Citation Nr: 21005620 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-01 020 DATE: February 2, 2021 ORDER 1. Entitlement to service connection for a lung disability is remanded. 2. Entitlement to service connection for bilateral upper and lower extremity peripheral neuropathy, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1968 to October 1969. These matters are before the Board of Veterans’ Appeals (Board) on appeal of November 2015 and October 2016 Department of Veterans Affairs (VA) rating decisions. In May 2019, a videoconference hearing was held before the undersigned; a transcript is in the record. In September 2019, these matters were remanded for additional development. 1., 2. Entitlement to service connection for a lung disability and for bilateral upper and lower extremity peripheral neuropathy. At the May 2019 hearing, the Veteran testified that excess cordite and gunpowder was burned while he was in B battery and cordite was also used to heat his C-rations. The September 2019 Board remand noted that he was exposed to significant levels of cordite, fuel, and gunpowder in service, and requested development for relevant, outstanding VA records and examinations to determine the nature and likely etiology of the claimed lung and peripheral neuropathy disabilities. The examiner was to specifically opine whether the Veteran’s lung and peripheral neuropathy disabilities re etiologically related to his service, to include his acknowledged exposures to herbicide agents, cordite, fuel, and gunpowder. In December 2019 VA medical opinions (pursuant to the September 2019 Board remand), the consulting provider opined that the Veteran was not exposed to significant amounts of gunpowder and gasoline, noting that gunpowder is still used in military fuses and ignition charges “but not in the rifle ammunition that this Veteran would have potentially been exposed to.” Additionally, the examiner stated cordite was no longer used (with no rationale for that conclusion) after WWII so he had no exposure to cordite. While the Board previously conceded significant exposure to gunpowder, gasoline, and cordite based on the Veteran’s military occupational specialty (MOS) and his lay statements, upon a quick review of online literature and the consulting provider’s explanation, the Board has found the it is unlikely (given what was found in the online search, including that use of cordite as a propellant for artillery rounds ended when it was replaced by other (plastic) propellants, including C-4, and manufacture of cordite was ultimately terminated) that the allegations of extensive exposure to cordite are inaccurate. However, he did serve in an artillery unit in Vietnam, and in all likelihood had some exposure to fumes from other artillery propellants. [And while such use was not recommended/authorized, the Board takes judicial notice that members of artillery units in Vietnam were known to use C-4 to quickly hear C-rations. The Board assumes that the Veteran was referring to the plastic propellants, with the erroneous assumption that their composition included the 19th century developed cordite.] Clarification of the nature of his exposures is now necessary. The Board’s review of the record also found that while the AOJ uploaded updated VA treatment records from the Louisville VA medical center (VAMC), it is not clear whether further pertinent VA treatment records exist and are outstanding. In the nexus opinion against these claims, the September 2019 examiner referred to a 2009 EMG study following complaints of calf cramping. Additionally, a May 2016 VA treatment record notes the Veteran has had extensive workups, to include PFT tests, CT of the chest, an echocardiogram, and a sleep study, over the past 12 months. A review of the record shows that VA treatment records from the Louisville VAMC from December 20, 2008 to February 29, 2012 and from February 2, 2013 to March 13, 2016 were not obtained (nor is does the record that such records do not exist). While VA received treatment records from the Robley Rex VAMC from 2011 to 2015, they do not include the treatment records/studies cited by the May 2016 VA provider. VA treatment records are constructively of record. Development for the outstanding pertinent VA record evidence is necessary. The matters are REMANDED for the following: 1. Secure for the record complete (all outstanding) VA medical records pertaining to evaluations and treatment the Veteran has received for his lung disability and peripheral neuropathy. Specifically, obtain complete VA treatment record from the Louisville VAMC between December 2008 to March 2012 and from February 2013 to March 2016 (if there are none, it should be so stated for the record, with the scope of the search described). 2. Then, noting that the Veteran service with an artillery unit in Vietnam and that his MOS was truck driver (suggesting that in addition to Agent Orange, during service was likely exposed to automotive fuels/fumes as well the propellants used for artillery, and with clarification from the Veteran regarding the nature of his alleged environmental exposures in service in light of the explanation above, make findings for the record regarding the nature and extent of his environmental exposures in service 3. After the development sought above is completed, arrange for the Veteran’s record to be forwarded to an appropriate clinician for review and an advisory medical opinion regarding the likely etiology of his claimed lung disability, specifically whether such disability is etiologically related to the likely environmental exposures in service VA acknowledges after the development sought above is completed. Specifically, is it at least as likely as not (a 50 percent or greater probability) that a diagnosed lung disability is etiologically related to his service and any environmental exposures acknowledged to have occurred therein? [The Board is aware that by definition a diagnosis of idiopathic suggests cause unknown. Nonetheless, this matter requires some medical guidance regarding etiology, considering the state of medical knowledge, any known risk factors for the claimed disability, and the facts presented in this case.] 4. Also, arrange for a neurological examination of the Veteran to determine the likely etiology of his peripheral neuropathy of both upper and both lower extremities. The Veteran’s claims file must be reviewed by the examiner and any tests or studies indicated should be completed. The examiner should: (a.) To the extent possible identify the likely etiology for the Veteran’s upper and lower extremity peripheral neuropathy. Specifically, is it at least as likely as not (a 50 percent or better probability) that it is etiologically related to his presumed or conceded exposures therein to: a. Herbicide agents (the rationale should include discussion of early-onset peripheral neuropathy (acknowledging the Veteran’s lay testimony that he began noting numbness in the extremities 40 years ago) b. Automotive fuels/fumes and lubricants and artillery propellants (including C-4 and any others alleged/acknowledged. (b.) If not, identify the etiology for the peripheral neuropathy that is considered to be more likely, and explain why that is so. All opinions must include rationale. The rationale should include comment on the (expression of agreement or disagreement with) the August 2019 medical statement submitted in support of the claim and December 2019 VA opinion. Citation to supporting clinical data, and supporting medical principles, as well as to medical texts would be helpful. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Naumovich, 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.