Citation Nr: 21041822 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-59 065 DATE: July 10, 2021 REMANDED Entitlement to service connection for a recurrent skin disability to include tinea versicolor and skin cancer, claimed as the result of herbicide agent exposure, is remanded. Entitlement to an effective date prior to July 3, 2012, for the award of service connection for coronary artery disease is remanded. Entitlement to an effective date prior to June 17, 2005, for the award of service connection for bilateral hearing loss is remanded. Entitlement to an effective date prior to June 17, 2005, for the award of service connection for tinnitus is remanded. Entitlement to an initial rating in excess of 30 percent for coronary artery disease is remanded. Entitlement to a rating in excess of 10 percent for bilateral hearing loss is remanded. Entitlement to a rating in excess of 10 percent, to include on an extraschedular basis, for tinnitus is remanded. REASONS FOR REMAND The Veteran had active service from February 1968 to September 1970 and from February 2003 to October 2003. He served in the Republic of Vietnam. The Veteran had additional duty with the Coast Guard Reserve. 1. Entitlement to service connection for a recurrent skin disability to include tinea versicolor and skin cancer, claimed as the result of herbicide agent exposure, is remanded. The Veteran asserts that service connection for a recurrent skin disability is warranted as skin cancer was manifested as the result of his presumed herbicide agent exposure while serving in the Republic of Vietnam. Service treatment records associated with the Veteran's duty with Coast Guard Reserve reflect that the Veteran was treated for tinea versicolor. The Veteran's periods of active duty, active duty for training, and inactive duty for training with the Coast Guard Reserve have not been verified and all service treatment documentation associated with that duty has not been requested for association with the record. In a December 2016 written statement, the accredited representative asserted that the Department of Veterans Affairs (VA) "ignored the fact that the Veteran had a skin cancer, and that no one else in his family had any type of cancer that he is aware of." Clinical documentation of the cited skin cancer is not of record. VA clinical documentation dated after July 2016 is not of record. VA should obtain all relevant service, VA, and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). The Veteran has not been afforded a VA skin examination. 2. Entitlement to an effective date prior to July 3, 2012, for the award of service connection for coronary artery disease and effective dates prior to June 17, 2005, for the award of service connection for both bilateral hearing loss and tinnitus is remanded. In September 2014, the Veteran submitted a Notice of Disagreement, (VA Form 21 0958), with the assigned effective dates for the awards of service connection for coronary artery disease, bilateral hearing loss, and tinnitus. A statement of the case which addresses those issues has not been issued. Where a veteran has submitted a timely notice of disagreement and a statement of the case has not been issued, the Board of Veterans' Appeals (Board) must remand the issue for issuance of a statement of the case. Manlincon v. West, 12 Vet. App. 238 (1999). 3. Entitlement to an initial rating in excess of 30 percent for coronary artery disease is remanded. The Veteran contends that an initial rating in excess of 30 percent for coronary artery disease is warranted as the disability has increased in severity since the last VA examination. The Veteran was last afforded a VA cardiovascular examination in March 2014. Given the Veteran's statements as to the worsening of the cardiovascular disability and the passage of over seven years since the last VA examination, the Board finds that further VA cardiovascular evaluation is needed. 4. Entitlement to a rating in excess of 10 percent for bilateral hearing loss and a rating in excess of 10 percent, to include on an extraschedular basis, for tinnitus is remanded. The Veteran asserts that ratings in excess of 10 percent are warranted both bilateral hearing loss and tinnitus as the disabilities are productive of severe impairment. The Veteran was last afforded a VA audiological examination in March 2014. Given the Veteran's statements as to the worsening of the hearing loss and tinnitus disabilities and the passage of over seven years since the last VA examination, the Board finds that further VA audiological evaluation is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated any skin disability including skin cancer and the service connected coronary artery disease, bilateral hearing loss, and tinnitus. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after July 2016. 3. Contact the National Personnel Records Center (NPRC) and/or the appropriate service entity and request that the Veteran's periods of active duty, active duty for training, and inactive duty for training with the Coast Guard Reserve be verified and all available service treatment records associated with that duty be forwarded for incorporation into the record. 4. Schedule the Veteran for a VA skin examination to assist in determining the nature and etiology of any identified skin disability and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all recurrent skin disabilities found. If tinea versicolor and/or skin cancer is not identified, the examiner should specifically state that fact. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified skin disability had its onset during active service or is related to any incident of service, including the Veteran's presumed herbicide agent exposure in the Republic of Vietnam and the documented tinea versicolor. 5. Schedule the Veteran for a VA cardiovascular examination to assist in determining the nature and severity of service-connected coronary artery disease. The examiner must review the record and should note that review in the report. All indicated tests and studies, including echocardiographic and METs testing, should be accomplished and the findings then reported in detail. If METs testing is medically contraindicated, the examiner should so state and the examiner should provide a METs estimate. A rationale for all opinions should be provided. The examiner should: (a) Specifically note whether chronic congestive heart failure is present and the frequency of any episodes. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow substantially gainful employment due to the coronary artery disease. If the Veteran is felt capable of work despite the service connected disabilities, the examiner should describe what type of work and what accommodations would be necessary due to the service-connected disabilities. 6. Schedule the Veteran for a VA audiology examination to assist in determining the current nature and severity of bilateral hearing loss and tinnitus and their impact on the Veteran's vocational pursuits. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the tinnitus results in marked interference with employment or frequent hospitalization. (Continued on the next page) (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow substantially gainful employment due to the bilateral hearing loss disability and tinnitus. If the Veteran is felt capable of work despite those and the other service connected disabilities, the examiner should describe what type of work and what accommodations would be necessary due to the service connected disabilities. 7. Issue a statement of the case which addresses the issues of an effective date prior to July 3, 2012, for the award of service connection for coronary artery disease and effective dates prior to June 17, 2005, for the award of service connection for both bilateral hearing loss and tinnitus. Notify the Veteran of his appeal rights and that he must submit a timely substantive appeal if he wants appellate review of those claims. If a timely substantive appeal is received, return those claims to the Board. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Middleton, 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.