Citation Nr: 21026182 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 19-33 357 DATE: April 30, 2021 REMANDED Entitlement to service connection for residuals of multiple myeloma, to include a facial growth, is remanded. Entitlement to a rating in excess of 40 percent for residuals of prostate cancer is remanded. Entitlement to an effective date earlier than June 13, 2016 for the increased rating of 40 percent for residuals of prostate cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to December 1969, including overseas service in Vietnam. The Veteran appeals a January 2017 rating decision by the Agency of Original Jurisdiction (AOJ). The Board of Veterans’ Appeals (Board) finds the September 2002 rating decision denying the issue of residuals for multiple myeloma was not final because additional, relevant service treatment records (STRs) were subsequently associated with the claims file. The September 2002 rating decision did not note the Veteran’s STRs were of record. The STRs of record were added in October 2014 and show a cyst removal on the scalp in April 1968. As additional relevant service department records were received relating to the Veteran’s claim, the Department of Veterans Affairs (VA) must reconsider the Veteran’s claim without regard to the finality of prior decisions. 38 C.F.R. § 3.156(c). 1. Multiple Myeloma Residuals, to Include Facial Growth The Veteran’s STRs noted a cyst removal on the scalp. The Veteran initially claimed a multiple myeloma tumor of the right jaw, and the Veteran variously claims an oral tumor and cysts. See July 2001 VA Form 21-526; December 2014 Veteran statement. The Board will expand the scope of the Veteran’s claim to encompass any facial growth. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009); Brokowski v. Shinseki, 23 Vet. App. 79, 85 (2009). Although it is conceded the Veteran was exposed to herbicide agents with his service in Vietnam and he claims the presumptive condition of multiple myeloma, the record is unclear as to whether the Veteran actually had multiple myeloma. The February 2002 VA examiner was unable to give a clear diagnosis or confirm the existence of the condition. January 2001 treatment records only noted a tumor excision of the right jaw, but did not note multiple myeloma. As such, the September 2002 rating decision denied the claim based on no evidence of the condition. However, the September 2002 rating decision noted the existence of records from the Atlanta Orthofacial Surgery Center that noted a jaw surgery for keratocyst in 1983. Those treatment records are not in the claims file. Additionally, the Veteran noted in his April 2017 notice of disagreement (NOD) that he sent records in 2015. However, those records do not appear to have been received or cataloged. The Board notes the claims file has only limited medical records. Ultimately, it appears that additional development is required to ensure all relevant treatment records are obtained. Additionally, the Veteran may be service connected for a condition other than multiple myeloma. As noted above, the record indicates in-service treatment for cysts and the Veteran may have had post-service treatment for cysts as well. Overall, a VA examination is warranted to clarify the nature and etiology of the Veteran’s facial growth. 2. Prostate Cancer The Veteran’s last VA examination was conducted in December 2016. Since that time, the Veteran stated that voiding has become a problem and that his condition has taken a downward turn with potential bladder surgery. See April 2017 NOD; October 2019 VA Form 9. Where a Veteran contends that a disability has worsened since his last VA examination, and the last examination is too remote to constitute a contemporaneous examination, a new examination is required. See Snuffer v. Gober, 10 Vet. App. 400, 403-04 (1997). Here, it appears the Veterans condition has worsened since the December 2016 VA examination. As such, the Veteran should be afforded a new examination to determine the current severity of his condition. As noted above, relevant medical records may be outstanding. Those records should be obtained prior to adjudicating the claim. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for facial growth and prostate cancer that are not already of record, to include noted records from the Atlanta Orthofacial Surgery Center. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, schedule the Veteran for an examination to determine the nature and etiology of his alleged multiple myeloma, to include facial growths. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. After the record review and examination of the Veteran, the examiner should identify all relevant facial growth conditions that are and were previously present, to include multiple myeloma, tumors, and cysts. Then, the examiner is asked to respond to the following inquiries: Does or did the Veteran have multiple myeloma? If so, what are the residuals? If multiple myeloma was not diagnosed, is it at least as likely as not that the Veteran’s facial growth(s) was incurred in, or otherwise related, to his time on active service, to include the in-service cyst removal? In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the development in #1 above is completed, schedule the Veteran for an examination to determine the current severity of his service-connected prostate cancer. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. 4. After the above development has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Zheng, 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.