Citation Nr: 19152243 Decision Date: 07/05/19 Archive Date: 07/05/19 DOCKET NO. 14-24 641A DATE: July 5, 2019 ORDER Entitlement to service connection for bilateral upper extremity vascular neuropathy, for substitution purposes, is granted. Entitlement to service connection for bilateral lower extremity vascular neuropathy, for substitution purposes, is granted. Entitlement to service connection for a back disability, for substitution purposes, is granted. REMANDED Entitlement to special monthly compensation for aid and attendance, for substitution purposes, is remanded. Entitlement to a total disability rating due to individual unemployability, for substitution purposes, is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his bilateral upper extremity vascular neuropathy is at least as likely as not related to Trichloroethylene exposure. 2. Resolving reasonable doubt in the Veteran’s favor, his bilateral lower extremity vascular neuropathy is at least as likely as not related to Trichloroethylene exposure. 3. Resolving reasonable doubt in the Veteran’s favor, his back disability is at least as likely as not related to military service. CONCLUSIONS OF LAW 1. The criteria for service connection, based upon substitution of the appellant as the claimant, for bilateral upper extremity vascular neuropathy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection, based upon substitution of the appellant as the claimant, for bilateral lower extremity vascular neuropathy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection, based upon substitution of the appellant as the claimant, for a back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to January 1969. The Veteran passed away in March 2019. The Appellant is the Veteran’s surviving spouse. The Veteran appealed February 2012 and November 2016 rating decisions from the Department of Veteran Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. After the Veteran’s passing, the Appellant moved to substitute herself into the Veteran’s shoes and continue the claim. After the RO’s determination, the Appellant has been substituted as the claimant for the purposes of processing the claims to completion. See 38 U.S.C. § 5121A. The Board notes that the RO has considered the bilateral vascular neuropathy issues on appeal as requiring new and material evidence. The RO originally denied the Veteran’s claim in August and November 2016 rating decisions. However, the Veteran submitted new and material evidence during the appellate period. Further, the Veteran timely appealed the November 2016 rating decision. As such, there has yet to be a final decision requiring a claim to be reopened. Therefore, the Board will look at merits of the claim. See 38 C.F.R. § 3.156(b). The Veteran had a Board hearing in September 2018. A transcript is included in the Veteran’s claim folder. Service Connection The Appellant contends that the Veteran’s back disability is related to military service. Additionally, the Appellant asserts that the Veteran’s bilateral vascular neuropathy of the upper and lower extremities resulted from Trichloroethylene exposure. Service connection is warranted where the evidence of record establishes that a particular injury or disease results in a present disability that incurred in the line of duty during active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131 (2014); 38 C.F.R. § 3.303(a). Bilateral Upper Extremity Vascular Neuropathy Bilateral Lower Extremity Vascular Neuropathy The Appellant asserts that the Veteran was exposed to the chemical solvent Trichloroethylene while working as an aircraft mechanic. See January 2017 Lay Correspondence. Trichloroethylene was used in solvents used to clean jet parts. See September 2018 Board Hearing. The Veteran’s exit exam noted paralysis, recurrent back pain, and leg cramps. See Service Treatment Record. Additionally, the Veteran’s service treatment record noted paralysis of the Veteran’s legs requiring a stay in the hospital. Id. The position was considered a form of conversion. Id. A private physician, opined in March 2016, “given the proven health impacts of exposure to trichloroethylene, I believe it is as likely as not, or at least possible that his vasculitic neuropathy was caused by exposure to trichloroethylene while on active duty.” See March 2016 Private Medical Opinion. The Veteran underwent a VA examination in October 2016. The VA examiner noted a diagnosis of varicose veins. The VA examiner opined that the Veteran’s vascular neuropathy was less likely than not related to service. The VA examiner reasoned that the vascular veins were not caused by a conversion reaction, as conversion is a psychological, not a physical finding. In a January 2017 private medical opinion, the private physician stated that it is “certainly possible that the [Veteran’s] history of muscle pain, weakness, back pain, and joint pain coupled with other neurological problems precluded his diagnosis of vasculitic neuropathy and autoimmune dysfunction.” As such, the private physician added, “it is as likely as not that [the Veteran] is suffering from long term effects from exposure to toxic substance of trichloroethylene.” A VA psychiatrist, in March 2017, stated that he could not agree or disagree with the conversion diagnosis in service. See March 2017 VA Medical Record. However, the VA psychiatrist noted the Veteran did not have another conversion episode for fifty years. Id. In September 2018 lay correspondence, the Veteran stated that his uniform and shoes would be covered with solvent. He added that the job required immediate shower, uniform change, and shoe rotation at the end of each shift. Whether or not the Veteran had a problem with chemical exposure is not particularly essential in this case: In this case, the Veteran’s exit exam noted paralysis, recurrent back pain, and leg cramps. In any event, the Board acknowledges the differing opinions proffered by two equally qualified medical professionals and concludes that one opinion does not outweigh the other. The Board notes that when the evidence is in relative equipoise, by law; the Board must resolve all reasonable doubt in favor of the claimant. See U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinksi, 1 Vet. App. 49, 53-56 (1990). Therefore, the Board finds that service connection for bilateral vascular neuropathy of the upper and lower extremities is granted. Back Disability The Appellant contends that the Veteran injured his back while working as an aircraft mechanic. See September 2018 Board Hearing. The Veteran noted recurrent back pain on his exit exam. See Service Treatment Record. The Board can not ignore such evidence. In November 2011, a private physician opined “I have reviewed [the Veteran’s] military medical records and it is my opinion that his back pain is as likely as not related to his military injury.” See November 2011 Private Treatment Record. The Veteran underwent a VA examination in January 2012. The Veteran was diagnosed with lumbar degenerative joint disease. The VA examiner opined that the Veteran’s back disability was less likely than not caused by military service. The VA examiner reasoned that there was no low back injury or paralysis noted in the service treatment records. Further, the Veteran had a normal spine on his exit exam. Any back pain did not require treatment or present complications. In April 2012, a private physician opined that the Veteran has chronic back pain that impacts him intermittently. He added, “It is certainly possible that his back pain could have arisen from this time in the service and has waxed and waned since then.” During the September 2018 Board Hearing, the Veteran stated that since separation he has had several flare ups of low back pain and spasms. He added that the pain cycles from flare ups to subsiding, and vice versa. In sum, the Board acknowledges the differing opinions proffered by two equally qualified medical professionals and concludes that one opinion does not outweigh the other. The Board notes that when the evidence is in relative equipoise, by law; the Board must resolve all reasonable doubt in favor of the claimant. See U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinksi, 1 Vet. App. 49, 53-56 (1990). Therefore, the Board finds that service connection for a back disability is granted. REASONS FOR REMAND Entitlement to special monthly compensation for aid and attendance is remanded. Entitlement to a total disability rating due to individual unemployability is remanded. The issues of special monthly compensation for aid and attendance, and total disability rating due to individual unemployability (TDIU) are remanded for further development. The Veteran contended that his service connected disabilities prevented him from substantially gainful employment. As mentioned above, the Veteran is now service connected for a back disability, bilateral upper extremity vascular neuropathy, and bilateral lower extremity vascular neuropathy. However, the Veteran currently does not meet the schedular requirements for TDIU. See 38 C.F.R. § 4.16(a). Further, the RO must first determine the disability rating for the Veteran’s new service connected disabilities. Such a disability rating may allow the Veteran to meet the schedular requirement. Thus, the Veteran’s TDIU and special monthly compensation claims are inextricably intertwined with the issue of an increased rating for a back disability, bilateral upper extremity vascular neuropathy, and bilateral lower extremity vascular neuropathy. Therefore, the issues are inextricably intertwined and adjudication of such must be deferred. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). The matters are REMANDED for the following action: 1. Obtain and associate with the record all VA and private treatment records. All actions to obtain the requested records should be fully documented in the record. If they cannot be located or no such records exist, the Appellant and her representative should be so notified in writing. If possible, the appellant and the representative are asked to submit these records themselves. 2. Then, readjudicate the issues on appeal. If any benefit sought on appeal remains denied, provide the Appellant and her representative with a supplemental statement of the case and afford them the requisite opportunity to respond before the case is returned to the Board for further appellate action. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Timothy A. Campbell, 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.