Citation Nr: 21021362 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 14-13 181 DATE: April 12, 2021 REMANDED The petition to reopen a claim of entitlement to service connection for asthma is remanded. The petition to reopen a claim of entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include depression, is remanded. Entitlement to service connection for chronic fatigue syndrome (CFS), to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for a cardiac disorder, to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1969 to September 1971, to include service in the Republic of Vietnam. The Veteran’s awards and decorations for his service include a Combat Infantryman Badge, among others. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Little Rock, Arkansas. The Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ) of the Board in January 2021. A transcript of the hearing has been associated with the claims file. The record was held open for 60 days following the hearing to allow for the submission of additional evidence and argument. However, no additional evidence or argument has been received. 1. Petitions to Reopen Asthma and PTSD and Service Connection for Acquired Psychiatric Disorder and CFS The Veteran asserts that his current asthma, PTSD, CFS, and depression are etiologically related to his active service. Specifically, with regard to asthma, the Veteran asserts that his asthma did not preexist active service and/or was aggravated by his service in the Republic of Vietnam, to include herbicide agent exposure. With regard to PTSD and depression, the Veteran has reported stressors related to his service in the Republic of Vietnam to include combat. With regard to CFS, the Veteran asserts that his fatigue began after active service as a result of his service in the Republic of Vietnam and to include as due to herbicide agent exposure. The agency of original jurisdiction (AOJ) scheduled the Veteran for VA examinations to ascertain the nature and etiology of his claims. However, the record reflects that the VA examinations were cancelled as a result of the COVID-19 pandemic. The Veteran submitted two requests in April and October 2020 to reschedule his cancelled VA examinations. See Correspondences, April 29, 2020, and October 12, 2020. The Board notes that when a Veteran fails, without good cause, to report for a necessary VA examination requested by VA in conjunction with a claim, VA is not obliged to attempt to provide another. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant or the death of an immediate family member. 38 C.F.R. § 3.655(a). As the Veteran indicated that the examinations were cancelled due to the COVID-19 pandemic and he has requested that the VA examinations be rescheduled, the Board finds that good cause has been shown. Therefore, on remand, VA examinations should be scheduled to ascertain the nature and etiology of the Veteran’s petitions to reopen his claims for service connection for asthma and PTSD as well as his claims for entitlement to service connection for an acquired psychiatric disorder and CFS. 2. Service Connection – Cardiac Disorder The Veteran claims that his current cardiac disorder is etiologically related to his exposure to herbicide agents during his service in the Republic of Vietnam. Service treatment records show that the Veteran complained of pain or pressure in his chest. See Report of Medical History, August 3, 1971. Initially, the Board notes that it is not clear whether the Veteran suffers from ischemic heart disease. A March 2010 private treatment note contained an impression of coronary artery disease. A February 2012 VA ischemic heart disease examination diagnosed the Veteran with hypertensive heart disease and arteriosclerotic heart disease (ASHD), and specifically noted that the Veteran had not been diagnosed with ischemic heart disease. The nature of the Veteran’s cardiac disorder is not clear from the current record. The Veteran was provided a VA examination for his claimed cardiac disorder in February 2012. However, an opinion as to direct service connection was not provided at this time. Rather, the examiner opined that the Veteran’s atherosclerosis heart disease was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because the Veteran did not have a history of documented myocardial infarctions, did not have angina, and did not meet the criteria for ischemic heart disease. However, a March 2010 private treatment note did reflect an impression of angina. Therefore, the Board finds that a new VA examination and opinion is warranted to determine the nature and etiology of the Veteran’s claimed cardiac disorder. The matters are REMANDED for the following action: 1. The Veteran should be given the 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). 2. Following the receipt of outstanding records, the Veteran should be afforded an appropriate VA examination to determine the etiology of his claimed asthma. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (a) Is it clear and unmistakable (obvious, manifest, and undebatable) that asthma preexisted active service? (b) If so, is it clear and unmistakable (obvious, manifest, and undebatable) that the preexisting asthma WAS NOT aggravated during service; or whether it is clear and unmistakable (obvious, manifest, and undebatable) that any increase in service was due to the natural progress? (c) If asthma did not preexist service, is it at least as likely as not (a probability of 50 percent or greater) had its onset in service or is etiologically related to service, to include herbicide agent exposure during his service in the Republic of Vietnam? A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion as to the Veteran’s claimed acquired psychiatric disorder, to include PTSD and depression. A complete and detailed rationale should be given for all opinions and conclusions expressed. The examiner should review the claims file and provide an addendum opinion. The need for further physical examination is left to the discretion of the examiner. The examiner should specifically opine as to: (A) Identify the acquired psychiatric disorder(s) that the Veteran has been diagnosed with anytime since August 2011. (B) For each acquired psychiatric disorder that is diagnosed, is at least as likely as not (50 percent or better probability) that it had its onset during his active service or is otherwise etiologically related to such service, to include combat service in Vietnam? A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 4. Following the receipt of outstanding records, obtain an etiology opinion as to the Veteran’s claimed CFS. A complete and detailed rationale should be given for all opinions and conclusions expressed. The examiner should review the claims file and provide an addendum opinion. The need for further physical examination is left to the discretion of the examiner. The examiner should specifically opine as to: Is at least as likely as not (50 percent or better probability) that CFS had its onset during his active service or is otherwise etiologically related to such service, to include the exposure to herbicide agents? A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 5. Following the receipt of outstanding records, obtain an etiology opinion as to the Veteran’s claimed cardiac disorder. A complete and detailed rationale should be given for all opinions and conclusions expressed. The examiner should review the claims file and provide an addendum opinion. The need for further physical examination is left to the discretion of the examiner. The examiner should specifically opine as to: (A) Does the Veteran suffer from ischemic heart disease? The examiner should specifically reconcile the impression of coronary artery disease in the March 2010 private treatment record with the finding that the Veteran did not suffer from ischemic heart disease in the February 2012 VA examination report. (B) Is at least as likely as not (50 percent or better probability) that the diagnosed cardiac disorder had its onset during his active service or is otherwise etiologically related to such service, to include the exposure to herbicide agents? The examiner should address the significance, if any, of the August 1971 Report of Medical History in which the Veteran complained of pain or pressure in his chest. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. (Continued on the next page)   6. When scheduling the VA examinations, please notify the Veteran that it is his responsibility to report for the examinations and to cooperate in the development of his claims. The consequences for failure to report for any VA examination without good cause may include denial of the claim. See 38 C.F.R. §§ 3.158, 3.655. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.