Citation Nr: 21010327 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 16-02 320 DATE: February 24, 2021 REMANDED Entitlement to service connection for a right ear condition, status post nasopharyngeal carcinoma, is remanded. Entitlement to service connection for a throat condition is remanded. Entitlement to service connection for a mouth condition is remanded. Entitlement to service connection for a jaw condition is remanded. Entitlement to service connection for a biting condition is remanded. Entitlement to service connection for a balance condition is remanded. Entitlement to service connection for a dental condition is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1975 to December 1977, including overseas service in Korea. His surviving spouse has been substituted as the Appellant for purposes of processing the claim to completion. See January 2021 correspondence. The Veteran appealed a November 2011 rating decision by the Agency of Original Jurisdiction (AOJ). A Board of Veterans’ Appeals (Board) hearing was held in July 2018. A transcript is of record. The Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board’s prior remand instructions. See Stegallv. West, 11 Vet. App. 268, 271 (1998). The September 2018 Board decision remanded the issues to obtain SSA records and for a VA examination to determine the nature and etiology of the Veteran’s right ear condition. The Board notes that inquiries were made to obtain the Veteran’s SSA records. However, the records were destroyed. See July 2019 correspondence. Generally, the Veteran asserted that his various conditions were due to radiation received for his right ear tumor which started, or were at least symptomatic, during service with hearing trouble and ear infections. See July 2018 Board hearing tr. at 12-13. The Veteran also alleged that all conditions were due to his hearing loss. See July 2018 Board hearing tr at 17-18; January 2019 correspondence. Therefore, the September 2018 Board decision remanded the issue of the Veteran’s right ear condition, status post nasopharyngeal carcinoma, for a VA examination, a direct nexus opinion, and a secondary service-connection nexus opinion with respect to the Veteran’s service-connected bilateral hearing loss. The September 2018 Board decision found the remaining issues were intertwined with the right ear condition claim and remanded those issues. July 2019 and October 2020 VA opinions found the Veteran’s right ear condition was not directly related to service or secondarily related to his service-connected bilateral hearing loss. However, the Board finds remand is again required since all theories and contentions of entitlement have not been addressed. As an initial matter, the Veteran contended that he was exposed to herbicide agents while stationed in Korea. See October 2016 VA Form 21-526EZ and Veteran statement. Veterans who served in certain military units along the Republic of Korea’s demilitarized zone (DMZ) in areas that are known to have been treated with herbicide agent between April 1968 and August 1971 are presumed to have been exposed to these certain herbicidal agents. 38 C.F.R. §§ 3.307(a)(6)(iv). Here, the Veteran served in Korea as a power generator operator from July 1976 to July 1977. See service personnel records (SPRs). Therefore, the Veteran served in Korea several years after the recognized period for when herbicide agents are presumed to have been used in certain units along the DMZ. This was confirmed by the JSRRC who was unable to verify exposure to Agent Orange. See December 2016 memorandum. Although exposure to herbicide agents may be found on a fact found basis, the record does not support that the Veteran was exposed to herbicide agents. The Veteran stated that he served at the Korean DMZ at Camp RC4. See October 2016. However, the Veteran did not provide specific details about working on or near the DMZ or being stationed along the DMZ. Additionally, the Veteran stated that he was exposed to herbicides and pesticides that were being sprayed for rats and rodents. See October 2017 VA Form 9. This suggests that the Veteran was exposed to certain pesticides rather than herbicide agents. As such, the Board finds that the Veteran was not exposed to herbicide agents. Nevertheless, the record suggests the Veteran encountered various other chemicals during service. As noted above, the Veteran may have encountered pesticides sprayed for rats in Korea. The Veteran also stated that he was exposed to various solvents in service together with lubricants and mineral spirits, combined with the use of steel wool, while doing work in the motor pool. See October 2016 Veteran statements. Exposures to these chemical agents have not been addressed in any etiology opinion. Therefore, remand is required for etiology opinions that address exposures to these chemical agents. Apart from the Veteran’s right ear condition, the Veteran generally claims entitlement to throat, mouth, jaw, biting, balance, and dental conditions. However, the exact nature of these conditions is unclear. The record includes various notations of symptoms relating to each claimed condition. Overall, etiology opinions have not been rendered regarding these other conditions in which the Veteran related to radiation for his right ear tumor. Given exposure to other chemical agents during service, and the Veteran additionally claiming all conditions secondary to his service-connected bilateral hearing loss, VA opinions should be obtained on remand to determine the nature and etiology of the Veteran’s claimed throat, mouth, jaw, biting, balance, and dental conditions. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his right ear, throat, mouth, jaw, biting, balance, and dental conditions that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Appellant and her representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran’s claimed right ear, throat, mouth, jaw, biting, balance, and dental conditions. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the reviewing clinician. After the record review, the reviewing clinician should identify all right ear, throat, mouth, jaw, biting, balance, and dental conditions that were present at any point during the appellate period. Then, the reviewing clinician is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran’s right ear condition, status post nasopharyngeal carcinoma, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s right ear condition, status post nasopharyngeal carcinoma, was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s right ear condition, status post nasopharyngeal carcinoma, was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s throat condition and/or throat functional loss, to include loss of the salivary gland and difficult swallowing, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s throat condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s throat condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s throat condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s throat condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s mouth condition and/or mouth functional loss, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s mouth condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s mouth condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s mouth condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s mouth condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s jaw condition and/or jaw functional loss, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s jaw condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s jaw condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s jaw condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s jaw condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s biting condition and/or biting functional loss, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s biting condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s biting condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s biting condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s biting condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s balance condition and/or balance functional loss, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants (with the use of steel wool) during service? Is it at least as likely as not that the Veteran’s balance condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s balance condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s balance condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s balance condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s dental condition and/or dental functional loss, was incurred in, or otherwise related, to his time on active service, to include, but not limited to, exposures to various pesticides, solvents, mineral spirits, and/or lubricants? Is it at least as likely as not that the Veteran’s dental condition was CAUSED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s dental condition was AGGRAVATED by his service-connected bilateral hearing loss? Is it at least as likely as not that the Veteran’s dental condition was CAUSED by his right ear condition, to include chemotherapy radiation treatment rendered? Is it at least as likely as not that the Veteran’s dental condition was AGGRAVATED by his right ear condition, to include chemotherapy radiation treatment rendered? In answering the above questions, the reviewing clinician should specifically discuss whether any identified dental/oral condition was productive of loss of the substance of the maxilla or mandible. The reviewing clinician is to consider in-service treatment for ear, nose, and throat symptoms. In rendering these opinions, the reviewing clinician is advised that the Veteran was competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). (Continued on the next page)   3. After the above development has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Appellant and her representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Zheng, 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.