Citation Nr: 21030664 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 19-02 436 DATE: May 19, 2021 REMANDED Entitlement to service connection for a chest or cardiac disorder is remanded. Entitlement to service connection for benign prostatic hypertrophy or a hip disorder, claimed as a urological defect, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1963 to April 1966. The Veteran's claims come before the Board of Veterans' Appeals (Board) on appeal of an April 27, 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran and his representative testified before the undersigned Veterans Law Judge on March 31, 2021. A transcript of the hearing was produced and has been associated with the claims file for Board review. This appeal has been advanced on the Board's docket on account of advanced age. 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). 1. Entitlement to service connection for a chest or cardiac disorder is remanded. 2. Entitlement to service connection for a benign prostatic hypertrophy or a hip disorder, claimed as a urological defect, is remanded. A VA examination is required 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 certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or 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 the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. The claims for a chest disorder and urological defect appear to have been developed by the Agency of Original Jurisdiction as claims for chronic obstructive pulmonary disorder (COPD) and benign prostatic hypertrophy, respectively. The Veteran has almost exclusively attributed his current disabilities to an in-service episode during which he was run over by a military vehicle. See, e.g.: NOD (rec'd Sept. 25, 2018 ); Hearing Tr. (Mar. 31, 2021), at Page 9. The Board notes in passing that it does not dispute that this incident occurred as the Veteran is service connected for an acquired psychiatric disorder specifically attributed to being run over by the vehicle and such incident is documented in the service treatment records. The Board further notes that the Veteran appears to have testified that his disorders may be of muscles or bones in the chest and hip, see Hearing Tr. (Mar. 31, 2021), at Page 8, as opposed to a respiratory or a prostate disorder as was previously developed. For the above reasons, the Board determines that the Veteran's claims must be remanded to clarify all potentially applicable diagnoses as pertaining to being run over by a vehicle in the chest and/or pelvis. The Board regrets the additional delay that this will cause in adjudicating the Veteran's claims; however, there is simply not enough evidence of record for the Board to make an informed adjudication. The Board reminds the Veteran that the "duty to assist is not always a one-way street," see Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), and the Veteran is expected to cooperate in the efforts to adjudicate his claim and that a failure to do so may subject him to the risk of an adverse adjudication. See 38 C.F.R. § 3.655. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records, to include any VA treatment records, should be obtained. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative, and afford them an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, the Veteran should be scheduled for VA examination(s) with an appropriate medical professional to determine the nature and etiology of his claimed chest or cardiac and benign prostatic hypertrophy or a pelvic disorders. A complete copy of the claims file, to include this remand, the March 31, 2021 hearing transcript, the Veteran's complete service treatment records, and the Veteran's complete medical treatment records, must be made available to the examiner. The need for physical examinations is left to the discretion of the examiner. The examiner is asked to respond to the following questions: (A) Identify all of the Veteran's chest, cardiac and pelvic disorder(s) present since April 2017. (B) For any such disorder diagnosed, is it at least as likely as not (50 percent or greater probability) that such disorder had onset in service or is otherwise related to his active duty service? The examiner must specifically explain the significance, or lack thereof, of the June 1964 incident in which the Veteran was run over by a military vehicle. The examiner should also consider the Veteran's hearing testimony regarding this incident. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Notify the Veteran in writing of the date, time, and location of the examination at his last known address. The examination notice should be given at least 30 days in advance of the scheduled examination to afford the Veteran sufficient time in which to contact the AOJ with any issues that may impede his ability to appear for the examination. A copy of the examination notice should be sent to the Veteran's representative and be placed in the claims file. The notice must state that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for an examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael B. Engle, 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.