Citation Nr: 21066743 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 12-21 113 DATE: November 2, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to diabetes mellitus, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to diabetes mellitus, is remanded. Entitlement to service connection for a heart disorder, to include as secondary to diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1966 to June 1969. In August 2013, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims file. Service Connection Claims The Veteran has presented multiple theories of entitlement with regard to his claims. First, the Veteran alleges that his disorders were caused by or incurred as a result to in-service exposure to hazardous chemicals, including mercury, arsenic, methylene chloride, chloroform, benzene, chromium, and/or trichloroethylene. Second, he contends that they were caused by or incurred as a result of in-service exposure to herbicide agents, including Agent Orange. Third, he argues that his disorders were caused by or incurred as a result of in-service radiation exposure. He also contends that his heart disorders and peripheral neuropathy of the bilateral upper and lower extremities were caused or aggravated by his diabetes mellitus, type II. Regarding the first theory of entitlement to service connection, the Veteran has provided internet articles identifying specific chemicals found at Fort Lewis and the McChord Air Force base, where he was stationed during active duty service. One article reports that, according to the Department of Defense, in 1992, trichloroethylene was found in the ground water at Fort Lewis and that methylene chloride, chloroform, benzene, arsenic, chromium, and mercury were found in test wells ad surface drainage at McChord Air Force Base. Another article reports that high levels of PFAS were found in the drinking water at both McChord Air Force Base and Fort Lewis in tests conducted in 2017 and 2018. A third article states that Fort Lewis and McChord Air Force Base had contaminated groundwater, soil, sludge, and surface water as a result of site operations which included maintaining aircraft and vehicles, repairing and refurbishing weapons, and neutralizing caustic paint stripping waste and battery acids throughout their operational history. The Veteran also provided medical treatise evidence in support of his claims. In that regard, he submitted articles linking arsenic exposure to an increased prevalence of diabetes mellitus, type II, and mercury exposure in young adulthood to an elevated risk for diabetes later in life. The Veteran was provided with a VA examination assessing the etiology of his diabetes in November 2019. At that time, the VA examiner concluded that it was less likely than not that the Veteran's diabetes, heart disorders, and peripheral neuropathy were caused by or incurred as a result of in-service exposure to hazardous chemicals. The only rationale provided by the examiner was that the "peer-reviewed medical literature is against a relationship of the [V]eteran's [exposure to] various substances during service as a possible causes [sic] of his medical conditions." The Board finds that the November 2019 VA opinion is conclusory in nature, does not provide sufficient rationale, and fails to address evidence in favor of the Veteran's claim, including the medical treatise evidence provided by the Veteran. Further, the November 2019 VA opinion was based primarily on "peer-reviewed medical literature" which was "against a relationship," but the examiner did not provide or identify the specific "medical literature" upon which the opinion was based. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("Most of the probative value of a medical opinion comes from its reasoning. Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it only contains data and conclusions."). The Board is cognizant of the opinions of record and the development accomplished. Nonetheless, regrettably, additional action is needed to address the above-reference internet articles. A new VA opinion is warranted that meaningfully addresses the nature and etiology of the Veteran's diabetes, heart disorders, and peripheral neuropathy. The matters are REMANDED for the following action: Obtain a new VA opinion from an appropriate clinician to determine the nature and etiology of the Veteran's diabetes, heart disorders, and peripheral neuropathy. To the extent possible, the examiner should be different from the November 2019 examiner. The Veteran's claims file, all electronic records, and a copy of this remand must be reviewed by the examiner, and the examiner must state that this evidence was reviewed in the examination report. All pertinent symptomatology and findings must be reported in detail. Based upon a complete review of the evidence of record, to include the numerous medical treatise articles submitted by the Veteran, the examiner must opine whether it is at least as likely as not (e.g., a 50 percent probability or greater) that the Veteran's diabetes, heart disorders, and/or peripheral neuropathy are related to in-service exposure to hazardous chemicals including methylene chloride, chloroform, benzene, arsenic, chromium, mercury, trichloroethylene, or PFAS. A complete rationale for all opinions must be provided. If medical literature or other sources are relied upon in the opinion provided, the examiner must identify the sources referenced and explain how those sources specifically apply to the Veteran's case. The examiner must consider and discuss all pertinent evidence in the claims file, to include the Veteran's lay statements regarding in-service and post-service symptomatology and observations. Also, the examiner is advised that the Veteran is competent to report observable symptomatology. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Katz, Counsel 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.