Citation Nr: 20034061 Decision Date: 05/15/20 Archive Date: 05/15/20 DOCKET NO. 16-30 201 DATE: May 15, 2020 REMANDED Service connection for vasomotor rhinitis, due to exposure to toxic chemicals and ground water contamination is remanded. Service connection for a back condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from April 1954 to December 1957. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in a Travel Board Hearing in St. Petersburg, Florida in October 2018. A transcript of that proceeding has been prepared and is associated with the file. This appeal was last before the Board in December 2019, and prior to then, in February 2019. The Board directed that the issues be remanded for development, specifically, for VA examinations and medical opinions in both remands. Although the Agency of Original Jurisdiction (AOJ) scheduled examinations, the Veteran has not been notified of those scheduled examinations. Of note, his current address is listed as a temporary address in recent VA medical treatment notes, and in VACOLS, the Veteran is listed as homeless. The file does not show that there has been any development in ascertaining his current address upon the receipt of previously returned mail and no-show documentation from the examiner’s office. Accordingly, the Board finds that a remand is necessary. In addition, the Board finds that no VA examinations should be scheduled before the AOJ undertakes appropriate efforts to ascertain the Veteran’s current address. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for vasomotor rhinitis, due to exposure to toxic chemicals and ground water contamination. As noted above, when this claim was last before the Board in February 2019 and in December 2019, it was remanded for VA examinations. Although the examinations were scheduled, the file shows that the Veteran was never notified of the scheduled examinations. The Veteran testified that his vasomotor rhinitis is due to his exposure to toxic chemicals at McClellan Air Force Base (AFB) and Warren AFB. He asserts that as these bases have been certified by the Environmental Protection Agency (EPA) as a Superfund Site, it shows that he was exposed to toxic chemicals. He further asserts that the ground water contamination at McClellan AFB caused his vasomotor rhinitis and he should be presumptively service-connected in the same way that the contaminated water claims from Camp Lejeune are presumptively service-connected. The Board notes that VA regulations do not include McClellan AFB ground water contamination as a condition for presumptive service connection, however, direct service connection remains as a theory of entitlement. 38C.F.R. §3.303, 3.307, 3.309. The Board requires that the Veteran be notified and given the opportunity to attend a VA examination and obtain a medical opinion to support his claims for service connection. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), (a medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159 (c)(4)(i). 2. Service connection for a back condition Between the February 2019 and December 2019 Board Remands, the Veteran submitted a statement in May 2019 wherein he wrote, “I now concede my 60 year old effort of claiming my (back) disability compensation as I am tired of getting nowhere about the back and wish to MOVE ON. I guess I will always have to deal with the pain regardless whether we both win or lose a settlement. I now submit a statement responding to my ongoing claim, exposure to toxic contaminated waste water…” He further stated, “I hereby Dis-avow any claim about my back injury...” In the last remand, the Board noted that given the ambiguity of this language, clarification must be sought as to whether the Veteran would like to continue his appeal for a back disability. The Board observes that a clarification letter was sent, however, it is unclear whether the Veteran ever received it. A clarification letter must be sent to the Veteran to determine whether he is withdrawing his back claim. If the Veteran intends to pursue his claim for service connection for a back condition, a VA examination must be scheduled. Regarding his service connection claim for his back condition, the Veteran testified that he first injured his back at his first duty station when he was tasked with moving heavy railroad tracks. The Board notes that his service treatment records (STR) show he was diagnosed with pain in the lumbar spine in March 1957. At the outset, the Board notes that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran was afforded a VA back (thoracolumbar spine) examination in June 2013. The examiner confirmed a diagnosis of lumbar degenerative disc disease (DDD) and opined that the condition was less likely than not (less than a 50 percent probability) proximately due to, or the result of, the Veteran’s active duty service. The rationale given was that the Veteran had no complaint of a back problem at his separation physical in November 1957 and there was a normal spine radiograph in March 1957. The examiner noted that the Veteran underwent a spinal tap in January 1956 which was documented as normal and found no service treatment records (STRs) that supported the Veteran’s contention that his lumbar DDD was related to his spinal tap. The examiner also noted chiropractic treatment records which indicated that the Veteran was employed lifting small and large boxes after his military service, and that the Veteran injured his lower back while on the job and sustained a workman’s compensation injury in the early 2000s. Finally, the examiner noted that the Veteran was involved in at least one motor vehicle accident post-service and opined that the Veteran’s DDD was likely due to his workman’s compensation injury and his age. However, in proffering his opinion, the examiner did not discuss the March 1957 treatment note in Veteran’s STRs where he was treated for lumbar spine pain. Instead the examiner said that there was no record of the Veteran “having prior back problems dating back to his active service” and that the Veteran “provided no medical documentation that he suffered from any type of back problem until at least 1970.” Based upon the above the VA examiner did not adequately assess whether the Veteran’s lower back condition was related to his active duty service. Additionally, the Board notes, that in an October 2018 correspondence the Veteran raised the contention that during his in-service spinal tap procedure he was exposed to a toxic disinfectant which he claims could have caused his lumbar spine disability. On remand, the VA examiner should address this contention as well. The matters are REMANDED for the following action: 1. Prior to scheduling any VA examination, undertake appropriate efforts to contact the Veteran to request that the Veteran provide VA with his current address and best telephone number at which to reach him. The specific procedures for contacting homeless veterans as set forth in 38 C.F.R. § 1.710 must be completed. The Veteran’s electronic record must be updated to reflect his current address and/or telephone number. All efforts to confirm the Veteran’s current address and/or telephone number must be documented in the record. Then, schedule and notify the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any vasomotor rhinitis. All notice of examinations must be included in the file. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s claimed exposure to toxic chemicals and contaminated ground water at McClellan AFB and Warren AFB in 1954-1955. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. The examiner should address the letter from Dr. R.W.H. that strong odors, strong chemicals and change in temperature worsen his vasomotor rhinitis symptoms and the Scorecard article, “Respiratory Toxicants.” A rationale for all opinions expressed is requested as the Board is precluded from making any medical findings. 3. IF the Veteran seeks to continue the appeal for his back disability, then schedule him for an examination by an appropriate clinician to determine the nature and etiology of any back condition, to include his diagnosed arthritis. All notice of examinations must be included in the file. The examiner must opine whether it is at least as likely as not that his current back condition is related to an in-service injury, event, or disease, including the Veteran’s claimed injury moving railroad tracks at his first duty station and the March 1957 diagnosis of lumbar spine pain in the STR, as well as the spinal tap he received in-service. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as the Board is precluded from making any medical findings. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Nelson 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.