Citation Nr: 21002012 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-45 177 DATE: January 12, 2021 ORDER New and material evidence having been submitted, the application to reopen the claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, type II diabetes, and sleep apnea is granted and the claims are reopened. Service connection for a right shoulder disorder is granted. Service connection for a right arm disorder is granted. Service connection for a left arm disorder is granted. Service connection for a left leg disorder is granted. Service connection for a right leg disorder is granted. Service connection for a neck disorder is granted. Service connection for type II diabetes is denied. Service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to type II diabetes, is denied. Service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to type II diabetes, is denied. REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. FINDINGS OF FACT 1. In June 2014 rating decision, the claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes were denied on the ground that the disorders neither occurred in nor were caused by active duty service. 2. The Veteran filed a timely notice of disagreement, but did not file a timely substantive appeal in response to the March 2016 statement of the case (SOC), and no new and material evidence was received within one year of that decision. 3. The evidence added to the record since the June 2014 rating decision relates to unestablished facts that are necessary to substantiate the claims of service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes. 4. In an August 2016 rating decision, the claim of entitlement to service connection for sleep apnea was denied on the ground that it neither occurred in nor was caused by active duty service. 5. The evidence added to the record since the August 2016 rating decision relates to unestablished facts that are necessary to substantiate the claim of entitlement to service connection for sleep apnea. 6. Resolving reasonable doubt in the Veteran’s favor, it is at least as likely as not that his right shoulder, right arm, left arm, left leg, right leg, and neck disorders are etiologically related to his active duty service. 7. The Veteran’s type II diabetes was not shown in service, or for many years thereafter, and is not otherwise etiologically related to active duty service. 8. The Veteran’s peripheral neuropathy of the bilateral upper and lower extremities was not shown in service, or for many years thereafter, and is not proximately due to or the result of a service-connected disability, including type II diabetes. CONCLUSIONS OF LAW 1. The June 2014 rating decision that denied the Veteran’s claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes are final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. Because the evidence received after the June 2014 rating decision is new and material, the requirements to reopen the Veteran’s claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 3. The August 2016 rating decision that denied the Veteran’s claim of entitlement to service connection for sleep apnea is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. Because the evidence received after the August 2016 rating decision is new and material, the requirements to reopen the Veteran’s claim of entitlement to service connection for sleep apnea have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 5. The criteria for service connection for a right shoulder disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. The criteria for service connection for a right arm disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 7. The criteria for service connection for a left arm disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 8. The criteria for service connection for a left leg disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 9. The criteria for service connection for a right leg disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 10. The criteria for service connection for a neck disorder have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 11. The criteria for Entitlement to service connection for type II diabetes have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 12. The criteria for service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to type II diabetes, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 13. The criteria for service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to type II diabetes, have not been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1977 to January 1988. In July 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. New and Material Evidence 1. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a right shoulder disorder 2. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a right arm disorder 3. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a left arm disorder 4. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a left leg disorder 5. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a right leg disorder 6. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for a neck disorder 7. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for type II diabetes 8. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for sleep apnea The Veteran contends that his claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a right leg disorder, a left leg disorder, a neck disorder, type II diabetes, and sleep apnea should be reopened because the record now contains new evidence, which shows that these disorders are etiologically related to active duty service. In order for evidence to be sufficient to reopen a previously disallowed claim, it must be both new and material. If the evidence is new, but not material, the inquiry ends, and the claim cannot be reopened. See Smith v. West, 12 Vet. App. 312, 314 (1999); Manio v. Derwinski, 1 Vet. App. 140 (1991). Under the relevant regulations, “new” evidence is defined as evidence not previously submitted to agency decision-makers. 38 C.F.R. § 3.156(a). “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. If it finds that the submitted evidence is new and material, VA may then proceed to evaluate the merits of the claim on the basis of all evidence of record, but only after ensuring that the duty to assist the veteran in developing the facts necessary for the claim has been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999). In this case, the Veteran’s claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes were denied by a June 2014 rating decision on the ground that the disorders neither occurred in nor were caused by active duty service. Although the Veteran submitted a notice of disagreement with the June 2014 rating decision, a March 2016 SOC confirmed the rating decision. He did not submit a substantive appeal of the March 2016 rating decision and, therefore, did not perfect his appeal after issuance of the March 2016 SOC. Additionally, no new and material evidence was submitted within one year of his receipt of that decision. Accordingly, the June 2014 rating decision represents the last final denial of his claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a left leg disorder, a right leg disorder, a neck disorder, and type II diabetes. The Veteran’s claim of entitlement to service connection for sleep apnea was denied by an August 2016 rating decision on the ground that it neither occurred in nor was caused by active duty service. The Veteran did not appeal the denial of his claim of entitlement to service connection for sleep apnea in the August 2016 rating decision, nor did he submit any new and material evidence within a year of receiving it. Accordingly, the August 2016 rating decision represents the last final denial of his claim seeking service connection for sleep apnea. After a review of the evidence submitted since the June 2014 and August 2016 rating decisions became final, the Board determines that the Veteran’s claims of entitlement to service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a right leg disorder, a left leg disorder, a neck disorder, type II diabetes, and sleep apnea should be reopened. The record now includes new evidence, including testimony by the Veteran and his brother-in-law and February 2020 and September 2020 opinions by a private physician concerning whether his right shoulder, right arm, left arm, right leg, left leg, and neck disorders are related to his active duty service. The Veteran’s testimony and the February 2020 and September 2020 opinions raise the possibility that his right shoulder disorder, right arm disorder, left arm disorder, right leg disorder, left leg disorder, neck disorder, type II diabetes, and sleep apnea are etiologically related to his active duty service. Not only is this evidence “new” because it was not of record prior to the last final denial of the claims, it is also “material” because it relates to unestablished facts necessary to support the claims. Therefore, his claims seeking service connection for a right shoulder disorder, a right arm disorder, a left arm disorder, a right leg disorder, a left leg disorder, a neck disorder, type II diabetes, and sleep apnea should be reopened. Shade, 24 Vet. App. at 118-21; see also 38 C.F.R. § 3.156(a). Service Connection The Veteran contends that service connection is warranted for a right shoulder disorder, a right arm disorder, a left arm disorder, a right leg disorder, a left leg disorder, a neck disorder, type II diabetes, peripheral neuropathy of the bilateral upper extremities, and peripheral neuropathy of the bilateral lower extremities. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Certain chronic diseases may be presumed to have been incurred during service if they become manifested to a compensable degree within one year from separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. Id. Moreover, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). Moreover, service connection is warranted for a disability that is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). Accordingly, when service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. 9. Entitlement to service connection for a right shoulder disorder 10. Entitlement to service connection for a right arm disorder 11. Entitlement to service connection for a left arm disorder 12. Entitlement to service connection for a left leg disorder 13. Entitlement to service connection for a right leg disorder 14. Entitlement to service connection for a neck disorder The Veteran contends that service connection is warranted for his right shoulder, right arm, left arm, right leg, left leg, and neck disorders. Specifically, he contends that his service treatment records document numerous occasions when he sought treatment for injuries to or disorders of the right shoulder, right arm, left arm, right leg, left leg, and neck after playing sports or carrying heavy objects, and that his current disorders are etiologically related to the injuries and disorders documented by his service treatment records. After a review of the evidence of record, and after resolving all reasonable doubt in the Veteran’s favor, the Board concludes that service connection is warranted for the Veteran’s right shoulder, right arm, left arm, right leg, left leg, and neck disorders. As an initial matter, the Veteran’s service treatment records, including September 1977, October 1977, September 1979, July 1983, March 1984, October 1985, and February 1986 document treatment for right shoulder, right and left arm, right and left leg, and neck disorders during his active duty service. Thus, the Veteran’s service treatment records, in conjunction with his competent and credible testimony regarding the injuries he sustained while participating in sports and performing his duties as a welder, show numerous in-service incidents. Next, after resolving reasonable doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise that the Veteran’s right shoulder, right arm, left arm, right leg, left leg, and neck disorders are etiologically related to his active duty service because the evidence includes private opinions linking these disorders to his active duty service that the Board concludes are entitled to significant probative weight. Specifically, a February 2020 private opinion reflects that a physician who treated the Veteran from 2007 to 2017 opined that his injuries began during his active duty service and continued to the present. In support of that opinion, the physician explained that he treated the Veteran for various medical issues including right shoulder, right arm, left arm, right leg, left leg, and neck disorders from 2007 to 2017 and that the Veteran’s injuries were not transitory injuries, but chronic and long-standing disorders. The Veteran’s private physician submitted an additional opinion in September 2020. The September 2020 opinion reflects that the physician similarly opined that it was “highly likely” that the Veteran’s condition was a direct result of his military service. The physician noted that he reviewed the Veteran’s medical history, the circumstances and events of his military service, and his diagnosis of vibratory injury by a physiatrist. The physician then supported his opinion by explaining that the Veteran had no other risk factors that may have precipitated his current condition and the medical literature supported a link between the Veteran’s active duty service and current right shoulder, right arm, left arm, right leg, left leg, and neck disorders. The Board finds that the February 2020 and September 2020 opinions by the Veteran’s private physician are probative given the physician’s expertise, treatment of the Veteran for 10 years, review of the relevant medical evidence, and supporting rationales. Further, after resolving all reasonable doubt in the Veteran’s favor, the Board finds that these opinions, in conjunction with the Veteran’s competent and credible testimony at the July 2020 Board hearing, establish that the evidence is at least in equipoise that the Veteran’s right shoulder, right arm, left arm, right leg, left leg, and neck disorders are etiologically related to his active duty service. The Board acknowledges that the negative evidence includes treatment records, including an April 2010 treatment record, relating the Veteran’s musculoskeletal disorders to the physical requirements of his job in a titanium factory, including lifting heavy objects. The Board finds that such treatment records are not entitled to significant probative weight. As an initial matter, such treatment records do not reflect that the treating physician had reviewed the Veteran’s history of treatment during his active duty service or that any rationale was provided for that opinion. Next, the opinions provided by the Veteran’s private physician explained that the symptoms of his disorders would abate, but would not resolve when he was not working. Finally, the Veteran’s competent and credible testimony reflects that company policy forbade him from lifting objects weighing in excess of 35 pounds. Accordingly, the Board finds that the opinions provided by the Veteran’s private physician are entitled to greater probative weight. By virtue of the foregoing, the Board concludes that service connection for the Veteran’s right shoulder, right arm, left arm, right leg, left leg, and neck disorders is warranted. 15. Entitlement to service connection for type II diabetes 16. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to type II diabetes 17. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to type II diabetes The Veteran contends that service connection is warranted for type II diabetes, peripheral neuropathy of the bilateral lower extremities, and peripheral neuropathy of the bilateral upper extremities. With respect to type II diabetes, the Veteran contends that his diabetes is etiologically related to active duty service and service connection is warranted because he was discharged because he was overweight and was diagnosed with type II diabetes approximately one year to one and a half years after his discharge. With respect to peripheral neuropathy of the bilateral lower and upper extremities, he contends service connection is warranted because he received treatment for ailments involving his bilateral lower and upper extremities while on active duty service and because his peripheral neuropathy is proximately due to his type II diabetes. Here, the Board concludes that although he has diagnoses of type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities, the preponderance of the evidence weighs against finding that service connection is warranted. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Initially, the Board finds that the Veteran’s service treatment records fail to establish that type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities were incurred in or are related to his active duty service. Specifically, his service treatment records fail to establish that his type II diabetes was incurred in or is otherwise etiologically related to his active duty service because they do not reflect that he sought treatment for, reported signs or symptoms of, or was diagnosed with type II diabetes. With respect to peripheral neuropathy of the bilateral lower and upper extremities, the Board acknowledges that numerous treatment records, including September 1977, October 1977, September 1979, October 1979, August 1980, July 1983, March 1984, December 1984, October 1985, and February 1986 treatment records reflect that the Veteran reported symptoms of or sought treatment for disorders involving his lower and upper extremities. However, the treatment he received was not for symptoms of neuropathy. Instead, he sought treatment for various injuries, including a pulled hamstring, bursitis, and pain, often after participating in sports such as football and softball. Moreover, the report from his November 1987 separation examination does not reflect that the examining physician found any symptoms of or issues related to peripheral neuropathy of the bilateral lower and upper extremities and determined that his neurological system was “normal.” The post-service clinical evidence also fails to establish a relationship between the Veteran’s active duty service and his type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities. Specifically, with respect to type II diabetes, the post-service evidence of record does not reflect that he sought treatment for or reported signs or symptoms of type II diabetes until a November 2010 treatment record noted that his medical issues included diabetes, more than 22 years after his separation from service. With respect to peripheral neuropathy of the bilateral lower and upper extremities, the post-service evidence of record does not reflect that he sought treatment for or reported signs or symptoms of peripheral neuropathy of the bilateral lower and upper extremities until May 2015, more than 27 years after his separation from service. Indeed, an April 2009 treatment record reflects that he had no symptoms of peripheral neuropathy, November 2010 and February 2011 treatment records reflect that he did not experience any radiating pain, numbness, tingling, or weakness, and a July 2014 treatment record reflects that he had normal sensations throughout his bilateral upper extremities. Given the significant gaps between his separation from service and when he first sought treatment for these disorders, a continuity of symptoms based upon the clinical evidence is not sufficient to support a direct nexus, including for purposes of the chronic disease presumption under 38 C.F.R. § 3.307(a)(3). The Board acknowledges the statements by the Veteran, his wife, and his brother-in-law regarding the history of his symptoms of type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities. Although the Veteran, his wife, and his brother-in-law are competent to report that he has experienced symptoms of these disorders, they are not competent to determine that these symptoms were manifestations of a particular disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed Cir. 2007). Nevertheless, to the extent the Veteran, his wife, and his brother-in-law contend that these disorders were caused by his service and have persisted since service, including the Veteran’s testimony that he was diagnosed with type II diabetes approximately one year to one and a half years after his separation from service, the Board determines that the reported history of continued symptoms while competent, is nonetheless not probative in establishing the nexus element because, as set forth above, the clinical evidence shows significant gaps between his separation from service and when he sought treatment for these disorders, and because no treatment records document a diagnosis of type II diabetes within one year to one and a half years after his separation from service. The fact that he did not seek treatment for these significant durations after his active duty service weighs against these claims and his credibility. See Kahana v. Shinseki, 24 Vet. App. 428, 439-40 (2011). Additionally, the Board finds that the reported history of continued symptoms is not probative because the report from his November 1987 separation does not reflect that the examining physician determined that the Veteran had diabetes or peripheral neuropathy, or symptoms of those disorders. Finally, service connection may be granted when the evidence establishes a medical nexus between active duty service (to include his toxic herbicide exposure) and the current diagnosis. However, there is not sufficient evidence in the medical records to demonstrate a nexus between his active duty service and his type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities. Indeed, there is no objective medical evidence linking these disorders to his active duty service. Further, the Board notes that the Veteran has not provided sufficient evidence, including private opinions and/or medical evidence, to establish a nexus between his active service and his type II diabetes and peripheral neuropathy because the February 2020 and September 2020 private opinions related to his right shoulder, right arm, left arm, right leg, left leg, and neck disorders, not his type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities. In arriving at its conclusion, the Board has also considered the statements made by the Veteran relating his disorders to his active duty service. The Federal Circuit has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau, 492 F.3d at 1377). In this case, however, the Veteran is not competent to provide testimony regarding the etiology of his type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities. See Jandreau, 492 F.3d at 1377, n.4. Although he can provide competent testimony regarding symptoms, these disorders are not disorders that can be diagnosed by their unique and identifiable features as they do not involve a simple identification that a layperson is competent to make. In any event, the diagnoses of dysfunctions and disorders, and their respective etiologies, are medical determinations and generally must be established by medical findings and opinion. See id. at 1376-77. Thus, to the extent that the Veteran believes that his type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities are related to his active duty service, he is a lay person without appropriate medical training and expertise to provide a medical diagnosis and etiological opinion. Finally, to the extent that the Veteran asserts that his peripheral neuropathy of the bilateral lower and upper extremities is secondary to his type II diabetes, the Board notes that it has found that service connection for his type II diabetes is not warranted. Given that secondary service connection cannot be granted as secondary to a nonservice-connected condition, secondary service connection for his peripheral neuropathy of the bilateral lower and upper extremities is not warranted. See 38 C.F.R. § 3.310 By virtue of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran’s claims seeking service connection for type II diabetes and peripheral neuropathy of the bilateral lower and upper extremities, and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea is remanded. 2. Entitlement to service connection for COPD is remanded. The Board concludes that the Veteran’s claims seeking service connection for sleep apnea and COPD require further development. Specifically, his service treatment records, including December 1984 service treatment records and a January 1985 service treatment record, reflect that he reported having respiratory issues while on active duty, that a pulmonary function test was performed, and a treating physician sought to rule out early COPD. These treatment records, in conjunction with the Veteran’s testimony that he inhaled toxic fumes during active duty service, which is competent and credible given that he was a welder while on active duty, confirm that a VA examination is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain any and all treatment records from the VA Portland Health Care System, including the Vancouver Campus of the VA Portland Health Care System in Vancouver, Washington, since March 2017. If the Veteran has received additional private treatment, he should be afforded an appropriate opportunity to submit the medical records of such treatment. 2. Schedule the Veteran for a VA examination by an appropriate clinician to determine the nature, extent, onset, and etiology of his chronic obstructive pulmonary disease (COPD) and sleep apnea. The claims file should be provided to the examiner for review. All indicated studies deemed necessary by the examiner should be performed, and all findings of those tests should be reported in detail. The examiner should specifically consider and address the Veteran’s testimony at the July 2020 Board hearing regarding his inhalation of toxic fumes on active duty while performing his duties as a welder and the December 1984 and January 1985 treatment records, which reflect that he reported respiratory issues and that a pulmonary function test was performed. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that Veteran’s COPD and sleep apnea are etiologically related to his period of service, to include as due to exposure to toxic chemicals while performing his duties as a welder. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Crosnicker, Associate Counsel