Citation Nr: 21030995 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 17-55 468 DATE: May 20, 2021 REMANDED Entitlement to service connection for tinea pedis, claimed as jungle rot, for the purpose of accrued benefits, is remanded. Entitlement to service connection for residuals of filariasis due to wucheria bancrofti infection, to include cardiac disorder(s), lymphedema, elephantiasis, and phlebitis for the purpose of accrued benefits, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from February 1965 to February 1968. He died in March 2020. The Appellant is the Veteran's surviving spouse This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York (Agency of Original Jurisdiction (AOJ)). The Veteran testified at a video conference hearing before the undersigned in April 2019. A transcript of the proceeding is of record. These issues were last before the Board in April 2020. At that time, the Board dismissed the claims due to the Veteran's death. Since that time, the Veteran's surviving spouse was properly substituted and requested to continue these claims on an accrued benefits basis. Regrettably, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the issues on appeal, in order to afford the Appellant every possible consideration. In the Board's decision dated August 2019, it sought the Veteran's VA treatment records, private treatment records, and new VA examinations and opinions. The examiner was explicitly asked the following: "The examiner should specifically indicate whether there is any current way to confirm whether the Veteran has filariasis due to wucheria bancrofti and, if so, conduct any reasonable testing. If any further testing is not practical and/or would not provide sufficient information, the examiner should state so. The examiner should...provide [an] opinion on the following question: whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran manifests filariasis due to wucheria bancrofti and, if so, identify all residuals of such infection to include lymphedema, elephantiasis, phlebitis, and any cardiac complications." Additional VA treatment records were associated with the file; however, the Veteran's VA Form 21-4142 did not identify any private treatment providers. Though the Veteran received new VA examinations in January 2020, the Board finds the opinion associated with this examination to be inadequate. In response to the inquiry regarding etiology, the examiner provided the following: "The patient's diagnosis of filariasis due to wucheria bancrofti is presumed according to the record, I could not see a confirmatory test. The other tests noted above included the FILARIA IgG4 AB (LAPCORP) were negative x2. He did in 20 (sic) have eosinophilia is (sic) noted in his CBC differential but this has resolved. The patient does have a diagnosis of chronic lymphedema as noted by recent vascular consult dated January 6, 2020...Thus, upon the available evidence to be (sic) difficult to say what the complications of due to (sic) a presumed disease. Thus, it is less likely as not...that the Veteran manifests filariasis due to wucheria bancrofti with residuals of such infection to include lymphedema, elephantiasis, phlebitis, and any cardiac complications." The inquiries presented to the examiner were not addressed in a satisfactory manner and the rationales provided were inadequate. As such, the Board will remand once more to seek an opinion regarding the nature and etiology of the Veteran's residuals of filariasis. Moreover, the Board observes that while the Veteran's death certificate is of record, the scanned copy is nearly illegible due to the lighting and the word "void" repeatedly printed on it. The AOJ previously requested that the Appellant resubmit the death certificate specifically, an amended version that includes the causes of the Veteran's death but to date, she has not. On remand, the Board seeks an addendum to the death certificate as well as a clean copy. Finally, the Appellant and her representative have suggested that the Veteran passed away from sepsis as due to his lymphedema. While the Board maintains that an addendum to the death certificate would be probative, records from St. Catherine's of Sienna Hospital are also relevant, as the Veteran was treated there at the time of his death. The Board will also seek these records on remand. The matters are REMANDED for the following action: 1. The AOJ shall associate seek to associate all records pertaining to the Veteran from St. Catherine's of Sienna Hospital including termination records from March 1, 2020 through April 1, 2020 and any other hospitalization and/or nursing home records which are not currently associated with the claims folder. 2. Ask the Appellant to furnish a legible copy/addendum of the Veteran's death certificate that includes the cause(s) of death. 2. The AOJ should seek a VA opinion by an infectious disease expert (or similarly qualified physician). The claims file must be made available to and be reviewed by the examiner. The examiner should specifically indicate whether there is any current way to confirm whether the Veteran had filariasis due to wucheria bancrofti and, if so, conduct any reasonable testing. If any further testing is not practical and/or would not provide sufficient information, the examiner should state so. The examiner should review the STRs which clearly reflect the Veteran had been treated with mosquito bites that caused an infection in light of the Veteran's tropical service, and provide opinions on the following question: Whether it is at least as likely as not (probability of 50 percent or greater) that the Veteran manifested filariasis due to wucheria bancrofti prior to his death and, if so, identify all residuals of such infection to include lymphedema, elephantiasis, phlebitis and any cardiac complications. The examiner should address the contentions that medical literature indicates that negative laboratory tests do not rule out filariasis (particularly if not conducted at night), and that the presence of eosinophils corroborates the theory that the Veteran manifested filariasis due to wucheria bancrofti. The examiner should consider the following: the Veteran's private treatment records and CAPRI VA treatment records, documenting diagnoses of lymphedema and elephantiasis; the Veteran's STRs, documenting treatment for mosquito bites and fungal dermatitis/bacterial infections on his feet during service; the April 2016 VA examination, finding there is no present foot condition from which the Veteran suffers but that the Veteran's lower extremity conditions are due to a parasite infection (wucheria bancrofti) which blocks his lymphatic system; the notation from Dr. Kim describing the Veteran as having "[a history of] stage III lymphedema due to filariasis thought to be due to wuchereria bancrofti infection (?)"; the June 2017 aid and attendance examination report which reflects a diagnosis of "[l]ymphedema due to Filariasis due to wuchernia bancrofti"; the article describing wuchereria bancrofti, associated with the record in September 2017; the Veteran's April 2019 hearing testimony, describing persistent foot problems since separation from active duty; the lay statement from the Veteran's wife associated with the record in January 2020 regarding an encounter they had at the hospital and commentary about his feet; the January 2020 VA examinations; correspondence from the Veteran's representative and associated medical literature associated with the record in February and March 2020. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Thereafter, readjudicate the claims. If any benefit sought on appeal remains denied, furnish the Appellant and her representative, if any, a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.