Citation Nr: 21022954 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-56 987 DATE: April 19, 2021 REMANDED Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a colon disability, claimed as the result of exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to November 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2017 the Veteran requested a Board hearing before a Veteran’s Law Judge. The Veteran subsequently withdrew the hearing request. Thus, the hearing request is considered withdrawn. In January 2020, the Board remanded to obtain service medical records and private medical records. In September 2016 the VA notified the Veteran that “all efforts to obtain the needed information have been exhausted, and based on these facts, we have determined that further attempts to obtain the records would be futile.” That notice is of record. The appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900. 1. Entitlement to service connection for a left wrist disability is remanded. In a July 2015 correspondence the Veteran stated some time during May 1967 or in 1968 he broke his left wrist in Vietnam. A month later the fracture was rebroken and reset. At a December 2015 VA examination, the Veteran stated since the wrist was reset he experienced problems, such as recurring pain and restricted mobility. The Veteran stated over the last several years he had intermittent join pain, swelling, and poor strength in the wrist. The examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted the Veteran’s medical records were all included the yearly medical examination. The examiner noted that each of the examinations mentioned the Veteran’s left wrist fracture, but that the Veteran claimed to be in excellent health. Furthermore, the examiner discussed the Veteran’s previous left wrist X-ray report, which indicated diffuse degenerative changes with cyst formation through the carpal bones and severe pantrapezial osteoarthritis. The examiner described the Veteran’s claimed symptoms as age related changes. The examiner did not discuss whether there was a causal connection between any current left wrist disability and any fracture during service. Because the examiner provided a negative etiology opinion without considering the Veteran’s contentions, the Board finds the December 2015 VA examination to be incomplete. 2. Entitlement to service connection for a colon disability, claimed as the result of exposure to herbicide agents, is remanded. The Veteran contends that a colon disability is due to active service. Specifically, the Veteran asserts that the colon problem is related to exposure to herbicide agents during service. The Veteran is presumed to have been exposed to herbicide agents based on service in the Republic of Vietnam. 38 U.S.C. § 1116; 38 C.F.R. § 3.307, 3.309(e). However, the colon disability is not a disease for which presumptive service connection based on exposure to herbicide agents is warrant. 38 C.F.R. § 3.309(e). That finding does not preclude the Veteran from raising a claim for service connection to be established on a direct basis. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Board finds that a VA opinion to determine any relationship between the a colon disability and service, or presumed exposure to herbicide agents, should be scheduled. The Veteran is notified that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim. The consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F. R. § 3.655. VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). When VA provides an examination, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Although the Board regrets the delay, additional development is needed prior to further disposition of the claim for entitlement for service connection for the claimed left wrist and colon disabilities. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to treatment for the claimed disabilities, including the names and addresses of all health care providers whose records have not already been provided to VA. On receipt of the requested information and the appropriate releases, contact all identified health care providers and request copies of all available records pertaining to treatment of the Veteran, not already of record. If identified records are not obtained, then notify the Veteran. 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for an examination by a medical doctor who has not previously examined the Veteran in conjunction with this claim, to determine the nature and etiology of any colon disability. The examiner must review the entire record, including this Remand, service medical records, the post-service medical records, and the Veteran’s statements. The examiner should note that review in the examination report. Exposure to herbicide agents during service in Vietnam is presumed. A clearly stated rationale for each opinion offered must be provided and cannot be based solely on the lack of any in-service records. After a review of the evidence, an interview with the Veteran, and an examination, the examiner should provide the following opinions: (a.) Diagnose all colon disabilities found or present during the pendency of this claim. (b.) Opine whether it is at least as likely as not (50 percent or greater probability) that any colon disability is related to service or any event, injury, or disease during service, to include presumed exposure to herbicide agents. (c.) Opine whether it is at least as likely as not (50 percent or greater probability) that any colon disability (1) began during active service, (2) manifested within one year after the Veteran’s November 1975 separation from service, or (3) was noted during service with continuity of the same symptomatology since service. The examiner is advised that the Veteran is competent to report symptoms during and since service, and that those reports must be acknowledged and considered in formulating any opinion. If the Veteran’s reports are discounted, the examiner should provide a reason for doing so.  The examiner should discuss the Veteran’s statements regarding symptoms during and since service.  3. Schedule the Veteran for an examination by a medical doctor who has not previously examined the Veteran in conjunction with this claim, to determine the nature and etiology of any left wrist disability. The examiner must review the entire record, including this Remand, service medical records, the post-service medical records, and the Veteran’s statements. The examiner should note that review in the examination report. A clearly stated rationale for each opinion offered must be provided and cannot be based solely on the lack of any in-service records. After a review of the evidence, an interview with the Veteran, and an examination, the examiner should provide the following opinions: (a.) Diagnose all left wrist disabilities found or present during the pendency of this claim. Left wrist pain resulting in functional limitation can be considered a left wrist disability. (b.) Opine whether it is at least as likely as not (50 percent or greater probability) that any left wrist disability is related to service or any event, injury, or disease during service. (c.) Opine whether it is at least as likely as not (50 percent or greater probability) that any left wrist disability (1) began during active service, (2) manifested as arthritis within one year after the Veteran’s November 1975 separation from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner is advised that the Veteran is competent to report symptoms during and since service, and that those reports must be acknowledged and considered in formulating any opinion. If the Veteran’s reports are discounted, the examiner should provide a reason for doing so.  The examiner should discuss the Veteran’s statements regarding symptoms during and since service.  Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sonya S. Tsao, 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.