Citation Nr: 18154560 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 13-00 476 DATE: November 30, 2018 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to August 1972. He died in January 2011. The Appellant is his surviving spouse. In March 2017, the Board remanded this case for additional development. The file has now been returned to the Board for further consideration Entitlement to service connection for the cause of the Veteran's death is remanded. The Veteran’s certificate of death indicates that he died in January 2011. The death certificate lists the immediate cause of death as “complications of fall with right hip fracture,” and “other significant conditions contributing to death but not resulting in the underlying cause” as Parkinson’s disease, and severe chronic obstructive pulmonary disease (COPD). The Veteran’s service treatment records are silent for complaint, treatment, or diagnosis of a right hip fracture, Parkinson’s disease, or COPD, and no party asserts otherwise. His service separation form, his DD Form 214, shows that his military specialty title and number were: Aero Ground Equipment Repairman, PAFSC 42153, and his awards included the Vietnam Service Medal and the Republic of Vietnam Campaign Medal. The Veteran’s service personnel records show that between September 1969 and September 1970, he served with a duty title of AGE (aircraft ground equipment) repairman with the 355th FMS (field maintenance squadron) at the Takhli RTAFB, Thailand. The Appellant asserts that service connection is warranted for the cause of the Veteran’s death based on exposure to Agent Orange and/or solvents. She asserts, in a March 2011 statement, that the Veteran, who was an aircraft ground equipment repairman during service, stationed at the Takhli Royal Thai Air Force Base (RTAFB), Thailand, was exposed to Agent Orange and/or that his duties required him to be near planes or work on planes that had been used to spray Agent Orange in the Republic of Vietnam. The Appellant has also asserted, in her November 2011 Notice of Disagreement (NOD), that the Veteran had temporary duty in the Republic of Vietnam. In a January 2017 statement, the Appellant’s attorney asserted that it is well known that the engine test stand and facility were located at the base perimeter of Takhli RTAFB, and that the Veteran’s duties required him to work with solvents or degreasing agents, specifically, carbon tetrachloride and trichloroethylene, and cited a 2012 medical study, identified as “Solvent Exposures and Parkinson’s Disease Risk in Twins,” from the National Institutes of Health (NIH), for the proposition that aircraft mechanics are frequently exposed to these chemicals and that there was a significant association between carbon tetrachloride and trichloroethylene exposure and the later development of Parkinson’s disease. In an August 2018 opinion, a private neurologist opined that due to the nature of the Veteran’s in-service duties with a maintenance squadron, including, but not limited to, repairing and overhauling aircraft, missiles, training equipment and accessories, maintaining aerospace ground equipment, and fabricating parts, he would have been exposed to carbon tetrachloride and trichloroethylene, according to an Air Force manual regarding Aerospace Ground Equipment and the 2012 NIH study. The neurologist also reported, in the August 2018 opinion, that the 2012 NIH study found that aircraft mechanics and industrial machinery repairers were frequently exposed to carbon tetrachloride and trichloroethylene and it was well known that trichloroethylene is a degreaser used on aircraft and carbon tetrachloride is a solvent used in weapon cleaning. The neurologist reported that the study determined that there was a significant association between carbon tetrachloride and trichloroethylene exposure and the later development of Parkinson’s disease, and that the Veteran’s Parkinson’s disease was a contributing factor to his death pursuant to 38 C.F.R. § 3.312. The Board notes here that while the 2012 NIH study cited by the neurologist is of record, as it was submitted by the Appellant’s attorney, the copy submitted does not appear complete. Specifically, the study contains headings or hyperlinks to tables regarding exposure to solvents which are not available for Board review. Review of the complete study is required, as the attorney and neurologist have reported that the study demonstrates that aircraft mechanics are frequently exposed to carbon tetrachloride and trichloroethylene; it does not appear that the copy of the study available to the Board concludes as such. Also, it does not appear that the neurologist included the Air Force manual upon which he relied in the August 2018 opinion. On remand, the Department of Veterans Affairs (VA) Regional Office (RO) should request that the Appellant’s attorney submit the complete 2012 NIH study, with tables or other attachments standing for the proposition that aircraft mechanics are frequently exposed to carbon tetrachloride and trichloroethylene, and the cited Air Force manual. The Board, in its March 2017 Remand, noted that it did not appear that relevant VBA Manual M21-1 provisions for claims based on exposure to herbicide agents in Thailand and exposure to environmental hazards had been complied with. The Board directed the RO to request that the United States Army and Joint Services Records Research Center (JSRRC) attempt to verify exposure to herbicide agents, and consider alternate evidence that may establish exposure to environmental hazards. The Board directed the RO to issue a formal finding as to: (1) whether or not the claimed exposure to herbicide agents is shown; and (2) whether or not the claimed exposure to carbon tetrachloride and/or trichloroethylene is shown, and, if so, the approximate length of the exposure, and the nature of the duties resulting in the exposure. The RO obtained the 2012 NIH study cited by the Appellant’s attorney as to exposure to solvents. The RO obtained a January 2018 response from the Defense Personnel Records Information Retrieval System (DPRIS) describing the Veteran’s unit’s responsibilities as it relates to aircraft and equipment maintenance and indicating that the unit histories were negative and did not report on the Veteran or unit personnel being exposed to herbicides while performing daily duties on or near the base perimeter or duty assignment locations in proximity to the base perimeter. The RO informed the Appellant of the negative DRPIS response in a March 2018 letter, however, it does not appear that the requested formal finding was made. On remand, the RO should issue a formal finding as to the Veteran’s claimed in-service exposures, considering the complete 2012 NIH study, sought herein, as well as the Air Force manual cited by the neurologist in August 2018, also sought herein, and the January 2018 DRPIS response. The Veteran’s certificate of death indicates that his place of death was a nursing home, specifically, the VITAS Inpatient Care Unit in Winter Garden, Florida. At the time of the Board’s March 2017 Remand, it noted that no records from VITAS were associated with the claims file, and directed the RO to attempt to obtain them. On remand, in September 2017, the RO requested that the Appellant submit such records or authorize VA to obtain them on her behalf. To date, the Appellant has not responded. On remand, the RO should again attempt to obtain the Veteran’s VITAS treatment records and associate such with the claims file. Also, the Veteran was in receipt of disability benefits from the Social Security Administration (SSA) as of June 2007. On remand, the RO should obtain the Veteran’s complete SSA records and associate such with the claims file. Finally, on remand efforts should be undertaken to determine whether the Veteran’s Air Force Squadron was permanently assigned any C-123 aircraft between September 1969 and September 1970. 38 C.F.R. § 3.307(a)(6)(v). The matter is REMANDED for the following action: 1. Obtain the Veteran’s federal records from the SSA. Document all requests for information as well as all responses in the claims file. 2. Ask the Appellant to complete a VA Form 21-4142 for VITAS Inpatient Care Unit in Winter Garden, Florida. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Ask that the Appellant submit: (1) a complete copy of the 2012 medical study, identified as “Solvent Exposures and Parkinson’s Disease Risk in Twins,” from the NIH, specifically to include the hyperlinked tables or other attachments standing for the proposition that aircraft mechanics are frequently exposed to carbon tetrachloride and trichloroethylene, cited by the neurologist in his August 2018 opinion; and (2) the Air Force manual regarding Aerospace Ground Equipment cited by the neurologist in his August 2018 opinion. 4. Undertake appropriate development to determine whether the Veteran’s Air Force Squadron was permanently assigned any C-123 aircraft between September 1969 and September 1970. See 38 C.F.R. § 3.307(a)(6)(v). 5. After the development above has been completed, make a formal finding as to: (1) whether or not the claimed exposure to herbicide agents is shown; and (2) whether or not the claimed exposure to carbon tetrachloride and/or trichloroethylene is shown, and, if so, the approximate length of the exposure, and the nature of the duties resulting in the exposure. 6. Then, if, and only if, the Veteran’s exposure to Agent Orange is established, or the Veteran’s exposure to carbon tetrachloride and/or trichloroethylene is established, make the Veteran’s claims file available for review by a physician, who should be asked to indicate in his/her medical opinion that such a review was conducted. The physician should be provided with a complete copy of the 2012 NIH study, “Solvent Exposures and Parkinson’s Disease Risk in Twins,” as well as the Air Force manual regarding Aerospace Ground Equipment. If the Veteran’s claimed exposure to herbicide agents during service at the Takhli RTAFB between September 1969 and September 1970 has been verified, the physician should be so notified. If the Veteran’s claimed exposure to carbon tetrachloride and/or trichloroethylene has been verified, the physician should be so notified, along with the approximate length of the exposure, and the nature of the duties resulting in the exposure. The physician should provide a nexus opinion as to whether it is at least as likely as not (50 percent or greater probability) that the established exposure to Agent Orange, and/or exposure to carbon tetrachloride and trichloroethylene, as applicable, either caused or contributed substantially or materially to the Veteran’s cause of death. The physician is advised that for a disability to be the cause of death it must singly or with some other condition be the immediate or underlying cause or be etiologically related thereto. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Purdum