Citation Nr: 21073250 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-62 621 DATE: December 8, 2021 REMANDED Service connection for heart disease, to include as due to exposure to herbicide agents, is remanded. Service connection for hypertension, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. Service connection for sleep apnea, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. Service connection for peripheral artery disease, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. Service connection for diabetes, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. REASONS FOR REMAND The Veteran has active service in the United States Air Force from May 1956 to May 1976. These matters are on appeal from a September 2014 rating decision. The Veteran did not appear for his October 2019 hearing and has not provided good cause for not appearing. The hearing request is deemed withdrawn. 38 C.F.R. § 20.704(d). This matter was previously before the Board in February 2020 when it was remanded for additional development. In his July 2017 DRO hearing testimony, the Veteran states that during the Vietnam era he spent five to eight days in Udorn and Phanom Air Force bases in Thailand. While there, he "look[ed] at the personnel accounts of suspicious records" of military personnel who had been misassigned to Thailand, or mistakenly detained there longer than required. The Veteran indicates that he lost his orders to go to Thailand. 1. Service connection for heart disease, to include as due to exposure to herbicide agents, is remanded. A medical examination or medical opinion is necessary in a claim for service connection 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. McLendon v. Nicholson, 20 Vet. App. 79, 8186 (2006). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). These elements are satisfied with regard to the claim of service connection for heart disease. Regarding the first element, the Veteran's VA problem list indicates chronic ischemic heart disease, bilateral renal artery stenosis, cardiac pacemaker in situ, carotid artery stenosis, paroxysmal atrial fibrillation, and subclavian artery stenosis. Regarding the second element, several service treatment records indicate heart problems or chest pain. A December 1968 service treatment record describes "chest pain." A March 1971 service treatment record describes "sudden onset of acute pain left thoracic area about 2 weeks ago." A May 1973 service treatment record describes "chest pain for 710 days." An August 1974 service treatment record describes "chest pain when breathing." An October 1974 service treatment record describes treatment for chest pain. A July 1975 service treatment record indicates "Sinus Bradycardia." The Veteran's July 1975 exit examination indicates a "history of mid chest discomfort." Regarding the third and fourth elements, there is an indication that current heart disease could be related to service, but there is insufficient evidence of record by which the Board can make a decision. As the four McLendon elements are satisfied, the Veteran is entitled to a VA examination and medical opinion. 2. Service connection for hypertension, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. 3. Service connection for sleep apnea, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. 4. Service connection for peripheral artery disease, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. 5. Service connection for diabetes, to include as due to exposure to herbicide agents and as secondary to heart impairment, is remanded. The McLendon elements are also satisfied with regard to the claims of service connection for hypertension, sleep apnea, peripheral artery disease, and diabetes. Regarding the first element, the Veteran's VA problem list indicates obstructive sleep apnea, benign essential hypertension, protal hypertension, peripheral vascular disease, and diabetes. Regarding the second element, the service treatment records above indicate heart impairment. Regarding the third and fourth elements, there is an indication that hypertension, sleep apnea, peripheral artery disease, or diabetes could be related to heart impairment, but there is insufficient evidence of record by which the Board can make a decision. As the four McLendon elements are satisfied, the Veteran is entitled to VA examinations and medical opinions. Additionally, on remand the RO should obtain all relevant VA treatment records dated from August 2021 to the present before the issues on appeal are decided on the merits. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all VA treatment records from August 2021 to the present. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After obtaining any additional records to the extent possible, provide an examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) and obtain a medical opinion regarding the nature, onset, and etiology of any heart disease, hypertension, sleep apnea, peripheral artery disease, and diabetes impairment. The examiner should review the entire claims file, conduct all necessary tests and studies, and provide the requested opinions: (a.) Whether the Veteran has any heart disease, hypertension, sleep apnea, peripheral artery disease, or diabetes impairment. (b.) Whether it is at least as likely as not that any heart disease, hypertension, sleep apnea, peripheral artery disease, or diabetes impairment was incurred in the Veteran's service. (c.) Whether the Veteran has any sleep apnea, peripheral artery disease, or diabetes impairment that is proximately due to heart disease/impairment. (d.) Whether the Veteran has any sleep apnea, peripheral artery disease, or diabetes impairment that was aggravated by heart disease/impairment. This must be addressed in a separate opinion from the "proximately due to" opinion. In rendering these opinions, the examiner should consider service treatment records describing chest pain, sinus bradycardia, or other heart disease/problems, including those dated December 1968, March 1971, May 1973, August 1974, October 1974, and July 1975 (described above). The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.