Citation Nr: 21065000 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-18 130 DATE: October 22, 2021 ORDER Entitlement to service connection for major depressive disorder is granted. REMANDED Entitlement to service connection for a skin disability, to include spots in right leg and right shoulder, swollen hands and feet, bacteria on feet and discoloration, to include as due to chemical exposure is remanded. Entitlement to service connection for left arm skin rash, to include as due to chemical exposure is remanded. Entitlement to service connection for type II diabetes mellitus, to include as due to chemical exposure is remanded. Entitlement to service connection for an eye disability, to include retinopathy, dry eye syndrome, cataracts, and lattice degeneration of the retina, to include as due to chemical exposure is remanded. Entitlement to service connection for erectile dysfunction, to include as due to chemical exposure is remanded. Entitlement to service connection for hypertension, to include as due to chemical exposure is remanded. Entitlement to service connection for bone loss in face and skull, to include as due to chemical exposure is remanded. Entitlement to service connection for tinnitus, to include as due to chemical exposure is remanded. Entitlement to service connection for a left kidney disability, to include as due to chemical exposure is remanded. Entitlement to service connection for a gallbladder disability, to include as due to chemical exposure is remanded. Entitlement to service connection for appendix tumor, to include as due to chemical exposure is remanded. Entitlement to service connection for rectal bleeding, to include as due to chemical exposure is remanded. Entitlement to service connection for a headache disability, to include as due to chemical exposure is remanded. Entitlement to service connection for right leg nerve damage, to include as due to chemical exposure is remanded. Entitlement to service connection for a left leg disability, to include as due to chemical exposure is remanded. Entitlement to service connection for sinusitis, to include as due to chemical exposure is remanded. Entitlement to service connection for a multi-site arthritis disability, to include rheumatoid arthritis, to include as due to chemical exposure is remanded. FINDING OF FACT The Veteran's current major depressive disorder began in service and continued after service. CONCLUSION OF LAW The criteria for service connection for major depressive disorder have been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1969 to April 1970. This matter came before the Board of Veterans Appeals (Board) on appeal from May 2014 and May 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). A May 2019 Board decision reopened the claim for service connection for sinusitis, diabetes mellitus, headaches, nerve damage, vision problems and a skin disability, and remanded the issues on appeal for further development. Evidence in the record suggests that the Veteran has been diagnosed with multiple eye conditions; therefore, the Board will broadly construe the issue of service connection for vision problems as a claim for service connection for an eye disability, to include retinopathy, dry eye syndrome, cataracts, and lattice degeneration of the retina. The record also shows a diagnosis of multi-site arthritis, and the Board will broadly construe the issue of service connection for rheumatoid arthritis as a claim for a multi-site arthritis disability, to include rheumatoid arthritis. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). The May 2019 Board decision asked that VA treatment records from January 1981 to September 1999 and from October 2017 to the present be obtained. The Board's review indicates that the outstanding VA treatment records were requested in November 2019 and VA treatment records from 1984 to 1999 and from October 2017 to the present have since been added to the claim file. The record also contains an April 2020 notice indicating that records from 1981 to 1983 had been requested but were unavailable. The Board therefore finds that there has been substantial compliance with the remand directives and will proceed to adjudicate the issues on appeal based on the evidence of record. 1. Entitlement to service connection for major depressive disorder The Veteran contends that his depressive disorder began in service and has continued since service. The Board concludes that the Veteran has a current diagnosis of major depressive disorder that began during active service and thus service connection is warranted. Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006). Service treatment records are silent for mental health complaints, symptoms, or diagnoses. December 2017 VA mental health records noted persistent nightmares dating back to the 1970s after a classified incident at Pease Air Force Base (AFB). The provider found delusional disorder. An April 2018 private examination diagnosed depressive disorder with psychotic and anxious distress features. The examiner noted that there were no mental health issues at entrance. The examiner opined that the Veteran's current disability likely began in service and continued uninterrupted to the present, specifically noting the Veteran's reports of fear, worry and anxiety beginning in service and worsening over the years and a buddy statement from a friend reporting personality changes including social withdrawal and isolation, when the Veteran returned from service. A January 2020 VA examination diagnosed major depressive disorder. The examiner found that it was at least as likely as not due to service, stating as a rationale that the Veteran had no mental health issues at entrance and experienced substantial stress in service. Based on this history, the examiner opined that the Veteran's disability had its roots in service, began as depression and anxiety and developed into its current psychotic form over time. At the outset, the Board finds that the VA examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds they are entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30205 (2008). In a January 2018 statement, the Veteran reported that his fear, worry, and anxiety began while he was stationed at Pease AFB and it worsened over the years. He also stated that he has had trouble interacting with other people since that time. The Veteran also submitted a January 2018 statement from his friend D.G., who reported that she had known the Veteran since grade school and observed changes in his personality after service. She specifically reported that prior to service he was friendly and happy, and that when he returned home after service, he was quiet, "spaced out" and withdrawn. The Board notes that the Veteran and his friend are competent to report the onset of lay observable symptoms they experienced and assigns their statements significant probative weight. The Board therefore finds that the Veteran's current depressive disorder had its onset in service. Both the April 2018 private opinion and the January 2020 VA opinion found that the current depressive disorder began in service and worsened over time. The Board notes that these opinions are consistent with VA treatment records noting symptoms of nightmares dating back to the 1970s as well as the competent lay evidence of record. Service connection for major depressive disorder is therefore warranted. 38 C.F.R. § 3.303(d). REASONS FOR REMAND 1. Entitlement to service connection for a skin disability, to include spots in right leg and right shoulder, swollen hands and feet, bacteria on feet and discoloration, to include as due to chemical exposure 2. Entitlement to service connection for left arm skin rash, to include as due to chemical exposure 3. Entitlement to service connection for type II diabetes mellitus, to include as due to chemical exposure 4. Entitlement to service connection for an eye disability, to include as due to chemical exposure 5. Entitlement to service connection for erectile dysfunction, to include as due to chemical exposure 6. Entitlement to service connection for hypertension, to include as due to chemical exposure 7. Entitlement to service connection for bone loss in face and skull, to include as due to chemical exposure 8. Entitlement to service connection for tinnitus, to include as due to chemical exposure 9. Entitlement to service connection for a left kidney disability, to include as due to chemical exposure 10. Entitlement to service connection for a gallbladder disability, to include as due to chemical exposure 11. Entitlement to service connection for appendix tumor, to include as due to chemical exposure 12. Entitlement to service connection for rectal bleeding secondary to chemical exposure 13. Entitlement to service connection for a headache disability, to include as due to chemical exposure 14. Entitlement to service connection for right leg nerve damage, to include as due to chemical exposure 15. Entitlement to service connection for a left leg disability, to include as due to chemical exposure 16. Entitlement to service connection for sinusitis, to include as due to chemical exposure 17. Entitlement to service connection for a multi-site arthritis disability, to include rheumatoid arthritis, to include as due to chemical exposure The Veteran has not yet been afforded a VA examination in connection with these issues. VA treatment records document current diagnoses of skin rashes on the arms and legs, diabetes mellitus, eye disabilities, erectile dysfunction, hypertension, maxilla deterioration, tinnitus, nephrolithiasis, contracted gallbladder with gallstones, fecalith in the appendix, right lower leg pain and a history of chronic sinusitis. The record also shows that the Veteran reported a history of rheumatoid arthritis and VA treatment records show a diagnosis of multi-site arthritis and a prescription to treat arthritis pain. The Board also notes that the Veteran is competent to report lay-observable symptoms such as left leg pain, rectal bleeding, and headaches. In August 2020, the Veteran submitted an article regarding contaminants, including water contaminants, at Pease AFB. While medical treatises that are not specific to a particular veteran's disability picture (like those submitted in this case) are generally insufficient, alone, to establish linkage for service-connection purposes, see, e.g., Wallin v. West, 11 Vet. App. 509, 514 (1998); Libertine v. Brown, 9 Vet. App. 521, 523 (1996), such medical treatise evidence may nevertheless provide "'important support' for service connection" outside of establishing linkage and trigger the need for a VA examination. McCray v. Wilkie, 31 Vet. App. 243, 255 (2019). Here, as the Veteran has diagnoses or has reported lay-observable symptoms related to the issues on appeal and has submitted evidence that his diagnoses may be related to service, the Board finds that remand for VA examinations is required. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In so finding, the Board notes that the threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event is a low one. Id. at 83. Regarding the Veteran's skin disabilities, October 2018 VA dermatology records noted a chronic eruption that may be exacerbated by the Veteran's mental health disability. As service connection for depressive disorder has been granted above, the question of whether the left arm skin disability was caused or aggravated by the service connected mental health disability should be addressed upon remand. The Board's review also indicates that there may be outstanding private treatment records. January 2018 records indicate that the Veteran saw an outside ENT and April 2018 and November 2019 VA treatment records noted that the Veteran saw an outside provider for dermatology. A remand is required to allow VA to obtain authorization and request these records. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any private dermatologist and ENT. Make two requests for the authorized records from all identified providers unless it is clear after the first request that a second request would be futile. 2. After the development in (1), schedule the Veteran for an appropriate VA examination, to determine the etiology of any skin disability, including rashes on the arms and legs. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current skin disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran's active service, to include whether it was due to contaminants from Pease Air Force Base and whether it was caused or aggravated by the Veteran's service connected depressive disorder. The opinion should address the article regarding contaminants submitted by the Veteran. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 3. After the development in (1), schedule the Veteran for an appropriate VA examination, to determine the etiology of any current diabetes mellitus, eye disabilities, erectile dysfunction, hypertension, maxilla deterioration, nephrolithiasis, contracted gallbladder with gallstones, fecalith in the appendix, right or left lower leg, chronic sinusitis, and multi-site arthritis disabilities. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current diabetes mellitus, eye disabilities, erectile dysfunction, hypertension, maxilla deterioration, nephrolithiasis, contracted gallbladder with gallstones, fecalith in the appendix, right or left lower leg, chronic sinusitis, and multi-site arthritis disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran's active service, to include whether it was due to contaminants from Pease Air Force Base. The opinion should address the article regarding contaminants submitted by the Veteran. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 4. After the development in (1), schedule the Veteran for an appropriate VA examination, to determine the etiology of the Veteran's tinnitus. The examiner should review the file and provide a complete rationale for all opinions expressed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that tinnitus is related to the Veteran's active service, to include whether it was due to contaminants from Pease Air Force Base. The opinion should address the article regarding contaminants submitted by the Veteran. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 5. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Arnold 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.