Citation Nr: 19154623 Decision Date: 07/15/19 Archive Date: 07/15/19 DOCKET NO. 17-57 457 DATE: July 15, 2019 REMANDED Entitlement to service connection for a kidney condition is remanded. Entitlement to service connection for a bilateral ankle condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for bilateral heel spurs is remanded. Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for a respiratory condition claimed as chronic cough is remanded. REASONS FOR REMAND The file contains a DD Form 214 indicating the Veteran had active duty service in the Navy from August 1989 to November 1992. The DD 214, as well as other evidence of record, indicates active duty service beginning in December 1984 that has not been verified, as well as service in the Navy Reserve and Army National Guard after November 1992. These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in September 2015 and March 2016. A transcript of the Veteran’s February 2019 hearing before the undersigned Veterans Law Judge is of record. As an initial matter, and as noted above, there are periods of service that need verification. This should be accomplished on remand. 1. Entitlement to service connection for a kidney condition The Veteran seeks service connection for a kidney condition, which he claims is a result of his exposure to environmental contaminants while stationed at the Naval Air Facility (NAF) in Atsugi, Japan. A VA Fact Sheet indicates that the Department of Defense has determined that personnel at NAF Atsugi were exposed to environmental contaminants during the years between 1985 and 2001 from an off-base waste incinerator business owned and operated by a private Japanese company known as the Jinkanpo or Shinkampo incinerator complex. The identified chemicals of potential concern included chloroform; 1,2 dichloroethane; methylene chloride; trichloroethylene; chromium; dioxins and furans; and other particulate matter. Private treatment records indicate that the Veteran has been diagnosed with end stage renal disease and chronic kidney disease. Personnel records indicate that he was stationed at Atsugi during the period outlined in the Fact Sheet; therefore, the Board will concede that he was exposed to environmental contaminants. The Veteran has submitted an April 2017 letter from Dr. S.M., a board-certified internal medicine physician, who provided an opinion that it is more likely than not that the Veteran’s kidney failure (end stage renal disease) is due to the toxins he was exposed to while serving in Atsugi, Japan. However, the toxins the physician listed were not those mentioned in the VA Fact Sheet. Moreover, none of the positive opinions addressed the family history of renal disease. See April 24, 2015 treatment record noting maternal grandmother with history of end stage renal disease. Accordingly, a VA opinion is needed. 2. Entitlement to service connection for a right knee condition is remanded. 3. Entitlement to service connection for a left knee condition is remanded. The Veteran underwent a VA examination in February 2016 during which he was diagnosed with bilateral knee strain and a negative opinion was provided based in part on the absence of evidence of chronicity of care. Another examination is needed to address several concerns. 4. Entitlement to service connection for bilateral heel spurs is remanded. 5. Entitlement to service connection for bilateral pes planus is remanded. An examination is needed to address these claims involving the feet since there is no evidence the Veteran has been diagnosed with heel spurs or pes planus during the pendency of the claim. Although Dr. Bash indicates that the Veteran has bilateral plantar fasciitis, such opinion was not based on examination of the Veteran. The Board does note a diagnosis of right heel spur in March 2004; a March 2004 x-ray showing bilateral flat foot, narrowing of bilateral 1st metatarsophalangeal joints, and a small spur on the plantar aspect of os calcis on left side; and the Veteran’s assertion during his hearing that flat feet and heel spurs developed in service due to wearing boots and running. 6. Entitlement to service connection for a bilateral ankle condition is remanded. An examination is needed to address this claim since there is no evidence the Veteran has been diagnosed with any condition specific to his ankles during the pendency of the claim except for a diagnosis of degenerative joint disease provided by Dr. Bash, which was not based on examination or radiographic imaging of the Veteran. The Board does note a diagnosis of gout flare involving the left ankle made in March 2015 and that the Veteran was having an attack of gout in his lower extremities in April 2015. 7. Entitlement to service connection for a respiratory condition claimed as chronic cough is remanded. The Veteran underwent a VA examination in February 2016 that was focused on asbestosis despite the fact that the Veteran’s claim was for chronic cough. Since it appears the opinion was rendered on the basis that the Veteran was claiming asbestosis, another examination is needed. This is especially important given that the Board has conceded the Veteran was exposed to environmental contaminants while stationed at the NAF Atsugi and given the opinion provided by Dr. Bash in February 2019 that the Veteran has diagnoses of interstitial pulmonary disease was rendered without examination of the Veteran. The matters are REMANDED for the following action: 1. Verify the dates of the Veteran’s over four years of prior active duty service noted on the DD 214 of record. 2. Verify the dates and types of the Veteran’s service in the National Guard and/or Reserve. Document all efforts made in this regard. 3. Send the claims file to a VA examiner specializing in occupational or environmental exposures to obtain an opinion concerning the Veteran’s claim for service connection for renal disease. If an examination is deemed necessary to respond to the question presented, one should be scheduled. Following review of the claims file, to include information concerning exposures at the Naval Air Facility in Atsugi, Japan (see VBMS entry 3/5/2019 Congressional), the specialist is asked to opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s renal disease is related to his toxic exposures during his service at the NAF in Atsugi and/or related to asbestos exposure. The specialist should explain why or why not, to include addressing the significance, if any of the history of end stage renal disease in the Veteran’s maternal grandmother and whether the Veteran has any nonservice-related risk factors for his renal disease. 4. Schedule the Veteran for a VA examination to determine the nature of the claimed bilateral knee condition and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. After review of the claims file and examination of the Veteran, the examiner should respond to the following: (a) Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current disability of the right knee arose during service or is otherwise related to service. (b) Regarding the left knee, does the evidence of record undebatably show that the Veteran had a left knee disability that existed prior to active duty service? (c) If so, does the evidence show that the pre-existing left knee condition underwent a permanent worsening during service? (d) If so, is that permanent worsening undebatably the result of the natural progression of the condition, versus being worsened as a result of in-service events? (e) If the Veteran has a left knee disorder that did not exist prior to service or was permanently worsened by service, is it at least as likely as not (at least a 50 percent probability) that any current left knee disorder is related to service? A rationale for all opinions expressed should be provided. The examiner is notified that the Veteran’s attorney contends that displacement of loads in the Veteran’s body because of knee pain, ankle pain, a puncture in the foot, and because the Veteran had to climb over construction equipment, as well as exposure to toxins where the Veteran was stationed at Atsugi, Japan, and Miramar, California, caused his knee condition. The examiner must also address the opinion pertinent to the knees provided by Dr. Bash in February 2019. 5. Schedule the Veteran for a VA examination to determine the nature of the claimed foot conditions (bilateral pes planus and bilateral heel spurs) and to obtain an opinion as to whether such is/are possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current foot condition, to include bilateral pes planus, bilateral heel spurs, and/or bilateral plantar fasciitis, arose during service or is/are otherwise related to service. A rationale for all opinions expressed should be provided. The examiner must address the Veteran’s assertion that flat feet and heel spurs developed in service due to wearing boots and running, as well as his attorney’s assertion that exposure to toxins where the Veteran was stationed at Atsugi, Japan, and Miramar, California, caused his foot condition(s). The examiner must also address the opinion pertinent to the feet provided by Dr. Bash in February 2019. 6. Schedule the Veteran for a VA examination to determine the nature of the claimed ankle conditions, to include gout, and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current ankle condition, to include gout, arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided. The examiner is notified that the Veteran’s attorney contends that displacement of loads in the Veteran’s body because of knee pain, ankle pain, a puncture in the foot, and because the Veteran had to climb over construction equipment, as well as exposure to toxins where the Veteran was stationed at Atsugi, Japan, and Miramar, California, caused his ankle condition. The examiner must also address the opinion pertinent to the ankles provided by Dr. Bash in February 2019. 7. Schedule the Veteran for a VA examination to determine the nature of the claimed respiratory disability, claimed as chronic cough, and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current respiratory disability, to include the reported chronic cough, arose during service or is otherwise related to service. A rationale for all opinions expressed should be provided. The examiner is notified that the Veteran’s attorney contends that exposure to toxins where the Veteran was stationed at Atsugi, Japan, and Miramar, California, caused his respiratory condition. The examiner must also address the opinion pertinent to the respiratory system provided by Dr. Bash in February 2019. (Continued on the next page)   8. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Van Wambeke, 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.