denied. Entitlement to service connection for a bilateral hearing loss disability is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for erectile dysfunction is denied. Entitlement to service connection for gout is denied. Entitlement to service connection for a back disability is denied. Entitlement to service connection for glaucoma is granted. Entitlement to service connection for a skin disability is denied. REMANDED Entitlement to service connection for a heart disability, to include ischemic heart disease, is remanded. Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for a bilateral eye disability other than glaucoma is remanded. Entitlement to service connection for a sinus disability, to include allergic rhinitis, is remanded. Entitlement to service connection for a gastrointestinal disability, claimed as a stomach disability, is remanded. FINDINGS OF FACT 1. The Veteran served within the 12-mile nautical territorial sea of the Republic of Vietnam and is presumed to have been exposed to herbicide agents. 2. Resolving reasonable doubt in the appellant's favor, the Veteran's hypertension was due to in-service exposure to herbicide agents. 3. The Veteran's chronic kidney disease was proximately due to or caused by his service-connected hypertension. 4. The Veteran's chronic headache disability was proximately due to or caused by his service-connected chronic kidney disease. 5. The preponderance of the evidence of record is against finding that the Veteran had bladder cancer at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence of record is against finding that the Veteran had peripheral neuropathy of the lower extremities at any time during or approximate to the pendency of the claim. 7. The Veteran's pre-existing bilateral pes planus was not aggravated by active service. 8. The Veteran did not have a hearing loss disability as defined in VA law and regulations. 9. The Veteran's tinnitus did not manifest during active service or within one year of separation of active service, and there is no indication that it was causally related to his active service. 10. The Veteran's erectile dysfunction did not manifest during active service, and there is no indication that it was causally related to active service. 11. The Veteran's gout did not manifest during active service, and there is no indication that it was causally related to active service. 12. The Veteran's back disability did not manifest during active service; arthritis did not manifest within one year of separation of active service; and there is no indication that his back disability was causally related to his active service. 13. The Veteran's glaucoma was caused or aggravated by his service-connected chronic kidney disease. 14. The Veteran's skin disability did not manifest during active service, and there is no indication that it was causally related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307 (2020). 2. The criteria for service connection for chronic kidney disease are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). 3. The criteria for service connection for a chronic headache disability are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). 4. The criteria for service connection for bladder cancer are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 5. The criteria for service connection for peripheral neuropathy of the lower extremities are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 6. The criteria for service connection for bilateral pes planus are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.306 (2020). 7. The criteria for service connection for a bilateral hearing loss disability are not met. 38 U.S.C. § 1110 (2018); 38 C.F.R. §§ 3.303, 3.385 (2020). 8. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1101, 1110, 1112, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 9. The criteria for service connection for erectile dysfunction are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 10. The criteria for service connection for gout are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). 11. The criteria for service connection for a back disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 12. The criteria for service connection for glaucoma are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2020). 13. The criteria for service connection for a skin disability are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from April 1965 to March 1969. He died in December 2020, and the appellant is his surviving spouse, who has been properly substituted in this appeal. This case initially came before the Board of Veterans' Appeals (Board) from June 2016 and March 2017 rating decisions issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). In September 2019, the Veteran and his spouse testified before a Veterans Law Judge (VLJ) who is no longer employed at the Board. A transcript of the hearing is of record. In July 2021, the appellant was offered an additional hearing by another VLJ; however, she did not respond to that letter. In January 2020, the Board remanded the claims for additional development. The case has since been returned to the Board. The Veteran also appealed the issue of entitlement to service connection for a psychiatric disability. In an April 2021 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for posttraumatic stress disorder (PTSD), which constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, that matter is no longer in appellate status. See Grantham, 114 F.3d at 1158. Service Connection Hypertension, Chronic Kidney Disease, and Headaches The Veteran served on the U.S.S. Carronade during the Vietnam era. The evidence, including deck logs, indicated that the U.S.S. Carronade traveled within the 12-mile territorial waters of the Republic of Vietnam during the Veteran's service aboard that ship. Therefore, the Veteran is presumed to have been exposed to herbicide agents during his service. See Procopio v. Wilkie, 913 F.3d 1371, 1380-81 (Fed. Cir 2019) (en banc). In other words, in-service exposure to herbicide agents, including Agent Orange, is conceded. Although hypertension is not presumptively related to herbicide exposure, 38 C.F.R. § 3.309(e), in 2018, the National Academy of Sciences (NAS) determined that there is "sufficient" epidemiologic evidence to conclude that there is a positive association between hypertension and herbicide exposure. In this case, the Veteran is presumed to have been exposed to herbicides while serving aboard the U.S.S. Carronade, and he had a diagnosis of hypertension. Although VA examiners have opined that the Veteran's hypertension was not caused or aggravated by his service-connected PTSD, there is no probative VA medical opinion of record against finding that his hypertension was related to herbicide exposure. Rather, there is sufficient evidence to conclude that there is a positive association between hypertension and herbicide exposure. Accordingly, the Board finds that the evidence for and against the claim of entitlement to service connection for hypertension is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the appellant and entitlement to service connection for hypertension is warranted. 38 U.S.C. § 5107(b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In addition, an August 2020 VA examiner opined that the Veteran's chronic kidney disease was at least as likely as not proximately due to or the result of his service-connected hypertension, and that his headaches were at least as likely as not proximately due to or the result of his chronic kidney disease. Therefore, the Board finds that entitlement to service connection for chronic kidney disease and a chronic headache disability is warranted. 38 C.F.R. § 3.310. Service Connection Bladder Cancer and Peripheral Neuropathy Although bladder cancer was recently added to list of diseases presumed to be associated with herbicide exposure under 38 U.S.C. § 1116(a)(2), the evidence does not indicate that the Veteran had bladder cancer. The Board has thoroughly reviewed the Veteran's VA and private treatment record, but has not found any indication that he was diagnosed with bladder cancer during his lifetime. The Board notes that early-onset peripheral neuropathy is also on the list of diseases presumed to be associated with herbicide exposure if it becomes manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during service. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309(e). In this case, there is no evidence of any complaints, treatment, or diagnoses related to peripheral neuropathy during active service or within one year of separation from active service. Therefore, service connection on a presumptive basis is not warranted. A December 2013 private treatment record indicated that the Veteran had neuropathy on his problem list and was taking Gabapentin. However, since filing his claim in December 2016, the evidence does not indicate the Veteran was treated for peripheral neuropathy. In fact, he denied neuropathy in December 2017, January 2018, February 2018, March 2018, May 2018, and June 2018. A September 2018 VA treatment record noted that he had a history of hemorrhagic stroke with no residual neurological deficit. In June 2019, he denied numbness, tingling, and weakness. No focal neurological deficit was observed. Sensory and motor examinations were normal. In the absence of proof of a present disability there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In this case, there is no evidence of bladder cancer or peripheral neuropathy proximate or during the pendency of the claim, to include any chronic functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The Board has also considered the lay evidence of record. The Veteran and the appellant are competent to describe what they have personally observed or experienced; however, to the extent their statements conflict with the contemporaneous medical evidence, the Board does not find them credible. Accordingly, the Board finds that the preponderance of the evidence is against the claims and that entitlement to service connection for bladder cancer and peripheral neuropathy is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53. Service Connection Bilateral Pes Planus The appellant maintains that the Veteran's pes planus was aggravated during active service. The Veteran's March 1965 enlistment examination report noted that he had pes planus and that the condition was not considered disabling. On his Report of Medical History, the Veteran denied having any foot trouble. In May 1965, he was seen at the foot clinic for pes planus and given 1/8-inch inner heel wedges. At his March 1969 separation examination, his feet were noted as normal. A January 2009 VA treatment record noted that the Veteran had right foot pain related to a bunion. VA and private treatment record do not show any complaints or treatment related to pes planus. During a March 2017 VA examination, the Veteran reported that he had pes planus prior to service and that it was aggravated by service. He stated that he had to perform duties that required walking and that he had pain with prolonged walking and standing. He stated that he was diagnosed with hallux rigidus after service in 2008. The diagnoses were flat foot (pes planus) and hallux rigidus. The examiner noted that the Veteran's pes planus existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury, or illness. The examiner noted that the Veteran did not have any pain on examination except in his fore foot, which was related to hallux rigidus. The examiner indicated that there was no indication that his pes planus was aggravated and that the hallux rigidus was not caused by his pes planus. In this case, the Board finds the most probative evidence weighs against the claim. The evidence indicates the Veteran's pes planus existed prior to service; however, it was not considered disabling, and he denied having any foot trouble. A month after entering service, he was seen at the foot clinic and received heel wedges, which suggests that he was having problems with his feet at that time. However, there were no further complaints of foot pain or pes planus during the remaining almost four years of active service. In addition, at his March 1969 separation examination, his feet were normal. There is also no evidence of any post-service treatment for pes planus. Furthermore, the March 2017 VA examiner opined that the Veteran's pre-existing pes planus was less likely than not aggravated by active service. The examiner considered and addressed the relevant evidence of record, the Veteran's contentions, and provided rationale for his opinion. For this reason, the Board finds the VA examiner's opinion significantly probative. Furthermore, there are no medical opinions to the contrary. The Board has also considered the lay evidence of record. The Veteran and the appellant are competent to describe what they have personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for bilateral pes planus is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Service Connection Bilateral Hearing Loss The appellant maintains that the Veteran had a bilateral hearing loss disability that was incurred in or was related to his active service. There are specific requirements regarding what constitutes a hearing loss disability under VA law. The threshold for normal hearing is from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. During a March 2017 VA audiology evaluation, audiometric testing results were as follows: 500 1000 2000 3000 4000 Right 15 10 5 15 15 Left 15 5 10 10 15 Speech recognition ability was measured at 94 percent in the right ear and 96 percent in the left ear. The VA examiner indicated that the Veteran's hearing was within normal limits bilaterally. In this case, the above-cited testing results do not establish a current right or left ear hearing loss disability as defined by 38 C.F.R. § 3.385. The Board has reviewed the claims file; however, the appellant has not presented or identified existing audiometric testing results that meet the requirements of that regulation for hearing loss. Hence, the Veteran did not have a right or left ear hearing loss disability for VA purposes. The test results are controlling and more probative than the lay evidence. Therefore, the claim for service connection for a bilateral hearing loss disability is denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Service Connection Tinnitus The appellant maintains that the Veteran's tinnitus was related to in-service noise exposure. The Veteran's service treatment records are unremarkable for any complaints, treatment, or diagnoses related to tinnitus. A May 2011 VA treatment record indicated that the Veteran denied experiencing tinnitus. At a May 2014 audiology consultation, he denied experiencing tinnitus. In January 2016, he also denied experiencing tinnitus. During a March 2017 VA examination, the Veteran reported that the onset of his tinnitus was after his kidney transplant in 2013. The examiner opined that his tinnitus was less likely than not incurred in or related to active service, noting that service treatment records were absent for complaints of tinnitus, that the Veteran reported onset many years after service, and that medical literature indicated that it was unlikely that such delayed effects from noise exposure could occur. During the September 2019 Board hearing, the Veteran testified that he did not notice experiencing tinnitus during active service. He stated that he first noticed tinnitus about one year after he was discharged. In this case, the Board finds the most probative evidence weighs against the claim. The evidence does not demonstrate that the Veteran's tinnitus manifested during active service. In fact, the first complaints and objective evidence of the claimed disability occurred many years after service. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Furthermore, the March 2017 VA examiner opined that the Veteran's tinnitus was less likely than not related to service. The examiner considered and addressed the relevant evidence of record, the Veteran's contentions, and provided rationale for her opinion. For this reason, the Board finds the VA examiner's opinion significantly probative. Furthermore, there are no medical opinions to the contrary. The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced, including the onset of his tinnitus. However, his reports as to the onset of his tinnitus have been inconsistent. During the March 2017 VA examination, he indicated that he first began experiencing tinnitus in 2013. During the September 2019 Board hearing, he stated that he first noticed experiencing tinnitus approximately one year after he separated from service. In addition, VA treatment records indicated that he denied experiencing tinnitus prior to the March 2017 VA examination. For these reasons, the Board does not find his statements regarding the onset of his tinnitus credible. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for tinnitus is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Service Connection Erectile Dysfunction, Gout, and Back Disability The appellant maintains that the Veteran's erectile dysfunction and gout were related to in-service herbicide exposure. During the September 2019 Board hearing, the Veteran stated that he hurt his back during service while lifting ammunition. He noted that his duties as a storekeeper required him to lift crates and boxes of supplies. He also stated that he hurt his back playing basketball during service. He stated that he sought treatment about a year after he separated from service. The Veteran's service treatment records are unremarkable for any complaints, treatment, diagnoses related to erectile dysfunction, gout, or a back disability. At his March 1969 separation examination, his genitourinary system, upper and lower extremities, feet, and spine were normal. An August 2006 VA treatment record noted "backache" on the Veteran's active problems list. In November 2007, he complained of low back pain. In July 2013, he complained of low back pain radiating down his left leg into his foot. The impression was sciatica. An April 2016 CT of the abdomen noted degenerative changes of the spine. A June 2019 CT scan of the right hip showed multilevel spondylosis with bilateral foraminal narrowing in the lumbar spine. An October 2007 VA treatment record indicated that the Veteran requested Viagra for an erection problem. In November 2014, it was noted that he was prescribed Sildenafil from an outside provider. A February 2013 VA treatment record indicated that the Veteran reported that he was diagnosed with gout in 2004. The Board notes that the Veteran was not provided with VA examinations or medical opinions in conjunction with the claims for service connection for erectile dysfunction, gout, and back disability. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See 38 C.F.R. § 3.159 (c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, however, the evidence does not indicate that the Veteran's erectile dysfunction, gout, and back disability may be associated with his service. See McLendon, 20 Vet. App. at 83; see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). There were no complaints of erectile dysfunction, gout, or a back disability during service. At his separation examination, his genitourinary system, upper and lower extremities, feet, and spine were normal, and there is no medical evidence otherwise linking his erectile dysfunction, gout, and back disability to service. Accordingly, the Board finds that VA examinations or medical opinions for those issues is not warranted. In this case, the Board finds the most probative evidence weighs against the claims. The first complaints and objective evidence of the claimed disabilities occurred many years after service. The passage of time between discharge from active service and the medical documentation of a claimed disability is a factor that tends to weigh against a claim for service connection. Maxson, 230 F.3d at 1333. Furthermore, there is no medical evidence linking the Veteran's claimed disabilities to his active service. The Board has also considered the lay evidence of record. The appellant and Veteran are competent to describe what they personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claims and entitlement to service connection for erectile dysfunction, gout, and a back disability is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. Service Connection Glaucoma During the September 2019 Board hearing, the Veteran testified that he was exposed to flashes from shooting and that his vision was all fuzzy. His wife stated that he also had glaucoma. A January 2015 VA treatment record indicated that glaucoma was suspected based on increased and asymmetric cup/disc ratios. In February 2015, it was noted that he had steroid induced glaucoma. He was taking Prednisone for inflammation and anti-rejection after his kidney transplant. In December 2015, it was noted that he had good intraocular pressure (IOP) without medication in the past, but IOP went up with steroid use for renal transplant. Based on the foregoing, the Board finds that it was at least as likely as not that the Veteran's glaucoma was caused or aggravated by his service-connected chronic kidney disease. Therefore, entitlement to service connection for glaucoma is warranted. 38 C.F.R. § 3.310. Service Connection Skin Disability An August 1965 service treatment record indicated that the Veteran was treated for a plantar wart on his right foot and corns. In November 1965, it was noted that he had chapped hands from working in the galley. In April 1968, it was noted that he had a corn on his left foot, acne vulgaris, and pseudofolliculitis barbae. His March 1969 separation examination report noted that his skin was normal. Post service, VA and private treatment records generally indicated that the Veteran denied rashes or lesions and that his skin was normal. A November 2019 private treatment record indicated that the Veteran had a history of skin cancer; however, there are no records of any treatment or diagnosis of skin cancer proximate or during the pendency of the claim. An April 2020 VA treatment record noted that the Veteran was treated for a pressure ulcer and that he had an open area to the sacrum. In August 2020, it was also noted that he had a left leg wound. The Board notes that the Veteran was not provided with VA examination or medical opinion in conjunction with the claim for service connection for a skin disability. In this case, however, the evidence does not indicate that any of the Veteran's skin disabilities may be associated with his service. See McLendon, 20 Vet. App. at 83; see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). Although the Veteran was treated for corns, a plantar wart, pseudofolliculitis barbae, and acne vulgaris during service, at his separation examination, his skin was normal. Post-service records do not show any treatment for the skin problems noted during service. Furthermore, there is no indication that his history of skin cancer, pressure ulcer, and left leg wound were related to service. Accordingly, the Board finds that a VA examination or medical opinion for this issue is not warranted. The Board has also considered the lay evidence of record. The appellant and Veteran are competent to describe what they personally observed or experienced. However, the ultimate questions of diagnoses and etiology in this case extend beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for a skin disability is not warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 49. REASONS FOR REMAND The Board finds that additional development is necessary before the remaining claims on appeal are decided. Service Connection Heart Disability The appellant maintains that the Veteran's heart disability is related to in-service herbicide exposure. A VA examination was conducted in March 2017. The examiner indicated that the Veteran had bradycardia status post pacemaker; however, the examiner did not provide an opinion as whether his bradycardia was etiologically related to the Veteran's service or a service-connected disability. Therefore, the Board finds that a remand is necessary for a VA medical opinion. Service Connection Hepatitis C The Veteran's service treatment records are unremarkable for any complaints, treatment, or diagnoses related to hepatitis. Post service, a February 2006 VA treatment record indicated that the Veteran underwent a hepatitis C screen panel. He denied having any risks factors for hepatitis C, including: blood/blood product prior to 1992; illicit injection drug use; unequivocal blood exposure; multiple sexual partners; hemodialysis; tattoo/repeated body piercing; intranasal cocaine use; unexplained liver disease; unexplained abnormal ALT value; and intemperate alcohol use. In June 2012, he reported that he was diagnosed with hepatitis C in approximately 2004. He stated that he used cocaine in the 1970s and 1980s. In February 2016, the Veteran stated that he believed he was exposed to hepatitis in Vietnam, and that he had shared vaccine needles while there. In January 2020, March 2020, and July 2020, the AOJ sent the Veteran letters requesting that he provide information regarding his hepatitis C risk factors. He did not respond. Based on the foregoing, the Board finds that a remand is necessary for a VA medical opinion. Service Connection Eye Disability Other Than Glaucoma As noted above, the Veteran stated that he was exposed to flashes from shooting and that his vision was fuzzy. A February 1967 service treatment record indicated that the Veteran was seen for a history of red, swollen eyes. He stated that they crusted over at night. He also complained of constant nasal congestion. The assessment was atopy. At his March 1969 separation examination, his eyes were normal. In addition to glaucoma, VA treatment records indicated that the Veteran had bilateral cataracts and dry eye syndrome. Based on the foregoing, the Board finds that a remand is necessary for a VA medical opinion. Service Connection Sinus Disability During the September 2019 Board hearing, the Veteran stated that he began to have sinus problems during service and that he believed he was allergic to something on board his ship. An April 1966 service treatment record indicated that the Veteran complained that his eyes were hurting and that he had headaches and allergies. In February 1967, he complained of red, swollen eyes and constant nasal congestion. The impression was atopy. In January 1969, he complained of cold symptoms and the impression was upper respiratory infection. At his March 1969 separation examination, his nose and sinuses were normal. Post service, a March 2006 VA treatment record noted that the Veteran had a history of seasonal allergic rhinitis. Private treatment records also noted chronic sinusitis. A VA examination was conducted in February 2018; however, the examiner only addressed the Veteran's claimed throat cancer. Therefore, the Board finds that a remand is necessary for a VA medical opinion. Service Connection Gastrointestinal Disability During the September 2019 Board hearing, the Veteran stated that he began to experience stomach pain during service. An October 2007 VA treatment record indicated that the Veteran was prescribed Omeprazole for his stomach. In February 2009, he reported having gastroesophageal reflux disease. In February 2013, he reported that he developed significant gastrointestinal problems that were attributed to medications he had taken. Based on the foregoing, the Board finds that a remand for a VA medical opinion is necessary. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion from a VA examiner with appropriate expertise to determine the nature and etiology of the Veteran's heart disability, to include bradycardia. The claims file must be made available to, and reviewed by the examiner. After a review of the evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any heart disability manifested during or was etiologically related to the Veteran's active service, to include herbicide exposure. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any heart disability was caused or aggravated by a service-connected disability. A rationale for all opinions expressed must be provided. 2. Obtain a VA medical opinion from a VA examiner with appropriate expertise to determine the nature and etiology of the Veteran's hepatitis C. The claims file must be made available to, and reviewed by the examiner. After a review of the evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's hepatitis C was etiologically related to his active service, to include his reports of having shared vaccine needles. A rationale for all opinions expressed must be provided. 3. Obtain a VA medical opinion from a VA examiner with appropriate expertise to determine the nature and etiology of the Veteran's eye disability other than glaucoma. The claims file must be made available to, and reviewed by the examiner. After a review of the evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any eye disability other than glaucoma manifested during or was etiologically related to the Veteran's active service, to include herbicide exposure. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any eye disability was caused or aggravated by a service-connected disability. A rationale for all opinions expressed must be provided. 4. Obtain a VA medical opinion from a VA examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed sinus disability, to include allergic rhinitis. The claims file must be made available to, and reviewed by the examiner. After a review of the evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any sinus disability, to include allergic rhinitis, manifested during or was etiologically related to the Veteran's active service. A rationale for all opinions expressed must be provided. 5. Obtain a VA medical opinion from a VA examiner with appropriate expertise to determine the nature and etiology of the Veteran's claimed gastrointestinal disability. The claims file must be made available to, and reviewed by the examiner. After a review of the evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any gastrointestinal disability manifested during or was etiologically related to the Veteran's active service, to include herbicide exposure. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any gastrointestinal disability was caused or aggravated by a service-connected disability, to include medications used to treat any service-connected disabilities. A rationale for all opinions expressed must be provided. 6. Confirm that the VA examination reports and all opinions provided comport with this remand and undertake any other development found to be warranted. 7. Then, readjudicate the issues remaining on appeal. If a decision is adverse to the appellant, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mishalanie, 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.