Citation Nr: 22049698 Decision Date: 08/31/22 Archive Date: 08/31/22 DOCKET NO. 19-32 433A DATE: August 31, 2022 ORDER Service connection for tracheal lesions status post tracheostomy is granted. REMANDED Service connection for a throat condition (other than tracheal lesions status post tracheostomy), to include thyroid goiter status post thyroidectomy, polyps, and subglottic stenosis, is remanded. Service connection for a colon condition (claimed as blood in stool) is remanded. FINDING OF FACT The Veteran's tracheal lesions were a result of a tracheostomy that was proximately caused by his service-connected heart disease. CONCLUSION OF LAW The criteria for entitlement to service connection for tracheal lesions status post tracheostomy have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1968 to April 1970including service in Republic of Vietnam from April 1969 to April 1970, including service in Republic of Vietnam from April 1969 to April 1970. A Board hearing was held before the undersigned Veterans Law Judge in November 2021, and a transcript of the hearing is of record. In November 2021, the Board remanded the issues currently on appeal for additional development. The issue of entitlement to service connection for a heart condition was also remanded in November 2021. In a June 2022 rating decision, the Veteran was awarded service connection for ischemic heart disease with cardiomyopathy and an implanted AICD. Such constitutes a full grant of the benefit sought, and the issue of entitlement to service connection for a heart condition is no longer before the Board. Tracheal Lesions Status Post Tracheostomy Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In August 2016, the Veteran filed a service connection claim for polyps on the larynx, which the agency of original jurisdiction (AOJ) recharacterized as service connection for tracheal lesions. See August 2016 VA Form 21-526EZ; see also December 2016 and March 2017 rating decision. During the November 2021 Board hearing, the Veteran's spouse testified that the Veteran went into cardiac arrest in 2016. The Veteran was admitted to the emergency room where providers performed a tracheostomy because the Veteran was unable to be intubated due to a blockage. The spouse testified that the Veteran had several throat surgeries for recurrent trachea lesions during the nearly three years he had the tracheostomy tube. Turning to the medical evidence of record, Dr. M.H. indicated that the Veteran was hospitalized in January 2016 for heart failure. See July 2016 Transcription Report. The Veteran required intubation due to his heart failure, which resulted in a tracheostomy. A March 2022 VA examination reported that the Veteran had tracheal debridement and wound cleaning every six month for three years following the tracheostomy in January 2016. As noted above, the Veteran was awarded service connection (effective August 22, 2015) for ischemic heart disease with cardiomyopathy and an implanted AICD following the November 2021 Board remand. The evidence of record in this case supports a finding that the Veteran's tracheal lesions were a result of his January 2016 tracheostomy that was proximately caused by his service-connected heart disease. Accordingly, entitlement to service connection for tracheal lesions, as secondary to service-connected heart disease, is established. To this extent the appeal is granted. REASONS FOR REMAND Throat Condition In August 2016, the Veteran filed a service connection claim for thyroid removal due to polyps, which the AOJ characterized as thyroid goiter status post thyroidectomy. See August 2016 VA Form 21-526EZ; see also December 2016 and March 2017 rating decision. For the reasons discussed further below, the Board has expanded the Veteran's claim as service connection for a throat condition, to include thyroid goiter status post thyroidectomy, polyps, and subglottic stenosis. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In November 2019, the Veteran indicated that his claimed thyroid condition was documented in his service treatment records. See November 2019 VA Form 9. During the November 2021 Board hearing, the Veteran's spouse testified that she had known the Veteran prior to entering service. She stated the Veteran's voice had changed following his return from service, that his voice sounded raspy and hoarse all the time, and that he experienced discomfort in his throat. The Veteran's spouse testified that the Veteran had polyps removed in his throat, as well as a goiter. Prior to entering service, clinical evaluation of the Veteran's mouth and throat was reported as normal. See May 1968 Report of Medical Examination. Service treatment records document that the Veteran reported a sore throat, and intermittent hoarseness with frequent coughing up of mucus. See May 1969 Health Record. In January 1970, the Veteran was referred to the Ear, Nose, and Throat (ENT) clinic for longstanding hoarseness that was getting worse. Examination revealed a "big polyp" on the Veteran's right vocal cord. The Veteran was advised to return to the ENT clinic one month later on March 1, 1970. It does not appear that the Veteran was seen again at the ENT clinic based on the available evidence of record, and he was separated from service in April 1970. In June 2016 correspondence, Dr. J.H. reported the Veteran underwent right thyroidectomy for benign disease with direct laryngoscopy and removal of subglottic lesion in May 2016. On examination in June 2016, Dr. J.H. stated the Veteran had normal true vocal fold motion but subglottis could not be fully assessed. Dr. J.H. recommended a repeat direct laryngoscopy with bronchoscopy and subglottic tissue removal. In July 2016, the Veteran underwent a preoperative examination for direct laryngoscopy with removal of subglottic tissue. See July 2016 Transcription Report (noting a diagnosis of subglottic stenosis). The Veteran was afforded a VA examination pursuant to the November 2021 Board remand. However, neither the March 2022 VA examination, nor the VA medical opinions obtained in May and June 2022, discuss (or appear to consider) the Veteran's symptoms and throat condition(s) documented in service treatment records. As open medical questions remain, the Board finds remand is necessary before and informed decision can be made. Colon Condition In August 2016, the Veteran filed a service connection claim for colon problems (blood in stool), to include as due to exposure to herbicide agents in the Republic of Vietnam. See August 2016 VA Form 21-526EZ; see also March 2018 VA Form 21-0958. In an August 2016 VA General Surgery Consult, the Veteran reported a history of chronic constipation. The Veteran underwent a colonoscopy in September 2016, which revealed advanced colon polyps. Pursuant to the November 2021 Board remand, the Veteran was afforded a VA examination to assess the nature and etiology of his claimed colon condition. While the VA examiner opined that the Veteran's colon polyps are not related to herbicide agent exposure, he did not offer an opinion as to whether the Veteran's claimed colon condition was incurred coincident with service. 38 C.F.R. § 3.303(a). As such, the Board finds remand is necessary before an informed decision can be made. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination to address the nature and etiology of his claimed throat condition, to include thyroid goiter status post thyroidectomy, polyps, and subglottic stenosis. The examiner should take a history from the Veteran as to his claimed throat condition. Following a review of the claims file, interview and examination of the Veteran, the examiner is asked to respond to the following: (a.) Identify all diagnosed throat conditions (other than tracheal lesions status post tracheostomy) during the period on appeal. (b.) Is it at least as likely as not that any identified throat condition during the period on appeal had onset in service? (c.) Is it at least as likely as not that any identified throat condition is related, at least in part, to the Veteran's presumed exposure to herbicide agents while serving in Vietnam? In offering an opinion, the examiner must consider and discuss: The Veteran's documented in-service symptoms of sore throat, intermittent hoarseness with frequent coughing up of mucus. The Veteran's in-service diagnosis of "big polyp" on the right vocal cord. The Veteran's competent and credible report of continued throat symptoms after service. Post-service treatment records documenting the Veteran's right thyroidectomy for benign disease with direct laryngoscopy and removal of subglottic lesion, and diagnosis of subglottic stenosis. A complete medical rationale for all opinions expressed must be provided. 2. Schedule the Veteran for an appropriate examination to address the nature and etiology of his claimed colon condition. The examiner should take a history from the Veteran as to his claimed colon condition. Following a review of the claims file, interview and examination of the Veteran, the examiner is asked to respond to the following: (a.) Identify all diagnosed colon conditions during the period on appeal. (b.) Is it at least as likely as not that any identified colon condition during the period on appeal had onset in service? The examiner should consider and discuss the Veteran's reported history of chronic constipation. (c.) Is it at least as likely as not that any identified colon condition is related to the Veteran's presumed exposure to herbicide agents while serving in Vietnam? A complete medical rationale for all opinions expressed must be provided. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Mask, 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.