Citation Nr: 21029063 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 20-23 609 DATE: May 12, 2021 REMANDED Entitlement to service connection for prostate cancer, to include as due to in service exposure to herbicide agents, is remanded. Entitlement to service connection for diabetes mellitus, type 2, to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for bladder cancer, to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for a disability manifested by tremors (including Parkinson's disease), to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for hypertension, to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for residuals of a stroke, to include as due to in service exposure to herbicide agents, is remanded. Entitlement to service connection for sleep apnea, to include as due to in-service exposure to herbicide agents, is remanded. Entitlement to service connection for a disability manifested by memory loss, to include as due to in-service exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran had active duty from August 1965 to July 1968. In January 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). Service connection for prostate cancer; bladder cancer; and diabetes mellitus, type 2, to include as due to in-service exposure to herbicide agents The Veteran seeks service connection for prostate cancer, bladder cancer, and diabetes mellitus, type 2, for which service connection is presumed if the Veteran was exposed to herbicide agents in service. His medical treatment records reveal that he has been diagnosed with each condition. As such, the remaining question is whether his asserted in-service Agent Orange exposure can be verified. Prior to the January 2021 Board of Veterans' Appeals (Board) hearing, the Veteran had only told VA that he was exposed while stationed at Torii Station in Okinawa during the Vietnam era. VA determined this information did not contain sufficient information for submittal to JSRRC for verification of Agent Orange exposure. At his Board hearing, he provided many more details about his alleged exposure. Specifically, while in Okinawa, he was stationed near Camp Kinser where he says Agent Orange was stored, and he went through three or four typhoons, which he asserts caused him to be exposed to the Agent Orange from Camp Kinser. Attempts should be taken to verify such exposure on remand, as he has given additional evidence which could help VA determine whether such exposure occurred. Service connection for a disability manifested by tremors (including Parkinson's disease), to include as due to in-service herbicide agent exposure The Veteran also seeks service connection for a disability manifested by tremors. At his hearing, his representative asserted that his essential tremors could be indicative of Parkinson's disease, another condition for which a presumptive service connection is allowed where in-service herbicide exposure is found. As such, after the Regional Office (RO) has developed the Veteran's in-service exposure, a VA examination is needed to determine whether the Veteran has Parkinson's disease or any other disability manifested by tremors which could be etiologically linked to his active service. Service connection for hypertension, to include as due to in-service exposure to herbicide agents The Veteran also seeks service connection for hypertension. The National Academy of Science (NAS) recently released a report entitled, "Veterans and Agent Orange: Update 11 (2018)", wherein it stated that the NAS found sufficient evidence of an association between hypertension and exposure to Agent Orange and other herbicides used during the Vietnam War. This report upgraded the association from its previous classification of having "limited or suggestive" evidence to the category of "sufficient" evidence of an association. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. Accordingly, after the RO has developed the Veteran's purported in service herbicide exposures, a VA examination is needed to address the etiology of the Veteran's hypertension considering the NAS findings. Service connection for residuals of a stroke, sleep apnea, and a disability manifested by memory lossall to include as due to in-service exposure to herbicide agents The Veteran also seeks service connection for residuals of a stroke, sleep apnea, and a disability manifested by memory loss, all as due to in-service exposure to herbicide agents. As such, after the RO has developed the Veteran's purported in service herbicide exposures, VA examinations are needed for these claims to determine the nature and/or etiologies of these claimed conditions, in light of the exposure findings. In addition to the above reasons for remanding the Veteran's claims, the Board notes that, in May 2021, the Veteran submitted an authorization for VA to attempt to obtain his medical treatment records from Auburn Community Hospital. (At the recent hearing, he testified that he received treatment for these conditions when he was in his twenties.) Attempts should be made to obtain these records, as none have yet been made. Accordingly, these matters are REMANDED for the following actions: 1. Using the authorization submitted by the Veteran in May 2021, make two requests for all records from Auburn Community Hospital, dating back to when the Veteran separated from active service in July 1968 to the present, unless it is clear after the first request that a second request would be futile. 2. Undertake appropriate development to verify whether the Veteran was exposed to Agent Orange during service, given his January 2021 Board testimony that he was exposed while stationed at Torii Station in Okinawa due to his presence in proximity to Camp Kinser where he says Agent Orange was stored, and that he went through three or four typhoons, which caused him to be exposed to the Agent Orange from Camp Kinser. 3. After completion of the development requested pursuant to the preceding paragraphs 1 and 2, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any disability manifested by essential tremors that he may have. The examiner is specifically asked to determine whether the tremors are manifestations of Parkinson's disease. If the tremors are found to be due to a diagnosed disability other than Parkinson's disease, the examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any such diagnosed disability manifested by essential tremors (other than Parkinson's disease) onset in, or is otherwise related to, any element of the Veteran's active duty, to include herbicide agent exposure, if any, from his service in Okinawa? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is the result of an exhaustion of the limits of current medical knowledge in providing an answer to that particular question. 4. Also after completion of the development requested in preceding paragraphs 1 and 2, schedule the Veteran for an appropriate VA examination to determine the etiology of his hypertension. The examiner should opine: Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hypertension onset in, or is otherwise related to, any element of his active service, to include herbicide agent exposure, if any, from his service in Okinawa? In rendering this opinion, the examiner should consider the NAS 2018 conclusion that hypertension has been upgraded from its prior classification in the category of "limited or suggestive" evidence of an association to the category of "sufficient" evidence of an association. According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is the result of an exhaustion of the limits of current medical knowledge in providing an answer to that particular question. 5. Also after completion of the development requested in the preceding paragraphs 1 and 2, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any residuals of a stroke that he may have. The examiner should opine: Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's stroke, which is noted in his medical records as having occurred in 2005 or 2006, was etiologically related to any element of his active service, to include herbicide agent exposure, if any, from his service in Okinawa? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is the result of an exhaustion of the limits of current medical knowledge in providing an answer to that particular question. 6. Also after completion of the development requested in the preceding paragraphs 1 and 2, schedule the Veteran for an appropriate VA examination to determine the etiology of his sleep apnea. The examiner should opine: Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's sleep apnea onset in, or is otherwise related to, any element of his active service, to include herbicide agent exposure, if any, from his service in Okinawa? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is the result of an exhaustion of the limits of current medical knowledge in providing an answer to that particular question. 7. Also after completion of the development requested in the preceding paragraphs 1 and 2, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any disability manifested by memory loss that he may have. For any such diagnosed disability manifested by memory loss, the examiner should opine: Is it at least as likely as not (i.e., 50 percent probability or greater) that any such diagnosed disability manifested by memory loss onset in, or is otherwise related to, any element of the Veteran's active service, to include herbicide agent exposure, if any, from his service in Okinawa? The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or is the result of an exhaustion of the limits of current medical knowledge in providing an answer to that particular question. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Davidoski, 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.