Citation Nr: 21072564 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-52 704 DATE: December 3, 2021 REMANDED The claim for a compensable rating for a bilateral hearing loss disability is remanded. The claim for service connection for a low back disability is remanded. The claim for service connection for obstructive sleep apnea, to include as due to in-service chemical exposure and secondary to service-connected lead toxicity, is remanded. The claim for service connection for diabetes mellitus, to include as due to in-service chemical exposure and secondary to service-connected lead toxicity, is remanded. The claim for service connection for diabetic peripheral neuropathy of the right lower extremity is remanded. The claim for service connection for diabetic peripheral neuropathy of the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1974 to February 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2015 and April 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a February 2021 videoconference hearing. A transcript of the hearing is of record. The Board finds that a remand is necessary in this case to allow for the development of additional evidence. Regarding the claim for a compensable rating for service-connected hearing loss, the Veteran testified during the February 2021 hearing that his hearing loss has increased in severity since it was last examined by VA in April 2017. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of the service-connected hearing loss disability. VA examinations are also necessary to determine the nature and etiology of the Veteran's claimed low back disability, sleep apnea, and diabetes mellitus with associated peripheral neuropathy of the lower extremities. The Veteran contends that service connection is warranted for a low back disability as it was incurred when he fell from a ladder during active duty. Service records document the Veteran's fall in February 1975 and resulting traumatic rupture of the right triceps muscle, but are negative for complaints or treatment related to the low back. Nevertheless, the Veteran is competent to report injuries that incurred during service and as the fall itself is documented in the service records, the Board finds that a medical opinion is necessary to determine whether the Veteran's current low back disability is due to service. The Veteran also contends that service connection is warranted for obstructive sleep apnea and diabetes mellitus with associated peripheral neuropathy. Service personnel records show that he served as a machinist's mate, to include on-board the USS BASILONE. His exposure to various chemicals, to include lead, has been established and the Veteran is service-connected for lead toxicity. The Veteran testified in February 2021 that he was diagnosed with obstructive sleep apnea soon after discharge when he participated in a sleep study at Beth Israel Deaconess Medical Center in Boston, Massachusetts. A VA central nervous system examination report in August 2018 also notes that adults with lead poisoning can frequently have sleep disorders, such as hypersomnolence and difficulty falling asleep. Furthermore, the Veteran submitted treatise evidence in February 2021 indicating that exposure to lead could be a potential contributing factor in the development of diabetes mellitus. As such, VA examinations and medical opinions are necessary to determine the nature and etiology of the claimed sleep apnea and diabetes mellitus. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Beth Israel Deaconess Medical Center in Boston pertaining to the study of his obstructive sleep apnea. Make two requests for the authorized records from this facility unless it is clear after the first request that a second request would be futile. 2. Invite the Veteran to submit a copy of the medical study referenced during his February 2021 hearing linking sleep apnea to exposure to lube oils (identified as JP-8, 7, and 6). 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hearing loss disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of his low back disability. The examiner must review the claims file. The examiner should determine whether it is at least as likely as not that the Veteran's current low back disability is etiologically related to his in-service fall from a ladder in February 1975. A full rationale must be provided. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Service records show that the Veteran fell from a ladder aboard ship in February 1975. He incurred significant damage to his right arm, including a traumatic rupture to the medial head of the right triceps muscle. The Veteran testified that he also injured his low back when he fell, but his treatment was focused on the more immediate problem of his right arm. There are no complaints or treatment for the low back in the service records. After service, the earliest evidence of low back pain dates from March 1997, when the Veteran was treated for low back pain radiating into the legs by his private chiropractor. He was diagnosed with neurogenic claudication by his private physician in December 2004 and an October 2011 lumbar MRI demonstrated severe arthritis and degenerative disc disease. The Veteran has also been diagnosed with spinal stenosis and undergone multiple spinal surgeries beginning with lumbar laminectomies in November 2011. 5. Schedule the Veteran for a VA examination to determine the nature and etiology of his obstructive sleep apnea. The examiner must review the claims file. The examiner should determine whether it is at least as likely as not that the Veteran's sleep apnea is etiologically related to chemical exposure during service and/or the Veteran's reports of in-service sleep disturbances. The Veteran testified in February 2021 that he experienced disrupted sleep during service. He testified that he would "act a little crazy waking up," and would gasp for air and kick his legs. The Veteran also reported participating in a sleep study in Boston a few years after his discharge from service. He was one of the first people diagnosed with sleep apnea in Boston and has used a continuous positive airway pressure (CPAP) machine since that time. Service records are negative for evidence of sleep apnea, but the Veteran's exposure to various chemicals and lead are established by his duties as a machinist's mate and the grant of service connection for lead toxicity. An August 2018 VA examiner noted that adults with lead poisoning can frequently have sleep disorders, such as hypersomnolence and difficulty falling asleep. 6. Schedule the Veteran for a VA examination to determine the nature and etiology of his diabetes mellitus with associated peripheral neuropathy of the lower extremities. The examiner must review the claims file. The examiner should determine whether it is at least as likely as not that the Veteran's diabetes mellitus is etiologically related to chemical exposure during service. Service records are negative for complaints or treatment for diabetes mellitus. The post-service record contains conflicting information regarding when the condition was first diagnosed. The Veteran reported in May 2018 that diabetes was identified in 1999; however, VA Medical Center records document his reports that the condition was diagnosed in approximately 2010. In any event, the Veteran contends that his diabetes is etiologically related to lead exposure during active duty. He is service-connected for lead toxicity and his exposure is therefore established. In support of his claim, the Veteran submitted treatise evidence addressing a possible link between diabetes mellitus and lead exposure. K. Conner Veterans Law Judge Board of Veterans' Appeals M. Riley, Attorney for the Board Department of Veterans Affairs 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.