Citation Nr: 21020736 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 19-34 911 DATE: April 8, 2021 REMANDED Entitlement to service connection for right elbow disorder is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for chronic obstructive pulmonary disease is remanded. REASONS FOR REMAND The Veteran had active service from July 1958 to July 1960, and from October 1961 to August 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. Upon the request of the Veteran’s representative, the record was held open for 60 days following the hearing to allow for the submission of additional evidence. No additional evidence was received by the Board following the hearing. 1. Right Elbow Disorder The Veteran contends that his right elbow disorder is related to his active service. Specifically, the Veteran asserts that he was fixing a flat tire on a truck when a piece of metal struck his right elbow, causing a chip fracture. See Elbow and Forearm Conditions Disability Benefits Questionnaire (DBQ), April 16, 2018. The Veteran’s service medical records show that he was seen for hurting his right elbow while lifting ammunition the day before. See service medical records, October 22, 1959. The Veteran was diagnosed with sprained right elbow and assigned to light duty for seven days, and X-rays were performed. See service medical records, November 2, 1959. The Veteran’s medical records show that he has been diagnosed with osteoarthritis of the right elbow and mild degenerative changes in both elbows. See Elbow and Forearm Conditions DBQ, April 16, 2018. VA’s duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. In this case, the Veteran has reported that he experienced a right elbow injury during service, which is shown in his service medical records. The post-service clinical records show that the Veteran has a diagnosed right elbow disorder. While the Veteran did undergo an elbow examination in April 2018, the examination did not address the etiology of his right elbow disorder. As, such a remand is required for an etiology opinion. McLendon v. Nicholson, supra. 2. Coronary Artery Disease The Veteran contends that his coronary artery disease is related to his active service. Specifically, the Veteran asserts that his coronary artery disease is related to cleaning up the military base at Fort Polk, Louisiana, and to spraying herbicides there in order to eradicate weeds at the base, which has not been used for 15 years and was overgrown with weeds. The Veteran related that, in addition to weed killer, he was also exposed to solvents and gasoline while in active service. The Veteran related that he was diagnosed with “chest blisters” when his chest was X-rayed in active service. See Hearing Transcript, January 14, 2021. The Veteran’s medical records show that he has been diagnosed with coronary artery disease. See private treatment records, Cardiology Associates – St. Bernard’s Heart and Vascular, February 7, 2018. VA’s duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, supra. The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, supra; McLendon, 20 Vet. App. at 83. In this case, the Veteran has reported that he experienced hazardous chemical exposure while in active service. The post-service clinical records show that the Veteran has been diagnosed with coronary artery disease. He has not been provided with an examination to address the etiology of his coronary artery disease. As, such a remand is required for an examination and an etiology opinion. McLendon v. Nicholson, supra. 3. Chronic Obstructive Pulmonary Disease The Veteran contends that his chronic obstructive pulmonary disease is related to his active service. Specifically, the Veteran asserts that his respiratory issues are related to cleaning up the military base at Fort Polk, Louisiana, and to spraying herbicides there in order to eradicate weeds at the base, which has not been used for 15 years and was overgrown with weeds. The Veteran related that, in addition to weed killer, he was also exposed to solvents and gasoline while in active service. The Veteran related that he was diagnosed with “chest blisters” when his chest was X-rayed in active service. See Hearing Transcript, January 14, 2021. The Veteran’s service medical records show that a chest X-ray was performed in October 1961. The X-rays report contained a notation that the X-rays should be repeated, but no other X-ray is in the records See service medical records, October 28, 1961. The Veteran’s medical records show that he has been diagnosed with chronic obstructive pulmonary disease. See VA treatment records, July 31, 2019. VA’s duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, supra. The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, supra; McLendon, 20 Vet. App. at 83. In this case, the Veteran has reported that he experienced hazardous chemical exposure while in active service. The post-service clinical records show that the Veteran has been diagnosed with chronic obstructive pulmonary disease. He has not been provided with an examination to address the etiology of his chronic obstructive pulmonary disease. As, such a remand is required for an examination and an etiology opinion. McLendon v. Nicholson, supra. The matters are REMANDED for the following action: 1. Obtain the Veteran’s Social Security Administration (SSA) records. 2. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 3. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed right elbow disorder. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) Identify all right elbow disorder(s) found to be present at any time since February 2018. (B) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the diagnosed right elbow disorder had its onset in service, or is etiologically related to the Veteran’s active duty service? The examiner should specifically consider whether the Veteran’s right elbow disorder is related to his in-service right elbow injury. The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. 4. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed coronary artery disease. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) Identify all cardiovascular disorder(s) found to be present at any time since February 2018. (B) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the diagnosed coronary artery disease had its onset in service, or is etiologically related to the Veteran’s active duty service? The examiner should specifically consider whether the Veteran’s coronary artery disease is related to his asserted in-service weed killer, solvents, and gasoline exposure. The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. 5. Following the receipt of outstanding records, afford the Veteran an appropriate VA examination so as to determine the nature and etiology of his claimed chronic obstructive pulmonary disease. The record should be made available to the examiner. All necessary tests should be conducted, and the results reported. The need for a physical examination is left to the discretion of the examiner. Following review of the record and examination of the Veteran, the examiner should provide an opinion as to the following questions: (A) Identify all pulmonary disorder(s) found to be present at any time since February 2018. (B) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the diagnosed chronic obstructive pulmonary disease had its onset in service, or is etiologically related to the Veteran’s active duty service? The examiner should specifically consider whether the Veteran’s chronic obstructive pulmonary disease is related to his asserted in-service weed killer, solvents, and gasoline exposure. The examiner should specifically address the significance, if any, of the October 1961 chest X-ray. The examiner should elicit a full history from the Veteran and the lay statements of record. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lech, 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.