Citation Nr: 21073688 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 17-34 175 DATE: December 10, 2021 REMANDED The issue of entitlement to service connection for Barrett's esophagus with dysplasia is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to June 1971. This matter comes before the Board of Veterans' Appeal (Board) on appeal from a November 2015 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. The Veteran contends that his Barrett's esophagus with dysplasia is related to his conceded Agent Orange exposure in service. The Veteran alternatively contends that his disability is related to exposure to multiple types of fuel as part of his in-service duties as a fuel specialist. The Veteran also reports that he began to have difficulty swallowing shortly after separation from service during the 1970s that has worsened over the years and now affects his ability to sleep. Even if the Veteran cannot be granted service connection on a presumptive basis, he can still be granted direct service connection if he had Barrett's esophagus at any point during the appeal period that is related to his Agent Orange exposure, or any other incident or injury in service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran has not yet been afforded a VA examination in connection with his service connection claim for Barrett's esophagus with dysplasia. VA must provide an examination when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Lay testimony as to continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service, and the threshold for finding that the disability (or symptoms of a disability) may be associated with service is low. Id. at 83. Furthermore, the Veteran is competent to testify to in-service injuries, symptoms, and events. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board notes that Agent Orange exposure has been conceded by VA. Given the Veteran's reports attributing Barrett's esophagus with dysplasia to exposure to Agent Orange and various types of fuel in service, the Board finds that the low threshold of the McLendon standard has been met in this instance, and that the Veteran should be afforded a VA examination and opinion prior to adjudication of the claim. See McLendon, 20 Vet. App. 79, 81 (2006). In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his peripheral artery disease. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matter is REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of any medical provider, VA or private, who has treated him for the above disability. After securing any necessary releases, the RO should request any relevant records identified that are not duplicates of those already contained in the claims file. Additionally, obtain any outstanding VA treatment records. If any requested records are unavailable, the claims file should be annotated as such and the Veteran and his representative notified of such. 2. After completing the above actions and associating any additional records with the claims file, schedule the Veteran for a VA examination with an appropriate clinician, such as a gastroenterologist, to determine the etiology of his Barrett's esophagus with dysplasia. The Veteran's claims file, including a copy of this remand, must be made available to the examiner. All diagnostic testing deemed to be necessary by the examiner should be accomplished. The examiner should address the following: Is it at least as likely as not (50 percent probability or more) that the Barrett's esophagus with dysplasia is related to service? The examiner should consider the Veteran's presumed herbicide exposure and exposure to various types of fuel as part of his in-service duties. Please note that a medical opinion that concludes that a disease is not related to herbicide exposure solely because there is no presumption of service connection is inadequate. For the purpose of providing the opinion requested, please accept as valid the Veteran's statements that he began to have difficulty swallowing shortly after separation from service during the 1970s that has worsened over the years and now affects his ability to sleep, and state whether a nexus between the Veteran's esophagus disability and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). A rationale for any opinions expressed should be set forth. If the examiner cannot provide an above opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Bilstein, 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.