Citation Nr: 21069823 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 19-01 590 DATE: November 19, 2021 REMANDED Entitlement to service connection for inclusion body myositis is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from March 1977 to March 1980. He died in July 2020. The Appellant is the Veteran's surviving spouse. The Board of Veterans' Appeals (Board) notes that the Appellant is appropriately recognized as the substitute-claimant in this case. 38 U.S.C. § 5121A. This matter comes before the Board on appeal from a June 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado (Agency of Original Jurisdiction (AOJ)). The Appellant testified at a video conference hearing before the undersigned in March 2021. A transcript of the proceeding is of record. The Appellant asserts that service connection should be awarded for the Veteran's inclusion body myositis based on his alleged chemical exposure during his active duty service. She testified that he told her he was required to mix chemical weapons during his service as part of the duties associated with his military occupational specialty (MOS). She stated that while his MOS is listed on his DD-214 as a medical specialist, his original MOS involved special forces training. Unfortunately, he allegedly sustained a disqualifying injury and had to change his MOS to a medical specialist. While his military personnel records only reflect one single MOS, they do contain a note under assignment considerations stating, "special forces voluntary terminee." Additionally, she has suggested that the Veteran may have been exposed to chemicals while stationed at Fort Bragg via the drinking water. In support of the claim, she provided several recent articles documenting that Fort Bragg's water was contaminated with high levels of lead, trihalomethanes, and per- and polyfluoroalkyl substances (PFAS). These articles also describe that exposure to PFAS can negatively impact one's immune system. The condition for which the Appellant seeks service condition inclusion body myositis is allegedly caused via genetics or environment and attacks the immune system. The effects are purportedly similar to those of ALS. The Board, finding that the Appellant has offered evidence that may suggest correlation between the Veteran's condition and his service, nonetheless must seek a medical opinion that considers this etiology. As such, a remand is necessary, The matters are REMANDED for the following action: 1. The AOJ shall associate the Veteran's outstanding VA medical treatment records with the file, specifically those records from November 2018 to July 2020. 2. Contact the appropriate entity to inquire as to the type(s) of chemical weapons that may have been handled by a "Special Forces Voluntary Terminee AR614-200" with "training in MOS 91B10" with the 10th Special Forces in 1977. 3. Ask the Appellant to complete a VA Form 21-4142 for any private treatment providers that treated the Veteran for inclusion body myositis. Thereafter, obtain and associate with the claims folder any private treatment records identified. 4. Then, after receiving a response concerning the types of potential exposures as a Special Forces trainee with the 10th Special Forces, the AOJ should seek a medical opinion from a neurologist or rheumatologist in order to determine whether the Veteran's sporadic inclusion body myositis is causally related to service. The claims file must be made available to and be reviewed by the examiner. The specialist should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sporadic inclusion body myositis occurred in or is otherwise etiologically related to his military service, to include any exposure to contaminated water at Fort Bragg and/or Fort Benning (as well as chemical weapons while a Special Forces Volunteer Trainee, if any). The examiner should consider the following: the Veteran's service treatment records; the Veteran's service personnel records, documenting his MOS as a medical specialist and his voluntary termination from special forces, as well as documenting his stationing at Fort Bragg and Fort Benning; his VA treatment records, documenting a diagnosis of and treatment for inclusion body myositis; the Military Myositis Questionnaire completed in November 2020; the March 2021 hearing testimony; the articles associated with the file in April 2021 suggesting the presence of contaminated water at Fort Bragg; the June 2021 correspondence from the Appellant including a Neurology Board Review Manual entitled "Neurodegenerative Disorders: Amyotrophic Lateral Sclerosis and Inclusion Body Myositis"; and the letter from the Veteran's former physician provided in June 2021, confirming his diagnosis of sporadic inclusion body myositis. The specialist must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the specialist must state this and provide a rationale for such conclusion. 5. Thereafter, readjudicate the claim. If any benefit sought on appeal remains denied, furnish the Appellant and her representative, if any, a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.