Citation Nr: 18141122 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 15-25 803 DATE: October 9, 2018 REMANDED Entitlement to service connection for diabetes mellitus, type 2 due to exposure to trichlorethylene is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from April 1967 to January 1971. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, MS, which denied service connection for diabetes mellitus type 2 due to exposure to trichlorethylene on the bases that the current diagnosis of diabetes did not manifest to a compensable degree within one-year of separation from service. Finding there is no evidence the condition begun in service, and finding that the VA has not determined that a relationship exists between diabetes and exposure to trichlorethylene. The Veteran filed a notice of disagreement within the one-year appellate period, thus, the rating decision did not become final. In May 2015, a Statement of the Case denied the claim, the Veteran filed a timely appeal. 1. Entitlement to service connection for diabetes mellitus, type 2 due to exposure to trichlorethylene (TCE) is remanded. The Veteran alleges that his diabetes mellitus, type 2, is a result of his in-service chemical exposure to trichlorethylene. Specifically, the Veteran described that his military service responsibilities included the use of trichlorethylene and methyl ethyl ketone to prepare fuze cavities of aerial bombs to accept C-4 explosives caused his diabetes. The Veteran claims that he experienced in-service headaches, nausea, and lightheadedness during the weapon degreasing process as a result of his exposure to trichlorethylene. The Veteran filed a claim for service connection in August 2012 for diabetes mellitus type 2, due to exposure to trichlorethylene (TCE); the application also contained a reference to benefit entitlement due to exposure to certain herbicide agents. However, in November 2013, the Veteran notified the VA that he was not seeking entitlement to compensation due to herbicide exposure, but rather, that he sought entitlement to service connection for military exposure to trichlorethylene. Throughout the pertinent time on appeal, the Veteran has been assessed with diabetes mellitus, type 2. The Veteran has not received a VA examination and opinion pertinent to his claimed diabetes mellitus, type 2. The Veteran has received treatment from VA and private practitioners near his home but has not received an examination and opinion to ascertain the nature and etiology of his claimed disability. Personnel service records show the Veteran was stationed at U.S. Naval Station, Keflavik, Iceland, from January 1968 to July 1969, assigned as an Ordnance Mechanic in the weapons department. As such, the Board finds that the Veteran’s report of in-service exposure to trichlorethylene is consistent with the place, type, and circumstances of his service. See 38 U.S.C. § 1154(a) (2012). In determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a Veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. §§ 5103A(d) (2012) and 38 C.F.R. 3.159(c)(4) (2017). The third factor, in particular, is a low threshold. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). In light of the evidence of an in-service event, a current diagnosis of a disability, and indication that the current disability or symptoms may be related to service, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of his diabetes mellitus, type 2. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his diabetes mellitus, type 2. The examiner should be provided a copy of the Veteran’s claims file and is requested to review it in conjunction with this remand. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted, and the results included in the examination report. Based on the examination results and review of the record, the examiner should provide an opinion as to the following: The examiner must opine whether it is at least as likely as not (50 percent or greater likelihood) that the current diabetes mellitus, type 2 disability had its onset in service or is otherwise related to service, to include the in-service exposure to trichlorethylene as an Ordnance Mechanic in the weapons department. Please explain why or why not. In formulating the opinions, the term “at least likely as not” does not mean “within the realm of possibility.” Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against. In offering the opinion, the examiner should consider the Veteran’s lay competent statements, as well as the following: (a) Article filed in November 2013 entitled Human Health Effects of Trichlorethylene: Key findings and Scientific Issues. Any opinions offered should be accompanied by the underlying reasons for the conclusions. If the examiner is unable to offer any of the requested opinions, a rationale should be provided for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Steele, Associate Counsel