Citation Nr: 21071767 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 19-02 261 DATE: December 1, 2021 ORDER Service connection for headaches is granted. REMANDED Service connection for left hand impairment is remanded. Service connection for right hand impairment is remanded. Service connection for left shoulder impairment is remanded. Service connection for right shoulder impairment is remanded. Service connection for gastrointestinal impairment, claimed as sporadic internal bleeding, is remanded. Service connection for heart impairment is remanded. FINDING OF FACT The Veteran's headaches began during active service. CONCLUSION OF LAW The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303 REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran has active service from June 1996 to July 2000. This matter is on appeal from a May 2017 rating decision. In November 2021, a hearing was held before the undersigned. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Service connection for headaches Regarding service connection for headaches, the Veteran' VA medical records contain several diagnoses of headaches. During the November 2021 hearing, the Veteran states that these headaches began during service. The Board finds that service connection for headaches is warranted. The Board finds the Veteran's testimony regarding the onset and continuation of headaches to be competent and credible. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) ("A lay witness may testify as to his or her observations of the features or symptoms that a claimant exhibited."). Resolving doubt in the Veteran's favor, the Board finds that the Veteran's headaches had their onset in service. See 38 C.F.R. § 3.303(a) ("Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces[.]"); Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"). In light of the foregoing, service connection is warranted for headaches. REASONS FOR REMAND The Veteran asserts that service connection is warranted for numerous conditions as a consequence of his exposure to environmental toxins while serving in Japan. The record shows that the Veteran served in Atsugi, Japan, in 1998 while on active duty. In addition, the Veteran testified that he was told by medical personnel that he might develop many of the conditions for which he is asserting service connection due to the environmental toxins he reportedly was exposed to while serving in Japan; the Veteran is competent to report what he was told. A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 8186 (2006). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). 1. Service connection for left hand impairment is remanded. 2. Service connection for right hand impairment is remanded. 3. Service connection for left shoulder impairment is remanded. 4. Service connection for right shoulder impairment is remanded. 5. Service connection for gastrointestinal impairment, claimed as sporadic internal bleeding, is remanded. 6. Service connection for heart impairment is remanded. These elements are satisfied with regard to the claims of service connection for hand disorders, shoulder disorders, gastrointestinal impairment (claimed as sporadic internal bleeding), and heart impairment. Regarding the first element, in the November 2021 hearing testimony, the Veteran states that he experiences these disorders. The Veteran is considered competent to testify regarding the existence of such symptoms because such symptoms are within the knowledge and personal observations of lay witnesses. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Regarding the second element, the Veteran argues that these disorders are the result of exposure to contaminants from an incinerator complex in Japan. Consistent with this, in December 2018, the RO obtained a fact sheet describing such emissions. Additionally, service treatment records indicate injuries to the Veteran's hands. A September 1996 service treatment record (page 41 of 150) describes an injury to the "5th digit [right] hand." A November 1997 service treatment record (page 55 of 150) describes a right thumb injury. A September 1996 service treatment record (page 102 of 150) describes a burn to the left hand. Regarding the third and fourth elements, there is an indication that the above disorders could be related to exposure to emissions from an incinerator complex, but there is insufficient evidence of record by which the Board can make a decision. As the four McLendon elements are satisfied, the Veteran is entitled to a VA examination and medical opinion. Additionally, on remand the RO should obtain all relevant VA treatment records dated from October 2019 to the present before the issues on appeal are decided on the merits. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all VA treatment records from October 2019 to the present. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. After obtaining any additional records to the extent possible, provide an examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) and obtain a medical opinion regarding the nature, onset, and etiology of any hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart impairment. The examiner should review the entire claims file, conduct all necessary tests and studies, and provide the requested opinions: (a.) Whether the Veteran any hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart impairment. (b.) Whether it is at least as likely as not that any hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart impairment was incurred in the Veteran's service, including but not limited to as a result of exposure to contaminations from an incinerator complex in Japan. (c.) If the Veteran does not have a diagnosis related to hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart impairment, is any such impairment characterized by pain or functional impairment? If yes, offer the following opinions: (i) does the Veteran's hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart pain reach the level of functional impairment of earning capacity, and if so (ii) is it at least as likely as not that any hand, shoulder, gastrointestinal (claimed as intermittent internal bleeding), or heart pain that reaches the level of functional impairment of earning capacity was incurred in the Veteran's service. In rendering these opinions, the examiner should consider the toxin-related documents submitted in February 2017 and May 2017, as well as the memorandum obtained by the RO in December 2018. The examiner should also address the service treatment records noting a September 1996 injury to the "5th digit [right] hand" (page 41 of 150), the November 1997 right thumb injury (page 55 of 150), and the September 1996 burn to the left hand (page 102 of 150). The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.