Citation Nr: 21010746 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-32 839 DATE: February 25, 2021 REMANDED Entitlement to service connection for hypertrophic pulmonary osteoarthropathy (HPO) is remanded. REASONS FOR REMAND The Veteran had active military service from March 1966 to March 1969, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a January 2021 Board video-conference hearing and a transcript of that proceeding has been associated with the claims file. The Veteran seeks service connection for HPO, to include as due to herbicide exposure. See 09/02/2014 VA 21-526EZ, Fully Developed Claim (Compensation). Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to decide on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The threshold for finding a VA examination and medical opinion are required due to a link between current disability and service is low. McLendon, 20 Vet. App. at 83. For the reasons set out below, the Board finds that a VA examination is necessary to determine the nature and etiology of the Veteran's HPO, to include whether it is related to active military service and herbicide exposure. VA treatment records show that the Veteran was diagnosed with HPO in January 2016. 05/24/2017 CAPRI at 161. The Veteran's military personnel records confirm that he served on active duty in the Republic of Vietnam, and he is therefore presumed to have been exposed to herbicide agents while in service. See 12/08/2014 Military Personnel Record, at 17, 19. The Veteran contends that he has had lung and breathing difficulties ever since discharge from the military, to include collapsed lung. See 09/02/2014 VA 21-4138, Statement in Support of Claim; see also 06/20/2017 Form 9. The Veteran has not yet been afforded a VA examination to determine the nature and etiology of his HPO and whether it is related to active military service, to include herbicide exposure. Accordingly, on remand, an opinion should be obtained to address the Veteran's contentions that his HPO was caused by active service or by presumed exposure to herbicide agents while serving in Vietnam. The opinion is to also address entitlement to service connection for HPO on a direct basis, as the Veteran is not precluded from establishing direct causation even if the claimed disorder is not presumed to be related to herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). This matter is REMANDED for the following action: Schedule a VA examination (or telehealth interview, review of the record etc. if an in-person examination is not feasible due to the current pandemic) with an appropriate VA clinician to determine the nature and etiology of the Veteran's current HPO, to include as due to herbicide agent exposure in Vietnam. Based on a review of the evidence to include a copy of this Remand, the clinician is asked to provide a response to each of the following: (a.) Is it at least as likely as not (50 percent probability or higher) that the Veteran’s HPO is related to active military service, to include as due to his presumed exposure to herbicide agents in Vietnam? (b.) Please note and consider in formulating the opinion the Veteran’s testimony that (1) he had no problems prior to service as he played many sports in high school; (2) he has had breathing problems since service, to include visits to sick call for respiratory issues, and (3) has had pneumonia many times. 1/06/2021 Hearing Transcript, at 3-6; 12/08/2014 STR – Medical, at 3-7. (Continued on the next page)   A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Tremont 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.