Citation Nr: 21071503 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-61 554 DATE: November 30, 2021 REMANDED Entitlement to service connection for prostate cancer, to include colon cancer, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for a throat disability, to include esophageal spasms, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II and/or herbicide agent exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as secondary to diabetes mellitus type II and/or herbicide agent exposure, is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as secondary to diabetes mellitus type II and/or herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to August 1969 with confirmed service in the Republic of Vietnam. The Veteran has been awarded the National Defense Service Medal, Vietnam Service Medal, Vietnam Campaign Medal, and Vietnam Cross of Gallantry with Palm. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran was previously scheduled for a Travel Board hearing on October 26, 2021. However, on October 17, 2021, the Veteran notified the VA that he wished to withdraw his hearing request. 1. Entitlement to service connection for prostate cancer, to include colon cancer, to include as due to herbicide agent exposure, is remanded. 2. Entitlement to service connection for a throat disability, to include esophageal spasms, to include as due to herbicide agent exposure, is remanded. 3. Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus type II and/or herbicide agent exposure 4. Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as secondary to diabetes mellitus type II and/or herbicide agent exposure is remanded. 5. Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as secondary to diabetes mellitus type II and/or herbicide agent exposure is remanded. To promote efficiency, the issues of entitlement to service connection for prostate cancer, to include colon cancer, throat disability, hypertension, and bilateral lower extremity peripheral neuropathy, to include as secondary to diabetes mellitus and/or herbicide agent exposure, will be addressed together. In this case, the Veteran seeks service connection for prostate cancer, to include colon cancer, a throat disability, hypertension, and bilateral lower extremity peripheral neuropathy to include as secondary to his service-connected diabetes mellitus type II and/or exposure to herbicide agents. To begin, as provided for above with evidence of a multitude of medals for his honorable service, the Veteran has confirmed service in the Republic of Vietnam. Furthermore, the Veteran is currently in receipt of a 20 percent disability rating for diabetes mellitus type II to include 60 percent disability rating for diabetic nephropathy to include as due to exposure to Agent Orange. As such, the Board concedes exposure to Agent Orange. The Veteran is currently prescribed two types of medication in order to treat "prostate enlargement." Further, an October 2017 colonoscopy revealed a history of colon cancer. Although the Veteran's current claim is for prostate cancer, given the additional adjudication of service connection for colon cancer in the July 2018 supplemental statement of the case, his representative's appellate brief arguing for service connection for colon cancer, and his medical treatment records which include a diagnosis and treatment for colon cancer, the Board will expand the claim to include entitlement to service connection for colon cancer. In addition, the Veteran's representative in their appellate brief submitted a number of articles arguing that his current throat disability, which he clarifies as esophageal spasms, is due to his diabetic neuropathy. Further, a gastroenterology note from February 2017 notes the Veteran underwent a barium swallow that revealed a hiatal hernia, Shatzke's ring, prominent cricopharyngeus muscle, and a small Zenker's diverticulum. He was diagnosed with dysphagia, GERD, cricopharyngeal hypertrophy, and Schatzke's esophageal ring. Moreover, it is noted that a June 2014 VA examination reveals that a complication of the Veteran's current diabetic nephropathy is hypertension, a July 2018 medical notes includes benign hypertension, and he is currently prescribed medication to treat hypertension. Lastly, in a January 2016 primary care note, the Veteran complained of diabetic neuropathy. However, the Veteran has not been afforded any VA examinations to determine the nature and etiology of these disabilities. Therefore, given the above evidence of current diagnoses and treatment of colon cancer, numerous esophageal disabilities, hypertension, and complaints of neuropathy, the Veteran's currently service-connected diabetes mellitus type II, his conceded exposure to Agent Orange, and the lack of a contemporary VA examinations, the Board concludes that the low threshold to provide the Veteran with VA examinations and etiological opinions has been met. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In McLendon, the United States Court of Appeals for Veterans Claims (Court) held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. Therefore, as the McLendon factors have been met, a remand is necessary to provide the Veteran with VA examinations to determine the etiology of his prostate cancer, to include colon cancer, any throat disabilities, hypertension, and bilateral lower extremity peripheral neuropathy. The matters are REMANDED for the following action: 1. The AOJ must obtain any and all updated records of VA and private treatment, with the Veteran's assistance regarding the latter. 2. Thereafter, the AOJ must request that the Veteran be scheduled for appropriate VA examinations to determine the nature and etiology of any prostate disorder, to include prostate cancer, colon cancer, throat disabilities, hypertension, and bilateral lower extremity peripheral neuropathy disabilities. The complete electronic record must be made available to, and reviewed by, the VA examiner prior to conducting the examination. All necessary studies and tests should be conducted. Thereafter, the examiners are requested to address the following: (a) Opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's prostate disorder, to include prostate cancer, and colon cancer had its onset during, or is otherwise related to, the Veteran's active-duty service, to include exposure to herbicide agents. (b) Opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's throat disability, to include a hiatal hernia, Shatzke's ring, prominent cricopharyngeus muscle, and a small Zenker's diverticulum, had its onset during, or is otherwise related to, the Veteran's active-duty service, to include as due to herbicide exposure. (i) The examiner is also asked to provide an opinion regarding secondary service connection as to whether his throat disability was either caused or aggravated by his service-connected diabetes mellitus type II. (c) Opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension had its onset during, or is otherwise related to, the Veteran's active-duty service to include exposure to herbicide agents. (i) The examiner is also asked to provide an opinion regarding secondary service connection as to whether his hypertension was either caused or aggravated by his service-connected diabetes mellitus type II. (d) Opine as to whether the Veteran has a current diagnosis of bilateral lower extremity peripheral neuropathy. If so, the examiner is as to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's peripheral neuropathy had its onset during, or is otherwise related to, the Veteran's active-duty service to include exposure to herbicide agents. (i) The examiner is also asked to provide an opinion regarding secondary service connection as to whether his bilateral lower extremity peripheral neuropathy was either caused or aggravated by his service-connected diabetes mellitus type II. 3. Any opinion expressed by the examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. DeBoer, 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.