Citation Nr: 21069449 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 18-09 770 DATE: November 18, 2021 REMANDED An increased rating in excess of 10 percent for insomnia is remanded. Entitlement to service connection for C2-C3 post traumatic neuralgia (diagnosed as degenerative arthritis of the spine) is remanded. Entitlement to service connection for numbness left arm (claimed as peripheral neuropathy) is remanded. Entitlement to service connection for numbness right arm (claimed as peripheral neuropathy) is remanded. Entitlement to service connection for L3-L4 diffuse disc bulging/L2-L5 lumbar spondylosis is remanded. Entitlement to service connection for hypercalcemia (also claimed as a skin condition) is remanded. Entitlement to service connection for left knee chondromalacia is remanded. Entitlement to service connection for abnormal myeloma cells are remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to December 1967. These matters come before the Board of Veterans Appeals (Board) on appeal from an October 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans Law Judge at a videoconference hearing in August 2021. A transcript of the hearing has been associated with the file. At the hearing, the Veteran's appeal was advanced on docket due to his age. 38 U.S.C. § 7107(b)(3)(C). REASONS FOR REMAND 1. An increased rating in excess of 10 percent for insomnia is remanded. The Veteran contends that his initial rating for insomnia should have been 30 percent rather than the 10 percent he was assigned. See Form 9 received 2/15/2018 at page 2. In his Form 9, the Veteran stated that he gets about 312 hours of sleep per night and wakes up on and off. The Veteran also stated that he has horrible nightmares. Id. At the hearing the Veteran stated that his insomnia had worsen, since he now gets 2-2 12 hours of sleep per night. See Hearing Transcript received 8/13/2021 at page 18. He testified that the lack of sleep leaves him unable to do activities he used to enjoy, as well as his household chores such as cutting the grass. Further, the Veteran testified that he now takes B12 supplements for added energy. Id. at page 19. Since the Veteran was last examined in 2016, and has indicated a worsening of symptoms, the Board finds a remand for a VA examination is necessary to assess the current level of severity of his insomnia. 38 C.F.R. § 3.327(a). 2. Entitlement to service connection for C2-C3 post traumatic neuralgia (diagnosed as degenerative arthritis of the spine) is remanded. The Veteran contends that he injured his neck during service from an improper landing as a paratrooper. The Veteran states that the injury resulted in C2-C3, post-traumatic neuralgia, that has led to nerve damage. See Form 9 received 2/15/2018 at pages 1-2. At the hearing, the Veteran testified he sought medical attention during service and afterwards with private physicians, Dr. H and Dr. S. The Veteran further testified that the pain continues to this day. See Hearing Transcript received 8/13/2021 at page 3. The Veteran was given a VA examination in May 2016. The May 2016 VA examiner diagnosed him with degenerative arthritis of the spine with bilateral upper extremity neuropathy. See C&P Exam received 10/04/2016 at page 27. The May 2016 VA examiner provided a negative nexus stating that the Veteran did not receive continuous care for his degenerative arthritis and that the treatment in 1970 for cervical neuralgia was not definitive for post-traumatic neuralgia. Id. at page 59. Upon review, the Board finds that the VA examination did not specifically reference the Veteran's claim of C2-C3 post traumatic neuralgia because it did not specify whether the Veteran's degenerative arthritis was found in the C2-C3. Additionally, since the imaging results were not provided, the Board is unable to independently determine whether his degenerative arthritis was found in the C2-C3 region of the spine. This information is necessary because it goes to the Veteran's contention that his post-service treatment in 1970 for C2-C3 post traumatic neuralgia has caused his current neck condition. Accordingly, the Board will remand the claim for a new VA examination with an x-ray to determine the location of the Veteran's degenerative arthritis of the spine. 3. Entitlement to service connection for numbness left arm (claimed as peripheral neuropathy) is remanded. 4. Entitlement to service connection for numbness right arm (claimed as peripheral neuropathy) is remanded. The Veteran contends that bilateral numbness of the arms was caused his improper landing of the 4th jump when he was stationed at Fort Benning. See Form 9 received 2/15/2018 at page 2. Alternatively, he contends that it is the result of exposure to herbicide agents when he was stationed in Vietnam. Id. In the May 2016 VA examination for the Veteran's cervical spine claim, he was diagnosed with mild bilateral upper extremity neuropathy. See C&P Exam received 5/06/2016 at page 27. Although the May 2016 VA examiner provided a secondary service connection opinion on whether his upper extremity neuropathy is related to his service connection claim of C2-C3 post traumatic neuralgia, he did not provide a direct service connection opinion. A review of the record shows that the Veteran was not provided a VA examination for his left and right arm numbness claim. The Board, however, finds that an examination was warranted since the Veteran has a current diagnosis of bilateral upper extremity neuropathy, the Veteran had boots on the ground in Vietnam and therefore is presumed exposed to herbicide agents, and the Board does not have sufficient evidence with which to adjudicate this claim. See Military Personnel Record received 1/13/2016 at page 84; see also McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Accordingly, the Board finds that a remand is warranted for a VA examination. 5. Entitlement to service connection for L3-L4 diffuse disc bulging/L2-L5 lumbar spondylosis is remanded. The Veteran contends that his disc bulge was caused by his paratroop jumps during service. See Hearing Transcript received 8/13/2021 at page 3. At the hearing, the Veteran estimated that he jumped 18 times in total. Id. at page 4. After service, he testified that he went to numerous clinics to treat his back. The Veteran was provided a VA examination in May 2016. He was diagnosed with degenerative arthritis of the spine and left lower extremity peripheral neuropathy. See C&P Exam received 10/04/2016 at page 2. The May 2016 VA examiner provide a negative nexus, opining that the Veteran's in service condition was acute only, and that there was no evidence of chronicity of care. Id. at page 39. The May 2016 VA examiner opined that his left lower neuropathy was also unrelated to service since its onset was in 2005, approximately 38 years after service. Given that the Veteran has submitted additional records and provided testimony, which may establish chronicity of care; the Board will remand this matter for an addendum opinion that considers the additional, relevant evidence. 6. Entitlement to service connection for hypercalcemia (also claimed as a skin condition) is remanded. The Veteran contends that his hypercalcemia was caused by exposure to herbicide agents, specifically Agent Orange while in service in Vietnam. See Form 9 received 2/15/2018 at page 2. The Veteran's medical treatment records show that he has been diagnosed with serum monoclonal gammopathy, therefore the Veteran has a current diagnosis. See Medical Treatment Record received 3/24/2016 at page 35. Given that the Veteran had in-country service in Vietnam, he is considered to have presumed exposure to herbicide agents. Therefore, the Veteran has an event that may be related to his current diagnosis. That said, since the Veteran was not provided a VA examination for this claim, the Board does not have sufficient information with which to decide. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Accordingly, the Board finds that a remand for a VA examination is warranted to assist with adjudication of this matter. 7. Entitlement to service connection for left knee chondromalacia is remanded. The Veteran contends that his left knee chondromalacia was caused by his paratroop jumps, and miles of running during airborne school. See Form 9 received 2/15/2018 at page 2. At the hearing, the Veteran testified that he completed roughly 18 jumps while in service. Id. at page 4. The Veteran is also in receipt of the parachute badge. See Certificate of Release or Discharge from Active Duty (DD 214) received 5/27/1970 at page 1. The Veteran received a VA examination in May 2016. The May 2016 VA examiner diagnosed the Veteran with bilateral degenerative arthritis of the knees and patellofemoral pain syndrome of the left knee. See C&P Exam received 10/04/2016 at page 13. The May 2016 VA examiner provided a negative nexus to service, opining that the Veteran knee symptoms did not manifest until 2001 and that there were no complaints of knee problems in his service treatment records (STRs). See C&P Exam received 10/04/2016 at page 54. The Board finds that a remand is warranted because during the hearing the Veteran reported private treatment providers. Although the Veteran subsequently submitted additional private treatment records, the Board cannot know if they are complete since the VA did not request that he provide authorization for his private treatment records. Accordingly, on remand the Board will request that the Veteran provide a list of relevant treatment records and authorization for the VA to receive them on his behalf. 8. Entitlement to service connection for abnormal myeloma cells are remanded. Relatedly, the Veteran contends that his abnormal myeloma cells (diagnosed as monoclonal gammopathy and leukopenia) were caused by his exposure to herbicide agents while in Vietnam. See Form 9 received 2/15/2018 at page1. The Board finds that a remand for a VA examination is warranted. First, the Veteran has a current diagnosis of abnormal myeloma cells (diagnosed as monoclonal gammopathy and leukopenia). The Veteran is presumed exposed to herbicide agents since he had in-country service in Vietnam. However, since the Veteran was not provided a VA examination, the Board does not have sufficient medical evidence to decide this issue. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Additionally, at the hearing, the Veteran testified that he is being treated by a private hematologist, Dr. G.T. On remand, the Board will direct that the RO send the Veteran a letter requesting that the Veteran provide authorization so that they may request treatment records from Dr. G.T. These matters are REMANDED for the following actions: 1. The RO is directed to send the Veteran a VA Form 21-4142 and request the names for any relevant private treatment providers to include Dr. G. Tana. Once the Veteran has returned the form, send letters to all the providers the Veteran identified requesting any relevant medical treatment records. If any identified records cannot be obtained and further attempts would be futile, note this in the claims file, and inform the Veteran so that he may attempt to obtain those records himself. 2. After #1, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected insomnia. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his insomnia alone. 3. After #1, schedule the Veteran for a VA examination and provide him with an x-ray for his C2-C3 post traumatic neuralgia. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: (a) Is his C2-C3 post traumatic neuralgia at least as likely as not related to service, including the Veteran's paratrooper jumps? (b) Is it at least as likely as not that the C2-C3 post traumatic neuralgia (1) began during active service, (2) manifested within the presumptive period after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 4. After #1, schedule the Veteran for a VA examination for his (a) left arm and (b) right arm numbness (claimed a peripheral neuropathy). The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. Please complete the functional impact section of the report. The examiner is asked to provide a response to the following: Is his (a) left arm and (b) right arm numbness (claimed as peripheral neuropathy) at least as likely as not related to service, including as due to his paratrooper jumps? Or, as due to in-service presumed exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the (a) left arm and (b) right arm numbness (claimed as peripheral neuropathy) is not on the list of diseases that are presumptively associated with exposure to herbicide agents. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. After #1, obtain an addendum nexus opinion for the Veteran's claim of service connection for L3-L4 diffuse disc bulging/L2-L5 lumbar spondylosis. The examiner is asked to consider the Veteran's testimony at the hearing, wherein he stated that he continuously sought treatment for his back condition after service, as well as any newly submitted private treatment records. Please proivde a rationale for the opinion, to include showing consideration of the Veteran's testimony and any relevant records. 6. After #1, schedule the Veteran for a VA examination for his hypercalcemia (claimed as a skin condition). The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. Please complete the functional impact section the report. The examiner is asked to provide a response to the following: Is the Veteran's hypercalcemia (claimed as a skin condition) at least as likely as not related to service, including related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the hypercalcemia (claimed as a skin condition) is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Provide a rationale to support the opinion. 7. Provide an addendum opinion for the Veteran's claim of service connection for left knee chondromalacia. The examiner is asked to consider the Veteran's testimony at the hearing, wherein he stated that he continuously sought treatment for his knee condition after service, as well as any newly submitted private treatment records. Provide a rationale to support the opinion. 8. After #1, schedule the Veteran for a VA examination for his abnormal myeloma cells. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Are the Veteran's abnormal myeloma cells at least as likely as not related to service, including related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that abnormal myeloma cells are not on the list of diseases that are presumptively associated with exposure to herbicide agents. (Continued on the next page) The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.