Citation Nr: 21072704 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 19-14 779A DATE: December 6, 2021 REMANDED Service connection for a lung/respiratory condition is remanded. Service connection for hypertension is remanded. Service connection for diabetes mellitus type II is remanded. Service connection for hypothyroidism is remanded. Service connection for morbid obesity is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from November 1983 to November 1987 and January 1989 to January 1995. The matter is on appeal before the Board from a January 2019 rating decision. The Veteran provided testimony at a September 2020 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Service Connection Lung/Respiratory Condition The Veteran asserts that he has a lung/respiratory condition that is related to his active military service. Specifically, he contends that he was exposed to environmental hazards from an incinerator while stationed in Atsugi Japan. He underwent a VA examination in January 2019, at which the VA examiner found that the Veteran did not have any diagnosed respiratory or lung conditions. The Veteran reported that in 1995, when he went into the federal law enforcement academy, that he was having shortness of breath and trouble completing the required running. He continued to have shortness of breath with exertion and tightness of the chest with prolonged walking and running. In 2011, he was given an albuterol inhaler for shortness of breath and wheezing on exertion as needed. He denied any other respiratory diseases. In addition, the VA examiner noted under the functional impact section, that the Veteran has shortness of breath on exertion and that he uses albuterol as needed. The examiner opined that the Veteran's obesity may contribute to his breathlessness on exertion, but he has no diagnosis of any respiratory disease at present time. It was noted that his spirometry demonstrated mild obstruction. There was no significant bronchodilator response that does not preclude a clinical response to bronchodilator. There is no diagnosis of either asthma or COPD. As the Veteran did not have a diagnosis, the examiner found that it was less likely than not that the Veteran had a respiratory/lung condition incurred in or otherwise related to his active military service, to include exposure to environmental hazards while serving in Atsugi Japan. Regardless of a diagnosis, the findings reported on the VA examination at least show that the Veteran has a problem significant enough to have been provided with an inhaler. As such, a remand is warranted to obtain a VA medical opinion for clarification purposes to determine whether the Veteran's symptoms of shortness of breath and wheezing are related to his active military service, specifically exposure to environmental hazards while serving in Atsugi Japan. Service Connection Hypertension The Veteran asserts that he has hypertension that is related to his active military service. Specifically, he contends that he was exposed to environmental hazards from an incinerator while stationed in Atsugi Japan. He underwent a VA examination in January 2019, at which the VA examiner found the Veteran to have a diagnosis of hypertension from December 2014. The VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's hypertension was related to his active military service, to include exposure to environmental hazards while serving in Atsugi Japan. The examiner explained that hypertension is an interaction between multiple genetic and environmental factors and is exacerbated by obesity, sleep apnea, increased salt intake, alcohol, cigarette smoking and metabolic syndrome. The examiner then stated that there is no relationship between the Veteran's hypertension and exposure to environmental hazards in Atsugi Japan. However, the examiner did not offer a proper explanation as to why there is no relationship. To state that hypertension is an interaction between multiple genetic and environmental factors that is exacerbated by other issues, and then to dismiss a potential environmental factor such as exposure to environmental hazards without explanation as to why it is not an appropriate environmental factor, does not provide an appropriate rationale. In addition, the Veteran has submitted multiple treatises and the rationale did not address any of the treatise information submitted by the Veteran. The Board also notes that the Veteran's service treatment records (STRs) reflect that the Veteran was noted to be borderline for hypertension at his January 1995 separation examination. At a March 1995 VA examination he was also diagnosed with asymptomatic borderline hypertension. These findings also were not discussed in the rationale. As such, a remand is warranted to obtain a VA medical opinion for purposes of clarification, which also takes into account and discusses the treatises submitted by the Veteran and his borderline hypertension noted at separation and at a March 1995 VA examination. Service Connection Diabetes Mellitus Type II The Veteran asserts that he has diabetes mellitus type II that is related to his active military service. Specifically, he contends that he was exposed to environmental hazards from an incinerator while stationed in Atsugi Japan. He underwent a VA examination in January 2019, at which the VA examiner found the Veteran to have a diagnosis of diabetes mellitus type II from February 2018. The VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's diabetes was related to his active military service, to include exposure to environmental hazards while serving in Atsugi Japan. The examiner explained that diabetes mellitus involves the absence of insulin secretion, which is type I, or peripheral insulin resistance, which is type II causing hyperglycemia. Early symptoms aren't related to hyperglycemia and include polydipsia, polyphagia, polyuria, and weight loss. The examiner noted that the Veteran was diagnosed with diabetes mellitus after his military service. The examiner then stated that there was no relationship between the Veteran's diabetes mellitus and environmental exposure in Atsugi Japan. The examiner provided an explanation of diabetes type I and type II, and gave some examples of early symptoms, but did not provide any explanation for why they came to the conclusion that there is no relationship between the Veteran's diabetes mellitus and environmental exposure in Atsugi Japan. In addition, the Veteran has submitted multiple treatises and the rationale did not address any of the treatise information submitted by the Veteran. As such, a remand is warranted to obtain a VA medical opinion for purposes of clarification, which also takes into account and discusses the treatises submitted by the Veteran. Service Connection Hypothyroidism The Veteran asserts that he has hypothyroidism that is related to his active military service. Specifically, he contends that he was exposed to environmental hazards from an incinerator while stationed in Atsugi Japan. He underwent a VA examination in January 2019, at which the VA examiner found the Veteran to have a diagnosis of hypothyroidism from February 2018. The VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's hypothyroidism was related to his active military service, to include exposure to environmental hazards while serving in Atsugi Japan. Other than the Veteran being diagnosed in February 2018 with hypothyroidism, the examiner did not offer any rationale for their conclusion. In addition, the Veteran had submitted multiple treatises, which were not addressed. As such, a remand is warranted to obtain a VA medical opinion that offers an explained rationale and takes into account and discusses the treatises submitted by the Veteran. Service Connection Morbid Obesity The Veteran asserts that he has morbid obesity that is related to his active military service and is secondary to his hypothyroidism. Specifically, he contends that he was exposed to environmental hazards from an incinerator while stationed in Atsugi Japan. A VA medical opinion was rendered in January 2019, in which the VA examiner found the Veteran to have a diagnosis of morbid obesity. The VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran's morbid obesity was related to his obesity during service. The examiner noted the Veteran's weight of 190 at the time of his discharge in January 1995, his weight of 281 in December 2009, his weight of 298 in December 2011, his weight of 260 in October 2014, his weight of 324 in April 2016, his weight of 228 in February 2018, and his current weight of 318. The examiner explained that the Veteran gained a lot of weight due to decreased physical activities and not eating good food. The rationale did not address the Veteran's contentions of exposure to environmental hazards from an incinerator while serving in Japan, nor his assertion that his morbid obesity is also related to his hypothyroidism. In addition, the Veteran has submitted multiple treatises and the rationale did not address any of the treatises. As such, a remand is warranted to obtain a VA medical opinion that addresses the contended exposure to environmental hazards while serving in Atsugi Japan, the contention that the morbid obesity is secondary to hypothyroidism, and that takes into account and discusses the treatises submitted by the Veteran. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's claimed lung/respiratory condition. If a VA examination is required to answer the Board's questions, then schedule the Veteran for an examination. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's claimed lung/respiratory condition, including the Veteran's symptoms of shortness of breath and wheezing for which he has a prescription for an albuterol inhaler, began in or were otherwise caused by his active military service, to include exposure to environmental hazards from an incinerator while serving in Atsugi Japan? Why or why not? The examiner should take into account and discuss the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. 2. Obtain a VA medical opinion to determine the etiology of the Veteran's hypertension. If a VA examination is required to answer the Board's questions, then schedule the Veteran for an examination. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension began in or was otherwise caused by his active military service, to include exposure to environmental hazards from an incinerator while serving in Atsugi Japan? Why or why not? The examiner should take into account and discuss the borderline hypertension noted in the Veteran's January 1995 separation examination and March 1995 VA examination, the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. 3. Obtain a VA medical opinion to determine the etiology of the Veteran's diabetes mellitus type II. If a VA examination is required to answer the Board's questions, then schedule the Veteran for an examination. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus type II began in or was otherwise caused by his active military service, to include exposure to environmental hazards from an incinerator while serving in Atsugi Japan? Why or why not? The examiner should take into account and discuss the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. 4. Obtain a VA medical opinion to determine the etiology of the Veteran's hypothyroidism. If a VA examination is required to answer the Board's questions, then schedule the Veteran for an examination. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypothyroidism began in or was otherwise caused by his active military service, to include exposure to environmental hazards from an incinerator while serving in Atsugi Japan? Why or why not? The examiner should take into account and discuss the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. 5. Obtain a VA medical opinion to determine the etiology of the Veteran's morbid obesity. If a VA examination is required to answer the Board's questions, then schedule the Veteran for an examination. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's morbid obesity began in or was otherwise caused by his active military service, to include exposure to environmental hazards from an incinerator while serving in Atsugi Japan? Why or why not? The examiner should take into account and discuss the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. (b.) If the examiner finds that the Veteran's hypothyroidism is at least as likely as not caused by or otherwise related to his active military service, then the examiner should answer whether it is at least as likely as not (50 percent or greater probability) that the Veteran's morbid obesity is caused by his hypothyroidism? Why or why not? The examiner should take into account and discuss the treatises submitted by the Veteran in July 2018, October 2018, February 2019, May 2019, his personal testimony at the September 2020 Board hearing, as well as the impact or lack thereof of exposure to environmental hazards from an incinerator while serving in Atsugi Japan. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, Associate 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.