Citation Nr: 21021083 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 20-21 188 DATE: April 9, 2021 REMANDED Entitlement to service connection for a heart disability, to include as secondary to service-connected posttraumatic stress disorder (PTSD) and herbicide agent exposure, is remanded. Entitlement to service connection for hypertension, to include as including as due to herbicides agent exposure is remanded. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, other than PTSD, is remanded. Entitlement to a rating in excess of 50 percent for PTSD is remanded. Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from April 1963 to April 1967, to include service in the Republic of Vietnam. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a Travel Board hearing on his VA Form 9. Subsequently, he requested a virtual tele-hearing. However, in a December 29, 2020 report of contact he withdrew his hearing request. See 38 C.F.R. § 20.704(e) (2020). The Veteran has raised the issue of entitlement to a TDIU. See October 2019 VA Form 21-8940. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) held that a TDIU claim is part of an increased rating claim when such claim is raised by the record. The record indicates that the Veteran has been unemployed during the appeal period. Accordingly, the Board finds that a TDIU claim is part and parcel of the current appeal, and that issue has been added to the cover page. 1. Entitlement to service connection for a heart disability, to include as secondary to service-connected PTSD and due to herbicide agent exposure, is remanded. 2. Entitlement to service connection for hypertension, to include as including as due to herbicide agent exposure, is remanded. 3. Entitlement to service connection for right upper extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. 4. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. 5. Entitlement to service connection for right lower extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. 6. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as due to herbicide agent exposure, is remanded. 7. Entitlement to service connection for a left knee disability is remanded. 8. Entitlement to service connection for an acquired psychiatric disorder, other than PTSD, is remanded. 9. Entitlement to a rating in excess of 50 percent for PTSD is remanded. 10. Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. 11. Entitlement to a TDIU is remanded. The evidence indicates there may be outstanding relevant VA treatment records. A July 13, 2020 appointment notice indicates that the Veteran had an appointment on August 26, 2020. VA treatment records after May 8, 2020 have not been associated with the claims file. Additionally, VA treatment records from July 8, 2011, August 5, 2011, March 3, 2014, and June 5, 2014 note that non-VA care records from May 10, 2011 and December 24, 2013, been scanned into VistA Imaging. An April 22, 2016 record indicates that an April 18, 2016 disability parking permit had been scanned. A September 2, 2011 VA record notes that a non-VA record from September 27, 2010 had been scanned. It does not appear that the referenced records have been associated with the claims file. A remand to obtain the outstanding records is required. The record also indicates that there are outstanding private treatment records. A VA treatment record from February 28, 2020 indicates that the Veteran received treatment, including anxiety medication, from a non-VA primary care provider. These records have not been requested or otherwise obtained. On remand, reasonable efforts should be made to obtain them. The Veteran has been diagnosed with heart palpations, tachycardia, and aortic sclerosis. The Board finds that a VA examination and opinion are warranted to determine that nature and etiology of the Veteran’s various heart disabilities. The Board acknowledges that a February 16, 2011 treatment record noted that the Veteran had tachycardia secondary to anxiety. Nevertheless, as that opinion lacks any rationale it is insufficient to decide the claim and a remand for a VA examination and opinion is warranted. The Veteran is diagnosed with hypertension, which he asserts is related to his in-service herbicide agent exposure. Accordingly, the Board cannot make a fully-informed decision on the issue because no VA examiner has opined whether the Veteran’s hypertension is related to his in-service herbicide agent exposure. The Veteran asserts that he has peripheral neuropathy due to his in-service herbicide agent exposure. While the record does not contain a diagnosis of peripheral neuropathy, VA treatment records from March 19, 2016 and November 26, 2018 document his reports of paresthesia and dysesthesia and “neuropathy.” Accordingly, he should be afforded an examination to address the nature and etiology of his claimed neuropathy. An October 2017 VA examiner opined that the Veteran’s anxiety was a symptom of his PTSD and not a separate disorder. Nevertheless, the record indicates that the Veteran has been separately diagnosed with generalized anxiety disorder and major recurrent depressive disorder. Accordingly, a VA opinion is warranted to determine whether those diagnoses are related to service and/or secondary to his service-connected PTSD. The Veteran’s last VA examination for his PTSD was in October 2017. A March 4, 2020 VA record indicates that the Veteran was flagged as a possible suicide risk. As the October 2017 examination report indicates that the Veteran denied suicidal ideation or intent, this evidence indicates that the Veteran’s PTSD symptoms may have increased in severity since he was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his PTSD. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities, including his non-VA primary care provider. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records dated since May 8, 2020 as well as the VistA Imaging records referenced in the July 8, 2011, August 5, 2011, September 2, 2011, March 3, 2014, June 5, 2014, and April 22, 2016 VA record entries. If any requested records are unavailable, the Veteran should be notified of such. 2. After records development is completed, the Veteran should be afforded a VA examination to determine the nature of any heart disability and to obtain an opinion as to whether such is possibly related to service or the Veteran’s service-connected PTSD. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any current disability of the heart arose during service or is otherwise related to service, including the Veteran’s in-service herbicide agent exposure. In so opining, the examiner should address the May 2016 article regarding herbicide agent exposure. (b.) Whether it is at least as likely as not (50 percent probability or greater) that any heart disability was caused by the service-connected PTSD? (c.) If not caused by the service-connected PTSD, is it at least as likely as not that any heart disability is worsened beyond natural progression (aggravated) by his service-connected PTSD? If the examiner finds that any heart disability was aggravated by his service-connected PTSD, the examiner should attempt to quantify the level of aggravation beyond the baseline level of the heart disability. In so opining, the examiner should address the February 16, 2011 record noting “[t]achycardia secondary to anxiety.” A complete rationale should be provided for all opinions and conclusions expressed. 3. After records development is completed, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's hypertension. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension had its onset during service or is otherwise related to service, including his in-service herbicide agent exposure. In so opining, the examiner should address the May 2016 article regarding herbicide agent exposure. A complete rationale should be provided for all opinions and conclusions expressed. 4. After records development is completed, the Veteran should be afforded a VA peripheral nerve examination to determine the nature of his reported paresthesia and dysesthesia and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current disability of the upper or lower extremity nerves arose during service or is otherwise related to service, including the Veteran’s in-service herbicide agent exposure. A rationale for all opinions expressed should be provided. 5. After records development is completed, schedule the Veteran for a VA PTSD examination to determine the current severity of the PTSD. The claims file should be reviewed by the examiner. All necessary tests should be performed, and the results reported. All symptomatology associated with the PTSD should be reported. The VA examiner should also state: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed generalized anxiety disorder and major depressive disorder were incurred during service or are otherwise related to service. (b.) Whether it is at least as likely as not (50 percent probability or greater) that his generalized anxiety disorder and major depressive disorder was caused by the service-connected PTSD. (c.) If not caused by the service-connected PTSD, is it at least as likely as not that his generalized anxiety disorder and major depressive disorder is worsened beyond natural progression (aggravated) by his service-connected PTSD? If the examiner finds that any heart disability was aggravated by his service-connected PTSD, the examiner should attempt to quantify the level of aggravation beyond the baseline level of the generalized anxiety disorder and/or major depressive disorder. A complete rationale should be provided for all opinions and conclusions expressed. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Anderson 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.