Citation Nr: 21022977 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 20-25 024A DATE: April 19, 2021 REMANDED Entitlement to service connection for type II diabetes as a result of exposure to herbicide agents is remanded. Entitlement to service connection for chronic kidney disease stage III, also claimed as non-functioning left kidney and hematuria, is remanded. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. Entitlement to service connection for atherosclerotic heart disease, also claimed as dyslipidemia, is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for peripheral vascular disease left lower extremity, also claimed as intermittent claudication and blockages, is remanded. Entitlement to service connection for peripheral vascular disease right lower extremity also claimed as intermittent claudication and blockages, is remanded. Entitlement to service connection for platelet dysfunction is remanded. Entitlement to service connection for benign prostatic hypertrophy, claimed as BPH and elevated PSA, is remanded. Entitlement to service connection for chronic gout, claimed as arthritis, is remanded. Entitlement to service connection to allergic rhinitis is remanded. Entitlement to service connection for pulmonary obstruction is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for malignant melanomas is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1957 to March 1959 and from May 1962 to April 1965. This matter is before the Board of Veterans’ Appeals (Board) on appeal of December 2016 and November 2017 rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA). In December 2020, the Veteran and his wife testified at a hearing held before the undersigned. 1. Entitlement to service connection for type II diabetes as a result of exposure to herbicide agents is remanded. 2. Entitlement to service connection for chronic kidney disease stage III, also claimed as non-functioning left kidney and hematuria, is remanded. 3. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded. 4. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded. 5. Entitlement to service connection for atherosclerotic heart disease, also claimed as dyslipidemia, is remanded. 6. Entitlement to service connection for hypertension is remanded. 7. Entitlement to service connection for peripheral vascular disease left lower extremity, also claimed as intermittent claudication and blockages, is remanded. 8. Entitlement to service connection for peripheral vascular disease right lower extremity, also claimed as intermittent claudication and blockages, is remanded. 9. Entitlement to service connection for platelet dysfunction is remanded. 10. Entitlement to service connection for benign prostatic hypertrophy, claimed as BPH and elevated PSA, is remanded. 11. Entitlement to service connection for chronic gout, claimed as arthritis, is remanded. 12. Entitlement to service connection to allergic rhinitis is remanded. 13. Entitlement to service connection for pulmonary obstruction is remanded. 14. Entitlement to service connection for obstructive sleep apnea is remanded. 15. Entitlement to service connection for malignant melanomas is remanded. Under its duty to assist, VA must obtain relevant records from a Federal department or agency, including records from a service department. See 38 C.F.R. § 3.159(c)(2). Service connection for some disabilities, including type II diabetes, atherosclerotic heart disease, prostate cancer, and early onset peripheral neuropathy, is presumed for Veterans who were exposed to herbicide agents during service. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). Service connection may be granted on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The duty to assist requires VA to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with military service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Veteran seeks service connection for multiple medical conditions as listed above. In December 2020, the Veteran’s representative explained that the Veteran seeks service connection based on the presumptions afforded due to exposure to herbicide agents and based on a theory of secondary service connection. Accordingly, the primary issue before the Board is whether in-service exposure to herbicide agents is established. The Veteran submitted an August 2016 statement asserting that he was stationed at Fort Bragg, North Carolina, from March 11, 1957 to March 10, 1959. During this assignment, he attended a training course to learn ways of decontaminating after exposure to chemical agents. As part of this training, he claims he was required to wash his hands with herbicide agents. In December 2020, the Veteran testified that he attended this chemical and biological warfare training course in April 1958. He described washing his hands in a pan which he was told contained “Agent Orange.” The Veteran also testified that a VA physician in Marion, Indiana told him that all of his health problems were related to exposure to herbicide agents. The Veteran remembered speaking with this physician approximately three years prior to the December 2020 hearing In December 2020, the Veteran’s wife, J. M., testified that she and the Veteran were married shortly after he began his active duty service and she was with him for most of the time he was stationed at Fort Bragg. She recalled that he told her about his biological and chemical warfare training. She indicated that she was also present when the VA physician stated the Veteran’s health problems were due to herbicide agent exposure. Here, the most recent VA treatment records associated with the claims file are from November 2017. All outstanding VA treatment records must be associated with the claims file. 38 C.F.R. § 3.159(c)(2) Fort Bragg is not a location where the use of herbicide agents has been conceded. However, the Veteran has provided details related to his claimed exposure including the time (April 1958) and nature of this exposure (chemical and biological warfare training.) Under VA’s duty to assist, additional efforts must be made to verify the Veteran’s claimed exposure. These efforts should include requesting corroborating information from the Joint Services Records Research Center (JSRRC.) Id. In addition, review of the Veteran’s service treatment records reveals February 1965 and March 1965 x-rays and diagnostic studies which found the Veteran had an unusually large cardiac shadow and his superior vena cava and right atrium were unusually prominent. As the Veteran seeks service connection for heart and circulatory disorders, and the service treatment records include evidence a heart abnormality, a VA examination must be provided to determine whether any current heart condition is causally related to an in-service event. See McLendon, supra. The Board notes an October 2016 VA heart conditions examination was provided. However, the examiner did not discuss the in-service heart diagnostic studies. This examination is inadequate to evaluate the claim. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Veteran testified that a VA physician informed him that all of his medical conditions were related to exposure to herbicide agents. While the Veteran is not competent to provide an opinion as to the etiology of his claimed disabilities, he is competent to report his understanding of information he received from a medical professional. Accordingly, all issues on appeal are inextricably intertwined with additional efforts to verify whether the Veteran was exposed to herbicide agents. See Harris, supra. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2017 to the present. 2. Take all indicated steps to determine whether the Veteran was exposed to herbicide agents while stationed at Fort Bragg from March 1957 to March 1959 to specifically include while he attended biological and chemical warfare training in April 1958. Request verification of the claimed exposure from any appropriate entity, including the JSRRC. Document all communications and responses related to this request in the claims file. Schedule the Veteran for a VA examination for all claimed heart and circulatory disorders. The examiner must review the claims file and respond to the following: Is any diagnosed heart and/or circulatory disorder at least as likely as not (50% probability or higher) related to the Veteran’s military service, including February 1965 and March 1965 diagnostic imaging which revealed a large cardiac shadow or unusually prominent superior vena cava and right atrium? Provide a rationale to support the opinion(s). 3. Develop and readjudicate the intertwined claims as required. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jeanne Celtnieks 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.