Citation Nr: 21023313 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-62 069 DATE: April 20, 2021 REMANDED Entitlement to service connection for a heart disability, to include coronary artery disease (CAD) and as due to nuclear radiation, engine fuel, and/or herbicide exposure, is remanded. Entitlement to service connection for occlusion and stenosis of the carotid artery, to include as due to nuclear radiation, engine fuel, and/or herbicide exposure, is remanded. Entitlement to service connection for hypertension, to include as due to nuclear radiation, engine fuel, and/or herbicide exposure, is remanded. Entitlement to service connection for an esophageal disability, to include dysphagia and gastroesophageal reflux disease (GERD) and as due to nuclear radiation, engine fuel, and/or herbicide exposure, is remanded. Entitlement to service connection for diabetes mellitus type II (DM), to include as due to nuclear radiation, engine fuel, and/or herbicide exposure, is remanded. Entitlement to service connection for left lower extremity (LLE) peripheral neuropathy, to include as due to nuclear radiation, engine fuel, and/or herbicide exposure, and as secondary to DM, is remanded. Entitlement to a psychiatric disability, to include adjustment disorder with depressed mood and as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active air service from June 1974 to June 1978. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in January 2019 and May 2020, at which time the issues currently on appeal were remanded for additional development. Regrettably, the Board finds that the development conducted does not adequately comply with prior Board remand directives. In this regard, the Board instructed the RO to verify the Veteran’s exposure to hazardous chemicals/gas, environmental toxins, and herbicides while stationed in South Korea, to include the Korean demilitarized zone (DMZ). Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). As such, the appropriate development should be completed upon remand. Furthermore, the Veteran’s military occupational specialty was munitions maintenance specialist in which his duties required, in part, that he maintain, transport, and dispose of munitions. To the extent that the Veteran is competent to report what he experienced or observed during his active service, the Board finds that addendum VA medical opinions should be obtained to determine the nature and etiology of his claimed disabilities as due to hazardous chemicals/gas and/or environmental toxins. The Board notes that the issue of entitlement to service connection for a psychiatric disability is inextricably intertwined with the matters remanded herein. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Hence, a determination on the claim is deferred. The matters are REMANDED for the following action: 1. Conduct the appropriate development to verify the Veteran’s reported exposure to herbicides, hazardous chemicals/gas, and environmental toxins while stationed in South Korea, to include the Korean DMZ, through official sources such as the U.S. Army and Joint Service Records Research Center (JSRRC) or other appropriate repositories. All development efforts must be clearly documented in the claims file. 2. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 3. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present heart disability, including CAD. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present heart disability, including CAD, is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist. The rationale for all opinions expressed must be provided. 4. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present occlusion and stenosis of the carotid artery. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present occlusion and stenosis of the carotid artery is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist and any conceded exposure to herbicides. The rationale for all opinions expressed must be provided. 5. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present hypertension. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present hypertension is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist and any conceded exposure to herbicides. The rationale for all opinions expressed must be provided. 6. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present esophageal disability, including dysphagia and GERD. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present esophageal disability, including dysphagia and GERD, is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist and any conceded exposure to herbicides. The rationale for all opinions expressed must be provided. 7. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present DM. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present DM is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist. The rationale for all opinions expressed must be provided. 8. Then, return the claims file to a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present LLE peripheral neuropathy. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present LLE peripheral neuropathy is etiologically related to the Veteran’s active service. The examiner must address the Veteran’s exposure to hazardous chemicals/gas and/or environmental toxins while performing his duties as a munitions maintenance specialist and any conceded exposure to herbicides. The rationale for all opinions expressed must be provided. 9. Confirm that VA examination reports and all medical opinions provided comport with this remand and undertake any other development determined to be warranted. 10. Then, readjudicate the appeal. If any decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Roya Bahrami Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ware, 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.