Citation Nr: 21023032 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 16-19 322A DATE: April 20, 2021 ORDER Entitlement to service connection for a stomach disability is denied. Entitlement to service connection for left arm cellulitis is denied. Entitlement to service connection for a back disability is denied. Entitlement to service connection for a fungus infection of the bilateral feet is denied. Entitlement to service connection for a bilateral eye disability, to include as due to herbicide exposure, is denied. REMANDED Entitlement to service connection for a heart disability, to include as due to herbicide exposure, is remanded. FINDINGS OF FACT 1. The evidence of record does not demonstrate that the Veteran has a current diagnosis of a stomach disability proximate to the claim, or during the appeal period. 2. The evidence of record does not demonstrate that the Veteran has a current diagnosis of left arm cellulitis proximate to the claim, or during the appeal period. 3. The evidence of record does not demonstrate that the Veteran has a current diagnosis of back disability that is etiologically related to his active duty service. 4. The evidence of record does not demonstrate that the Veteran has a current diagnosis of fungal infection of the feet, claimed as trench foot, proximate to the claim, or during the appeal period. 5. The preponderance of the evidence is against finding that the Veteran’s bilateral eye disability had its onset during service, within one year of separation from service, or is otherwise etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a stomach disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for entitlement to service connection for left arm cellulitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for entitlement to service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for entitlement to service connection for a fungal infection of the bilateral feet have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for entitlement to service connection for a bilateral eye disability, to include as due to herbicide exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1971 to March 1973. These matters come before the Board of Veterans’ Appeals (Board) on appeal from May 2013 and April 2014 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the issues on appeal in April 2020 for additional development to obtain and upload updated VA treatment records and request any outstanding private treatment records. A review of the record shows substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The Board previously determined that the Veteran’s hearing request was deemed withdrawn for failure to show at his scheduled hearing. See 38 C.F.R. § 20.704(d). To date, the Veteran, nor his representative, has requested a new hearing, and good cause has not been shown for failure to appear at the previously scheduled hearing or timely file a new hearing request. Therefore, the Veteran’s hearing continues to be deemed withdrawn, and the Board will proceed with adjudication of the issues on appeal. See 38 C.F.R. § 20.704(d). Service Connection Generally, service connection may be established for a disability resulting from disease or injury in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish service connection for a disability, there must be (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Regulations create a presumption of service connection for certain diseases, including diabetes mellitus, type II, found to be associated with exposure to an herbicide agent such as Agent Orange. See 38 U.S.C. §§ 1113, 1116; 38 C.F.R. §§ 3.307(d), 3.309(e). Absent affirmative evidence to the contrary, such diseases will be service connected even if there is no evidence of the disease during service, provided that the herbicide exposure is established. Id. The Board notes the RO requested private treatment records indicated by the Veteran. The RO requested medical records from Cryderman and St. Joseph’s Manor. In June 2020, the RO contacted Cryderman and were informed that private medical records were destroyed and notified the Veteran in July 2020. See June 2020 Report of General Information; July 2020 Development Letter. The RO made multiple requests for private medical records from St. Joseph’s Manor in June and July 2020. See July 2020 Report of General Information. The RO notified the Veteran that he could request an extension of time to gather and submit private treatment records from St. Joseph’s Manor for good cause and provided the Veteran 15 days to respond. See July 202 Notification Letter. No response was received, and to date, no request for additional time to obtain private treatment records has been received. Entitlement to service connection for a stomach disability. The Veteran seeks service connection for a stomach disability. See October 2013 VA Form 21-526; September 2012 Statement in Support of Claim. The requirement for a current disability is satisfied if the disability is present at any point proximate to the claim, or during the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Veteran complained and was treated for stomach pain and gastritis while in service. See March and October 1971 service treatment records. However, the Veteran’s February 1973 separation examination was normal, does not list any disabilities at the time of separation related to a stomach disability, and notes the Veteran’s report of being in good health at the time of separation. Additionally, a January 1974 VA examination did not find any diagnosed stomach condition. The Board acknowledges the Veteran’s representative’s request for a VA examination to determine a diagnosis, etiology, and severity of symptoms for a stomach disability. See December 2020 Appellate Brief. The Board notes the Veteran has not been afforded a VA examination; however, the Board finds that one is not required. The VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, (3) an indication that the disability or persistent recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file to decide the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Here, the first and third elements to trigger the VA’s duty to assist have not been met. The Veteran has not submitted post-service treatment records diagnosing the Veteran with a stomach disability. Post-service medical records demonstrate the Veteran denied symptoms related to his stomach that would indicate he has a current stomach disability. For example, throughout the appeal period, the Veteran denied any bowel disturbances, nausea, and vomiting. See September 2013, April 2016, December 2018, February 2019, April 2020. In March 2015, the Veteran complained of abdominal pain and problems with constipation. See March 2015 VA treatment records. However, a VA physician found no evidence of bowel obstruction and an April 2015 ultrasound did not result in a diagnosis for any stomach disability. Id.; see also April 2015 VA treatment records. Moreover, there is no evidence that indicates the Veteran has a stomach disability or persistent symptoms that may be related to his service. Neither the Veteran, nor his representative, have submitted any post-service treatment records that indicate a link between a current stomach and the Veteran’s active duty service. Accordingly, although McClendon sets a low bar, that bar has not been met as there is no competent evidence of record indicating a current stomach disability linked to the Veteran’s active service. Consequently, remand for a VA examination is not warranted. See McLendon, 20 Vet. App. at 81. To the extent that the Veteran asserts that he has a current stomach disability, the Board notes that he has not been shown to have the medical training necessary to be deemed competent to diagnose such conditions. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case, there is an absence of proof of a current stomach disability during or in proximity to the appeal period. Without evidence of a current diagnosis of a disability, the Board need not address the other elements of service connection. The preponderance of the evidence is therefore against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 59 (1990). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Entitlement to service connection for left arm cellulitis. The Veteran seeks service connection for left arm cellulitis, claimed as jungle rot. See October 2013 VA Form 21-526; September 2012 Statement in Support of Claim. The Board finds that the evidence of record does not contain probative evidence of a diagnosis or other symptoms demonstrating a current disability of left arm cellulitis proximate to the claim, or during the appeal period. Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321. The Veteran was treated for left arm cellulitis while in service. See September 1971 service treatment records. However, the Veteran’s February 1973 separation examination was normal, and notes the Veteran’s report of good health at the time of separation. The Board notes the Veteran has not been afforded a VA examination; however, the Board finds that one is not required. See McLendon, 20 Vet. App. at 81. Here, the first and third elements to trigger the VA’s duty to assist have not been met. Id. As noted, the Veteran’s February 1973 separation examination was normal, does not list any disabilities or symptoms at the time of separation related to left arm cellulitis, and notes the Veteran’s report of being in good health at the time of separation. Additionally, a September 1971 service treatment record indicates the Veteran’s cellulitis of the left arm was markedly improved following treatment. The Board notes that a July 1981 post-service medical record indicates the Veteran’s complaints of left arm numbness and notes the Veteran was status post cellulitis of the left arm in 1972. See July 1981 Medical Certificate. However, the physician did not indicate the complaint of left arm numbness was related to the cellulitis the Veteran experienced while in service, or otherwise etiologically related to his service. Id. Additionally, there are no VA or private treatment records that demonstrate a current diagnosis for left arm cellulitis or any residuals proximate to, or during the appeal period. Neither the Veteran, nor his representative, have submitted any post-service treatment records that indicate a link between a current left arm cellulitis disability and the Veteran’s active duty service. Accordingly, although McClendon sets a low bar, that bar has not been met as there is no competent evidence of record indicating a current left arm cellulitis disability linked to the Veteran’s active service. Consequently, remand for a VA examination is not warranted. See McLendon, 20 Vet. App. at 81. To the extent that the Veteran asserts that he has a current left arm cellulitis disability, the Board notes that he has not been shown to have the medical training necessary to be deemed competent to diagnose such conditions. See Kahana, 24 Vet. App. at 435. In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case, there is an absence of proof of a current diagnosis of left arm cellulitis or subsequent residuals during or proximate to the appeal period. Without evidence of a current diagnosis of a disability, the Board need not address the other elements of service connection. The preponderance of the evidence is therefore against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 59. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. Entitlement to service connection for a back disability. The Veteran seeks service connection for a back disability, claimed as a bad back. See October 2013 VA Form 21-526; September 2012 Statement in Support of Claim. In regard to the first criteria for service connection, a current disability, the Board notes the Federal Circuit held that “disability” in § 1110 refers to the functional impairment of earning capacity and “pain in the absence of a presently-diagnosed condition can cause functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, 1363-69 (Fed. Cir. 2018). The Federal Circuit concluded that “pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability.” Id. Here, the Veteran’s VA treatment records reflect the Veteran’s medical history report of back pain. See March 2015, and February 2009 VA treatment records. As such, the Board finds there is evidence showing impairment in capacity due to back pain symptoms that meets the current disability requirement. See Saunders, 886 F.3d at 1363-69. Therefore, the Board finds the first element of service connection has been met. See Shedden, 381 F.3d at 1167. At a prior July 2010 VA examination, the Veteran reported he had a back strain while in service. However, service treatment records are silent for any complaints, treatment, or diagnosis of any conditions related to his back. Additionally, the Veteran’s February 1973 separation examination was normal, does not list any disabilities at the time of separation related to a back disability, and notes the Veteran’s report of being in good health at the time of separation. The Board notes that the Veteran has not been afforded a VA examination; however, the Board finds that one is not required. See McLendon, 20 Vet. App. at 81. Here, the third element to trigger the VA’s duty to assist has not been met. There is no competent evidence of record demonstrating the Veteran’s current back pain is related to an in-service injury, event, or disease. Though the Veteran’s VA treatment records note the Veteran’s complaint of back pain, there is no indication the back pain is related to his service. The only evidence of record is the Veteran’s own statements. However, to the extent the Veteran asserts that he has a back disability etiologically related to his service, the Board notes that he has not been shown to have the medical training necessary to opine as to the nature and etiology of any back disability. See Kahana, 24 Vet. App. at 435; see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). There is no other competent evidence of record relating the Veteran’s low back disability to his active duty service. The Veteran’s conclusory statements, alone, are insufficient to trigger VA’s duty to assist to provide a medical examination. See 38 C.F.R. § 3.159(c)(4); see also Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). Neither the Veteran, nor his representative, have submitted any post-service treatment records that indicate a link between a current back disability and the Veteran’s active duty service. Therefore, a VA examination is not warranted because there is no competent evidence of a link between his current back pain and his active duty service. McLendon, 20 Vet. App. at 81. In sum, while the Board finds there is a current diagnosis for a back disability, the preponderance of the evidence is against the claim for service connection, and the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 59 (1990). Accordingly, entitlement to service connection for a back disability is denied. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. Entitlement to service connection for a fungal infection of the bilateral feet. The Veteran seeks service connection for a fungal infection of the feet, claimed as trench feet due to service in the Republic of Vietnam. See October 2013 VA Form 21-526; September 2012 Statement in Support of Claim. The Board finds that the evidence of record does not contain probative evidence of a diagnosis or other clinical demonstration of a fungal infection, or any residuals, of the bilateral feet. The Veteran’s February 1973 separation examination was normal, does not list any disabilities at the time of separation related to a fungal infection of the bilateral feet, claimed as trench feet, and notes the Veteran’s report of being in good health at the time of separation. Post-service VA treatment records demonstrates active problems that includes foot pain, dry skin, and calluses. See April 2016, and December 2013 VA treatment records. However, there is no indication the Veteran’s claim for a fungal infection of the bilateral feet, claimed as trench feet, is related to current foot pain, dry skin, or calluses indicated in his VA treatment records. Additionally, VA treatment records indicate the Veteran underwent left foot surgery. See April 2015 VA treatment records. There is no indication that foot pain, dry skin, and/or calluses are symptoms associated with his claim for a fungal infection of the bilateral feet. For example, VA treatment records indicate dry skin of the Veteran’s bilateral legs and does not demonstrate a current skin condition of his bilateral feet. See December 2016 VA treatment records. The Board notes the Veteran has not been afforded a VA examination; however, the Board finds that one is not required. McLendon, 20 Vet. App. at 81. Here, the first and third elements to trigger the VA’s duty to assist have not been met. The Veteran has not submitted any post-service treatment records demonstrating a diagnosis of a fungal infection of the feet, claimed as trench feet, related to his active duty service. The only evidence of record is the Veteran’s own statements. However, to the extent that the Veteran asserts that he has a current fungal infection of the bilateral feet, the Board notes that he has not been shown to have the medical training necessary to be deemed competent to diagnose such condition. See Kahana, 24 Vet. App. at 435. With regard to whether the Veteran incurred bilateral trench feet in service, or has residuals of the disorder now, the Board finds the lay evidence is outweighed by the medical evidence, the preponderance of which indicates that the Veteran neither incurred such a chronic disorder during service, nor has such a disorder today. The Veteran’s conclusory statements, alone, are insufficient to trigger VA’s duty to assist to provide a medical examination. See 38 C.F.R. § 3.159(c)(4); see also Waters, 601 F.3d at 1278. The Veteran, nor his representative, have submitted any post-service treatment records that indicate a link between a current fungal infection of the feet and the Veteran’s active duty service. Accordingly, although McClendon sets a low bar, that bar has not been met as there is no competent evidence of record indicating a current fungal infection of the feet linked to his active service. Consequently, remand for a VA examination is not warranted. See McLendon, 20 Vet. App. at 81. In the absence of proof of a current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. In this case, there is an absence of proof of a current fungus infection of the bilateral feet during or in proximity to the appeal period. Without evidence of a current diagnosis of a disability, the Board need not address the other elements of service connection. The preponderance of the evidence is therefore against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 59. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. Entitlement to service connection for a bilateral eye disability, to include as due to herbicide exposure. The Veteran seeks service connection for a bilateral eye disability. See October 2013 VA Form 21-526. VA treatment records demonstrate the Veteran has current diagnoses for cataracts, blepharitis and retinopathy related to his eyes. See June 2016 VA treatment records. Therefore, the first Shedden element of service connection has been established. See Shedden, 381 F.3d at 1166-67. As an initial matter, the Veteran’s military personnel records, DD Form 214, documents and confirms service in the Republic of Vietnam from August 1971 to June 1972. As such, the Veteran’s exposure to herbicide agents during service is presumed. See 38 C.F.R. § 3.307. However, the Veteran’s eye disabilities, including cataracts, blepharitis and retinopathy, are not diseases listed in the regulations for which service connection may be presumed based upon herbicide exposure. See 38 C.F.R. § 3.309(e). Therefore, there must be evidence to support a finding of direct service connection, i.e., evidence showing a current diagnosis that was incurred during or as a result of active duty service. The Board acknowledges the Veteran’s representative’s request for a VA examination to determine a diagnosis, etiology and severity of symptoms for each claimed condition. See December 2020 Appellate Brief. The Board notes the Veteran has not been afforded a VA examination; however, the Board finds that one is not required. See McLendon, 20 Vet. App. at 81. In this case, the third element required to trigger VA’s duty to assist has not been met because there is no competent evidence of a current eye disability that may be associated with the Veteran’s service. The Veteran’s service treatment records are silent for any symptoms, complaints, treatment, and/or diagnosis of an eye disability while serving on active duty. The Veteran’s separation examination was normal for any eyes conditions and the Veteran reported he was in good health. Post-service treatment records do not indicate a link between a current eye disability and the Veteran’s active duty service. Neither the Veteran, nor his representative, have submitted any post-service treatment records that indicate a link between a current eye disability and the Veteran’s active duty service. As noted above, the RO made multiple requests for any outstanding private treatment records and provided the Veteran with an opportunity to request additional time to submit and/or obtain private treatment records. No response was received, and to date, no request for additional time to obtain private treatment records has been received. Additionally, neither the Veteran nor his representative asserted that any medical professional has told him that his bilateral eye disabilities are directly related to his active duty service, including herbicide agent exposure. To the extent the Veteran asserts that he has a current eye disability etiologically related to his active duty service, the Board notes that he is not competent to establish an etiological nexus between his current eye disabilities and his active duty service as such opinion requires medical expertise and knowledge that he has not been shown to possess. See Kahana, 24 Vet. App. at 435. The Veteran’s conclusory statements, alone, are insufficient to trigger VA’s duty to assist to provide a medical examination. See 38 C.F.R. § 3.159(c)(4); see also Waters, 601 F.3d at 1278. Accordingly, although McClendon sets a low bar, that bar has not been met as there is no competent evidence of record indicating a current eye disability linked to the Veteran’s active service. In the absence of evidence, there cannot be even equipoise, and there can be no resolution of doubt. The Veteran still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). Consequently, remand for a VA examination is not warranted. See McLendon, 20 Vet. App. at 81. For the reasons discussed above, the Board concludes that the preponderance of the evidence is against a finding that the Veteran’s claimed bilateral eye disability is related to his active duty service, including as due to herbicide agent exposure. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107(b); see also Gilbert, 1 Vet. App. at 59. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy, 27 Vet. App. at 495; Doucette, 38 Vet. App. at 369-70. REASONS FOR REMAND Entitlement to service connection for a heart disability, to include as due to herbicide exposure, is remanded. The Veteran seeks service connection for a heart disability, claimed as a bad heart. See October 2013 VA Form 21-526; September 2012 Statement in Support of Claim. The Board notes that the United States Court of Appeals for Veterans Claims (Court) has held that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009) (holding that a claimant may satisfy the requirement to identify the benefit sought by referring to a body part or system that is disabled or by describing symptoms of the disability); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Therefore, the Board has recharacterized the Veteran’s claim of entitlement to service connection for a bad heart to service connection for a heart disability, to include as due to exposure to herbicide agents. In this case, the Veteran’s VA treatment records demonstrate the Veteran reported chest pain within a year following separation from service. See January 1984 VA treatment records. VA treatment records also demonstrate complaints and treatment for tachycardia, angina, and a diagnosis for hypertension throughout the appeal period. See March 2020, October 2017, and March 2015 VA treatment records. As noted, the Veteran’s exposure to herbicide agents during service is presumed. See 38 C.F.R. § 3.307. The Board notes that the Veteran has not been afforded a VA examination to determine the nature and etiology of any heart disability. The VA must provide a medical examination or obtain a medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing that certain diseases manifested during an applicable presumptive period for which the veteran qualifies; (3) an indication that the disability or persistent recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability; but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 83-86. In this case, it is unclear whether the Veteran has a current diagnosis of a heart disability. The Board notes that National Academy of Sciences (NAS) Institute of Medicine (IOM) has determined that there was “sufficient evidence of an association” between hypertension and exposure to Agent Orange and other herbicides used during the Vietnam War, indicating that “there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. See IOM of the NAS, Veterans and Agent Orange: Update 2018. As this study has indicated a possible relationship between exposure to herbicide agents and hypertension, remand is warranted to afford the Veteran with a VA examination to address its applicability to this Veteran’s claim for service connection for a heart disability. McLendon, 20 Vet. App. at 83-86. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate clinician to determine the nature and etiology of any heart disability demonstrated of record proximate to, or during the appeal period. Provide a copy of this remand and the record to the examiner for review. Any and all tests and evaluations deemed necessary by the examiner should be performed. The examiner must indicate review of all medical evidence of record. The examiner must provide an opinion as to the following: (a.) Identity any and all heart disabilities that demonstrated proximate to, or during the appeal period, if any. (b.) For each identified heart disability, opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the identified heart disability manifested during, or as a result of, the Veteran’s active military service, to include as due to exposure to herbicide exposure. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resorting to speculation, he/she should explain why an opinion cannot be provided. (Continued on the next page)   The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). Hannah Fisher Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. P. Moore, 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.