Citation Nr: 21075881 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-49 608 DATE: December 21, 2021 REMANDED Entitlement to service connection for respiratory disorder, to include chronic obstructive pulmonary disease (COPD), including as due to herbicides is remanded. Entitlement to service connection for ischemic heart disease, to include as due to herbicides is remanded. Entitlement to service connection for hypertension, to include as due to herbicides is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from June 1966 to June 1970. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which denied his claims of service connection that he filed on June 5, 2013 and August 2, 2013. The Veteran and his wife presented sworn testimony at a hearing before the undersigned in April 2021. 1. Entitlement to service connection for respiratory disability, to include COPD, to include as due to herbicides, is remanded. 2. Entitlement to service connection for ischemic heart disease, to include as due to herbicides, is remanded. 3. Entitlement to service connection for hypertension, to include as due to herbicides, is remanded. The Veteran has reported he was exposed to Agnt Orange while stationed at Korat Royal Thai Air Force Base in Thailand from 1969 to 1970. The Board notes that RO did not attempt to obtain any information from the Joint Service Records Research Center. Further, the Board notes that in a September 2021 private medical opinion, it was asserted that the Veteran's exposure Agent Orange, aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP exposure provide a "causal nexus" to his claimed COPD, ischemic heart disease, and hypertension. The Board further notes that none of these exposures has been corroborated. A remand is necessary to request records from appropriate sources, including the JSRRC, regarding the details of the Veteran's service in Thailand and his alleged exposure to Agent Orange, aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP. Further, remand is necessary to provide the Veteran appropriate VA examinations for these claimed conditions. 4. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, is remanded. The Veteran has reported numerous stressors regarding his service in Thailand. In addition, the Veteran seeks both direct and secondary service connection for his psychiatric disability, which includes his claim of service connection for PTSD. At a March 2014 VA examination, the Veteran reported that while stationed in Thailand he felt anxious and worried throughout his time there and was "especially concerned that armed Vietnamese soldiers were the ones guarding them while they loaded the aircraft" and they he "never knew how to tell one side's soldiers from the other." He then reported that his base came under fire and would have to take cover, though acknowledged that he "did not see the shooting and he was not aware of anyone being injured or killed." He did report learning of a friend's combat-related death which "impacted his fear of the Vietnamese soldiers guarding him during his work." The Board notes that the VA examiner found these stressors did not meet the criteria for a PTSD diagnosis under DSM-5. The Veteran testified at the April 2021 Board hearing that while stationed in Thailand he worked with explosive munitions every day that were dangerous and that this weighed heavily on his mind. The Veteran's wife testified that he "suffers deeply over the loss of some of the pilots" that flew from the airbase. A May 2021 private opinion from Dr. Austin Smalls, a psychologist, notes the Veteran reported that "...there was a shooting, and the base came under fire. He was not sure if anyone was injured or killed. However, this was frightening". The record contains no objective evidence corroborating these claimed stressors or indicating exposure to combat circumstances. The Veteran has not been awarded a decoration that evinces combat. Further, the record indicates that the Veteran's entire period of service in the Vietnam era was limited to Thailand, without any presence in Vietnam. As such, a remand is required to allow VA to attempt to corroborate the Veteran's reported stressors. Further, the Board notes that between the March 2014 VA examination and the September 2021 private medical examination, neither opinion discussed the April 1967 service treatment record which notes the Veteran had unspecified nervousness for the prior 3 months, with a fine tremor in both hands beind noted, and anxiety, non-specific being provisionally diagnosed. As such, the Board finds that a remand for a VA psychiatric examination is necessary to adjudicate this appeal. The matters are REMANDED for the following action: 1. Attempt to corroborate the Veteran's asserted in-service exposure to herbicide agents, as well as aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP, to include requesting information from the JSRRC. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. 2. Attempt to corroborate the Veteran's in-service stressors, Korat RTAFB coming under attack in 1969 or 1970. If more details are needed, contact the Veteran to request the information. 3. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service psychiatric problems. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 4. Schedule the Veteran for a VA examination for his respiratory disability, to include COPD. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is a respiratory disability, and in particular COPD, at least as likely as not related to service, including claimed exposure to Agent Orange, aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP. Provide a rationale to support the opinions. The examiner is advised that a negative opinion cannot be based solely on the fact that COPD is not on the list of diseases that are presumptively associated with exposure to herbicide agents. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 5. If Agent Orange exposure is not corroborated, schedule the Veteran for a VA examination for his ischemic heart disease. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: Is ischemic heart disease at least as likely as not related to service, including claimed exposure to aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP? It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. Schedule the Veteran for a VA examination for his hypertension. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's hypertension manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: Is hypertension at least as likely as not related to service, including claimed exposure to Agent Orange, aircraft fuels, additives, aromatic hydrocarbons, insecticides, diesel fuel exhaust, and jet engine exhaust with JP? Provide a rationale to support the opinions. Is hypertension at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that hypertension is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Although hypertension is not listed as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e), the National Academy of Sciences Institute of Medicine (NAS) has recently concluded that there is "sufficient" information indicating that "there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide exposure. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 6. After the Veteran's reported stressors have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any psychiatric disability found to be present. A diagnosis of posttraumatic stress disorder (PTSD) must be ruled in or excluded. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include an in-service diagnosis of anxiety. The examiner must also opine as to whether it is at least as likely as not that any psychiatric disability found to be present was caused or aggravated by a service-connected disability. The examiners attention is invited to the April 1967 service treatment record which notes the Veteran had unspecified nervousness for the prior 3 months. A fine tremor in both hands was noted. Anxiety, non-specific was provisionally diagnosed. The examiner is asked to comment on the March 2014 VA opinion and September 2021 private opinion. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Keeley, 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.