Citation Nr: 21011099 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-34 032 DATE: February 26, 2021 REMANDED Entitlement to service connection for myelodysplastic syndrome, to include as the result of exposure to herbicides is remanded. REASONS FOR REMAND The Veteran served in active duty from September 1954 to June 1958, August 1981 to October 1984, and September 1986 to August 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In November 2018, the Board denied the Veteran’s motion to reschedule the Board hearing. In January 2019, the Board denied the Veteran’s claim for this issue. The Veteran appealed to the Board’s decision to the Court of Appeals for Veterans Claims (“CAVC” or “the Court”). In February 2020, the Court issued an order that vacated the Board’s decision, further addressed herein, and remanded the claims for compliance with a Joint Motion for Remand (JMR) regarding the issue sub judice. In June 2020, the Veteran requested an extension of time to obtain additional medical opinion. The Board granted that extension request through October 20, 2020. Prior to the expiration of the request for extension, the Veteran requested a subsequent extension of time through December 18, 2020 due to delays in obtaining the additional medical opinion. On December 18, 2020, the Board received additional medical records, to include a medical opinion from Dr. C.K. The Veteran’s representative also included a cover letter with the submission wherein he indicated that he has nothing more to submit, and that he wants the Board to proceed with adjudication. The Board hereby GRANTS that motion, and notes that this period encompasses the date he submitted the new opinion. Entitlement to service connection for myelodysplastic syndrome, to include as the result of exposure to herbicides is remanded to obtain a medical opinion. The Veteran had active service in Southwest Asia from December 1990 to April 1991. Therefore, he is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). The Veteran asserts that his myelodysplastic syndrome (MDS) is related to his exposure to environmental hazards while stationed in Southwest Asia. Specifically, he asserts in his April 1997 VA claim for other disabilities that he was exposed to chemicals used by the military “both stateside and in Saudi Arabia.” Additionally, the Veteran asserts that he began to experience symptoms of lightheadedness, coldness in his hands and feet, weakness, fatigue, blood spots and bleeding easily. He asserts continuous supportive care for his MDS and bone marrow issues by way of marrow stimulating drugs, close monitoring of blood counts, transfusions and strict precautions against bleeding and infection. The pathophysiology and etiology of this condition is unclear. The Veteran has not been afforded a VA examination to evaluate these contentions. In light of the foregoing, the Board finds that a VA examination is necessary in order to properly evaluate the Veteran’s theories of entitlement to service connection for his myelodysplastic syndrome. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his myelodysplastic syndrome. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: (a.) Is the etiology of the Veteran’s myelodysplastic syndrome (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. (b.) Is the pathophysiology of the Veteran’s myelodysplastic syndrome (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. (c.) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s myelodysplastic syndrome was incurred in, or is otherwise related to, his active service? 2. Schedule the Veteran for a VA Gulf War examination with an examiner with the appropriate expertise to determine the nature and etiology of the Veteran’s claimed myelodysplastic syndrome disability. All studies and tests deemed necessary by the examiner should be performed. The examiner is asked to address the following: (a.) Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s claimed myelodysplastic syndrome disability is due to a (1) diagnosable chronic multi-symptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis. If it is the latter the examiner must provide the diagnosis of the disability or disabilities. (b.) If the examiner determines that the Veteran’s disability pattern is either a diagnosable chronic multi-symptom illness with a partially explained etiology or a disease with a clear and specific etiology and diagnosis, then the examiner should opine whether it is at least as likely as not (i.e., probability of 50 percent) that the Veteran’s claimed myelodysplastic syndrome disability was incurred in service, to include as a result of his exposure to environmental hazards while serving in Southwest Asia during the Persian Gulf War. In rendering these opinions, the examiner is asked to consider all service treatment records, private treatment records and opinions and lay statements regarding the Veteran’s claimed myelodysplastic syndrome disability. (c.) Opine whether the Veteran’s claimed myelodysplastic syndrome disability is due to objective indications of a qualifying chronic disability to include (1) an undiagnosed illness, or (2) medically unexplained chronic multisystem illness. In rendering the opinion, the examiner should specify whether the Veteran has objective indications of a chronic disability as established by history, physical examination, and laboratory tests, that have either (1) existed for 6 months or more, or (2) exhibited intermittent episodes of improvement and worsening over a 6-month period. Objective indications of chronic disability include both signs, in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. (Continued on the next page)   A clear explanation and complete rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner is unable to provide an opinion he or she should explain why. 3. The AOJ shall readjudicate the claim on appeal. If any decision is averse to the Veteran, issue a supplemental statement of the case and allow an appropriate time for response. Then, if applicable, return the case to the Board. Roya Bahrami Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hamilton, 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.