06-13 799
06-13 799
| Board of Vet. App. | Jan 31, 2017Background
- Veteran served in the U.S. Army (1966–1969), including service in Vietnam as a combat engineer.
- Claims on appeal: increased rating for ischemic heart disease, service connection for residuals of bamboo poisoning, service connection for chronic peripheral neuropathy (including herbicide exposure), and TDIU.
- Prior Board denial (Aug 2007) of peripheral neuropathy and bamboo wound residuals was vacated by the Court (Aug 2008) and remanded for further development; subsequent Board remands occurred in 2009 and 2010.
- VA clinical records from 2012–2016 are incomplete in the claims file; Board is not satisfied it has all VA treatment records.
- Existing VA examinations (neurological/bamboo-related exams ~2010 and cardiology exam 2015) are old and provide equivocal or incomplete opinions, particularly on causation and functional impact on employability.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| 1. Higher rating for ischemic heart disease (30%→>30% from 1/18/2012–9/24/2015; >60% from 9/25/2015–present) | Heart symptoms have worsened and cause greater functional limitation and unemployability. | RO has not yet compiled full records or obtained updated opinions on functional impact/employability. | Remanded: obtain VA records; if worsening shown, obtain new exam; obtain addendum opinion on employability (2015 examiner and internal med examiner). |
| 2. Service connection for residuals of bamboo poisoning | Bamboo cuts/infections in service caused current lower-extremity problems and systemic susceptibility to infection. | Lack of contemporaneous service treatment record specifically documenting bamboo strikes; prior exam only opined possibility. | Remanded: obtain records; new internal medicine exam to address current disability and nexus to bamboo exposure (assume exposure occurred); examiner must provide reasoned opinions. |
| 3. Service connection for chronic peripheral neuropathy (including as due to herbicides) | Neuropathy of lower extremities is present and attributable to service or herbicide exposure. | Prior exams equivocal; incomplete records prevent reliable nexus/diagnosis. | Remanded: new exam to determine current neurological disorder and whether herbicide exposure or service events more likely than not caused it, with rationale. |
| 4. TDIU (individual unemployability due to service-connected disabilities) | Combined service-connected conditions render Veteran unable to secure/substantially follow employment. | No adequate medical opinions addressing functional impact of combined disabilities on employability. | Remanded: obtain medical opinions from cardiology and internal medicine examiners as to whether conditions alone or combined preclude employment. |
Key Cases Cited
- Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA must obtain all records in federal custody before deciding claim)
- Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (medical opinions must be based on complete review of the record and provide adequate rationale)
- Kutscherousky v. West, 12 Vet. App. 369 (1999) (appellant may submit additional evidence and argument after remand)