Citation Nr: 21003512 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-59 843 DATE: January 21, 2021 REMANDED Entitlement to service connection for bladder cancer, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for coronary artery disease, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for emphysema, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for sleep apnea, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for right upper extremity vascular disease, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for left upper extremity vascular disease, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for right lower extremity vascular disease, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. Entitlement to service connection for left lower extremity vascular disease, claimed as due to asbestos exposure and galvanized metal poisoning, is remanded. REASONS FOR REMAND The Veteran had active duty from June 1966 through September 1969. The issues on appeal arise from the Veteran’s October 2015 claim and the agency of original jurisdiction’s (AOJ’s) August 2016 rating decision. The Veteran testified during a November 2019 Board hearing. A transcript is of record. The Veteran’s DD Form 214 and other service department records show that the Veteran performed duties as a Damage Controlman while serving on board seafaring vessels as a member of the United States Coast Guard. A duty description for the Veteran’s military occupational specialty that is among the service department records describe various tasks that involve work cutting and welding steel and removing asbestos. Given the nature of the Veteran’s duties and testimony presented during his Board hearing, the Board concedes that the Veteran was exposed to asbestos and galvanized metals during service. 1. VA treatment records. The record reflects that the Veteran’s VA treatment records were most recently obtained via request through VA’s CAPRI record system in October 2016. During his Board hearing, the Veteran testified that he had received additional VA treatment, to include several recent hospitalizations for his heart condition and vascular conditions. The Veteran apparently requested and obtained copies of VA treatment records via signed release. Copies of those records were submitted by the Veteran and received by VA in March 2019. Nonetheless, it is unclear as to whether those records constitute a complete set of the Veteran’s treatment records since October 2016. Notably, the records received in March 2019 include various radiology reports and scattered treatment records that pertain to procedures performed from 2016 through 2019 for conditions in the Veteran’s left lung and apparent relapses of bladder cancer in 2016 and 2018. Not included, however, are doctor’s notes and treatment notes that are normally associated with the various studies and reports that were provided. Under the circumstances, VA should obtain the complete records relating to relevant VA treatment received by the Veteran from October 2016 through the present. 38 C.F.R. § 3.159(c)(2). 2. Examination for coronary artery disease and vascular disease in the upper and lower extremities. The Veteran contends that he has coronary artery disease and vascular disease in his upper and lower extremities that he believes resulted from in-service asbestos exposure and galvanized poisoning. As mentioned, the Board concedes that the Veteran was exposed to asbestos and galvanized metals during service. Consistent with the Veteran’s assertions, the records indicate that the Veteran has been followed for longstanding coronary artery disease. During January 2016 VA treatment, he reported that he first experienced the onset of chest pain and shortness of breath in 2005. In conjunction, a May 2014 treatment record from Compass Medical notes that the Veteran had a known medical history of peripheral vascular disease. The records, however, express no opinions relating to the etiology of the Veteran’s coronary artery disease and/or of the vascular disorder in his extremities. The Veteran should be scheduled to undergo an examination of his coronary artery disease and claimed vascular disease in his upper and lower extremities to determine their nature, and, whether any disorders were incurred during service or were caused by an in-service injury, illness, or event, to include conceded asbestos exposure and galvanized metal exposure. 38 C.F.R. § 3.159(c)(4). 3. Examination for emphysema and chronic obstructive pulmonary disorder (COPD). The Veteran also contends that he has emphysema that he believes resulted from in-service asbestos exposure and galvanized poisoning. As mentioned, the Board concedes that the Veteran was exposed to asbestos and galvanized metals during service. April 2008 records from Dr. P.E.L. note that the Veteran had a known history of lung disease. Chest CT studies conducted in January 2014 at Compass Medial showed ground glass opacity in the upper lobe of the Veteran’s left lung. Repeat studies conducted in April 2014 showed parenchymal disease. Pulmonary function tests conducted in May 2014 revealed a mild airway obstruction. A problem list noted in the record includes known diagnoses for COPD. The records express no opinion as to the cause or etiology of the Veteran’s COPD or other pulmonary or respiratory disorder, to include emphysema. 4. Medical opinion for sleep apnea. The Veteran contends that he has sleep apnea that he also believes resulted from in-service asbestos exposure and/or galvanized poisoning. He acknowledges in his Board hearing testimony that he was not aware of his sleep apnea symptoms until 2012 or 2013. Post-service VA treatment records show that sleep apnea was first diagnosed for the Veteran following a sleep study conducted in November 2015. Again, the records provide no opinion as to the cause or etiology of the Veteran’s sleep apnea. VA should obtain a medical opinion as to whether the Veteran’s sleep apnea resulted from the Veteran’s conceded in-service asbestos exposure and/or galvanized poisoning, and, whether the Veteran’s sleep apnea resulted from or was aggravated by COPD, emphysema, or other respiratory disorder incurred during service or caused by an in-service injury, illness, or event. If the reviewing clinician determines that a full examination of the Veteran is necessary in order to render the opinions being sought, then the examiner should be scheduled for such an examination. 38 C.F.R. § 3.159(c)(4). The matters are REMANDED for the following action: 1. The Veteran should be asked whether he has additional evidence pertaining to his claims on appeal. Records for VA treatment received by the Veteran since October 2016 and any private treatment identified by the Veteran and not already of record should be obtained. If the records are not available, such unavailability should be documented in the record. The Veteran and his representative should be notified of unsuccessful efforts in order to allow them the opportunity to obtain and submit those records for VA review. 2. After the development ordered in Paragraph 1 is complete, schedule the Veteran to undergo an examination for coronary artery disease and vascular disease in his upper and lower extremities to determine the nature and etiology of any such disorders. The examiner should review the claims file in conjunction with the examination. The examiner should assume for purposes of the examination that the Veteran was exposed to asbestos and galvanized metals during service. The examiner should provide diagnoses associated with the Veteran’s claimed coronary artery disease and vascular disease in his upper and lower extremities, and for each diagnosis, opine as to whether it is at least as likely as not (at least a 50 percent probability) that the diagnosed disorder was: 1) incurred during service; and/or 2) resulted from an in-service injury, illness, or event, to include asbestos exposure and/or galvanized metal poisoning. The examiner should provide a detailed rationale that explains fully all of the reasons for the given opinions. 3. After the development ordered in Paragraph 1 is complete, schedule the Veteran to undergo an examination for emphysema and COPD to determine the nature and etiology of any such disorders. The examiner should review the claims file in conjunction with the examination. The examiner should assume for purposes of the examination that the Veteran was exposed to asbestos and galvanized metals during service. The examiner should provide diagnoses associated with the Veteran’s claimed emphysema and COPD, and for each diagnosis, opine as to whether it is at least as likely as not (at least a 50 percent probability) that the diagnosed disorder was: 1) incurred during service; and/or 2) resulted from an in-service injury, illness, or event, to include asbestos exposure and/or galvanized metal poisoning. The examiner should provide a detailed rationale that explains fully all of the reasons for the given opinions. 4. After the development ordered in Paragraph 1 is complete, obtain a medical opinion as to whether it is at least as likely as not (at least a 50 percent probability) that the Veteran’s sleep apnea was: 1) incurred during service; and/or 2) resulted from an in-service injury, illness, or event, to include asbestos exposure and/or galvanized metal poisoning. The reviewing clinician should assume for purposes of the examination that the Veteran was exposed to asbestos and galvanized metals during service. The examiner should provide a detailed rationale that explains fully all of the reasons for the given opinions. If the reviewing clinician determines that a full sleep apnea examination of the Veteran is necessary in order to render the requested opinions, then the Veteran should be scheduled to undergo such an examination. (Continued on the next page)   5. After completion of the above development, the issues on appeal should be readjudicated. If the determination remains averse to the Veteran, he and his representative should be furnished with a SSOC and be given an opportunity to respond. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.S. Lee 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.