Citation Nr: 21065141 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 18-18 084 DATE: October 25, 2021 REMANDED Entitlement to service connection for type 2 diabetes mellitus (diabetes), to include as due to exposure to herbicide agent, jet fuel, and/or sarcoidosis treatment is remanded. Entitlement to service connection for a lung disorder, to include as due to exposure to herbicide agent and/or jet fuel is remanded. Entitlement to service connection for chronic kidney disease, to include as due to exposure to herbicide agent and/or jet fuel, and diabetes is remanded. Entitlement to service connection for actinic keratosis, to include as due to exposure to herbicide agent and/or jet fuel is remanded. Entitlement to service connection for neuropathy of the bilateral upper extremities is remanded. Entitlement to service connection for neuropathy of the bilateral lower extremities is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to May 1971. The Board has expanded the Veteran's sarcoidosis claim to encompass all lung disorders diagnosed, including bronchitis, aspergillus, mycotic lung infection, and sarcoidosis. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record). This matter was previously denied by the Board in April 2020. The Veteran appealed those denials to the Court of Appeals for Veterans Claims (Court), which in a March 2021 Order, vacated the Board's prior decisions and remanded those claims for further development. Of note here, the Court ordered the Board to remand the issues of diabetes, lung disorder, kidney disease, and actinic keratosis, for an examination to assess whether any of those disabilities is related to jet fuel exposure. As the Board is remanding the issues for further development per the Court's directive, the Board will address the Veteran's herbicide agent-based claims when the Court-ordered examinations have been completed and any issues on appeal still unadjudicated are returned to the Board. 1. Entitlement to service connection for type 2 diabetes mellitus (diabetes), to include as due to exposure to herbicide agent, jet fuel, and/or sarcoidosis treatment is remanded. 2. Entitlement to service connection for a lung disorder, to include as due to exposure to herbicide agent and/or jet fuel is remanded. 3. Entitlement to service connection for chronic kidney disease, to include as due to exposure to herbicide agent and/or jet fuel, and diabetes is remanded. 4. Entitlement to service connection for actinic keratosis, to include as due to exposure to herbicide agent and/or jet fuel is remanded. As to diabetes, a lung disorder, chronic kidney disease, and actinic keratosis, the Veteran argues that they are related to breathing and coming into physical contact with jet fuel in service. An examination has not been rendered to determine the etiology of these disabilities, to include as due to jet fuel exposure. Remand is required for such an examination. 5. Entitlement to service connection for neuropathy of the bilateral upper extremities is remanded. 6. Entitlement to service connection for neuropathy of the bilateral lower extremities is remanded. The Veteran's claim for service connection for peripheral neuropathy is premised on service connection for diabetes. Because a decision on the issue of diabetes could significantly impact a decision on the issues of upper and lower bilateral peripheral neuropathy, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).Therefore, a remand of the claims for service connection for neuropathy of the bilateral upper and lower extremities is required. 7. Entitlement to service connection for obstructive sleep apnea is remanded. The 2017 VA negative nexus examination upon which the RO's denial of service connection is based was provided without the benefit of the Veteran's February 2020 Hearing Testimony. Specifically, the Veteran and his wife attest to the Veteran suffering some of the unique symptoms of sleep apnea in service, including waking up with a dry mouth, and gasping for air. Accordingly, to afford the Veteran every possible chance of obtaining a grant of service connection, the Board remands the appeal and orders as follows. The matters are REMANDED for the following action: 1. Add all outstanding VA treatment records not currently associated with the Veteran's claims file. If the Veteran has obtained treatment outside of VA, the Veteran should be afforded an opportunity to add any applicable records 2. Schedule the Veteran for a comprehensive VA examination by an appropriate clinician for each of diabetes, respiratory, kidney, and skin disorders. The examiner must review the claims file and specify each disorder for which the Veteran has a current diagnosis. For each diagnosed disorder, the examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any currently diagnosed disorder is etiologically related an in-service injury, event, or disease, to include as secondary to exposure to toxic chemicals (particularly jet fuel). 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his sleep apnea. The examiner should opine as to whether the Veteran's current disability is at least as likely as not related to an in-service injury, event, or disease, including his testimony that while on active duty, he would wake up gasping for air. A complete rationale must be provided for all opinions expressed. As long as they attribute the Veteran's disorders to active duty service, the Veteran's statements should be discussed in any examination ordered. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Maskatia