Citation Nr: 21007359 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 17-12 244 DATE: February 9, 2021 ORDER As new and material evidence has been received, the claim for entitlement to service connection for an acquired psychiatric disorder, to include an unspecified adjustment disorder, posttraumatic stress disorder (PTSD), a neurobehavioral disorder, trouble sleeping, and bipolar disorder, is reopened; to that extent only, the appeal is granted. Entitlement to service connection for a traumatic brain injury (TBI), to include as secondary to service-connected sleep apnea, brain disease, and/or acquired psychiatric disorder, and/or to include as due to exposure to toxic contaminants, is denied. Entitlement to service connection for brain disease (claimed as white matter disease), to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is denied. Entitlement to service connection for chronic fatigue, to include as secondary to service-connected sleep apnea and/or to include as due to exposure to toxic contaminants, is denied. Entitlement to an evaluation in excess of 10 percent for allergic rhinitis is denied. REMANDED Entitlement to service connection for cerebral infarction/cerebral arteriosclerosis (claimed as stroke), to include as secondary to hypertension and/or service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include an unspecified adjustment disorder, PTSD, a neurobehavioral disorder, trouble sleeping, and bipolar disorder, to include as secondary to service-connected sleep apnea, brain disease, hypertension, and/or cerebral infarction/cerebral arteriosclerosis, and/or to include as due to exposure to toxic contaminants, is remanded. Entitlement to service connection for headaches, to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Entitlement to basic eligibility to Dependents’ Educational Assistance (DEA) under 38 U.S.C. Chapter 35 is remanded. FINDINGS OF FACT 1. In a March 2010 rating decision, the RO denied the Veteran’s claims for service connection for PTSD and bipolar disorder; the Veteran did not submit a Notice of Disagreement, no new and material evidence was received within one year of the decision, and the decision became final. 2. The evidence received since the March 2010 rating decision is not cumulative or redundant of the evidence of record, does relate to an unestablished fact, and does raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder. 3. The preponderance of the evidence demonstrates that the Veteran does not have a current diagnosis for a TBI. 4. The preponderance of the evidence demonstrates that the Veteran does not have a current diagnosis for a brain disease. 5. The preponderance of the evidence demonstrates that the Veteran does not have a current diagnosis for chronic fatigue. 6. Throughout the appeal period, the Veteran does not manifest allergic rhinitis with polyps. CONCLUSIONS OF LAW 1. The March 2010 rating decision that denied entitlement to service connection for PTSD and bipolar disorder is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.52, 20.1103. 2. New and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for a TBI, to include as secondary to service-connected sleep apnea, brain disease, and/or acquired psychiatric disorder, and/or to include as due to exposure to toxic contaminants, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for entitlement to service connection for brain disease (claimed as white matter disease), to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 5. The criteria for entitlement to service connection for chronic fatigue, to include as secondary to service-connected sleep apnea and/or to include as due to exposure to toxic contaminants, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for entitlement to an evaluation in excess of 10 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.97, Diagnostic Code 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from September 1974 to December 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Jurisdiction of the case is now before the RO in Pittsburgh, Pennsylvania. The Board remanded the issues on appeal for additional development in November 2015 and January 2018. As the actions specified in the remands have been substantially completed, the matters have been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). In August 2020, the Veteran submitted additional evidence in support of his appeal along with a signed waiver of RO consideration of evidence. The Board accepts this evidence for inclusion in the record. See 38 C.F.R. § 20.1305. In a March 2012 statement, the Veteran indicated that he was unable to work due to his service-connected disabilities. In Rice v. Shinseki, the U.S. Court of Appeals for Veterans Claims (Court) held that a TDIU rating is part of an increased rating claim when such issue is raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the issue of a TDIU is raised by the record, is part and parcel of the increased rating claim, and is properly before the Board. Id. Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). New and Material Evidence 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for an acquired psychiatric disorder, to include an unspecified adjustment disorder, PTSD, a neurobehavioral disorder, trouble sleeping, and bipolar disorder Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of a RO decision to initiate an appeal by filing a notice of disagreement (NOD) with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105(b) and (c); 38 C.F.R. §§ 3.160(d), 19.20, 19.21, 19.22, 19.52. If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The U.S. Court of Appeals for Veterans Claims (Court) has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In a March 2010 rating decision, the RO denied the Veteran’s original claim for service connection for bipolar disorder, because there was no evidence that his currently diagnosed psychiatric disability was incurred in or aggravated by military service. Additionally, the RO denied the Veteran’s original claim for service connection for PTSD, because there no was evidence of a current medical diagnosis of PTSD, a verifiable military stressor, and medical evidence showing the diagnosed disorder was related to the verified stressor. That decision is final. Since the Veteran’s last prior final denial in March 2010, the record includes a March 2012 statement, in which the Veteran asserts that his psychiatric disorder was caused by his in-service exposure to toxic contaminants. He further asserts that his PTSD was the result of performing his in-service duties during adverse hurricane conditions in 1975. The Board finds that this evidence is new as it was not previously of record and tends to relate to an unestablished fact necessary to substantiate the underlying claim of service connection. The March 2012 statement will be presumed credible for the purpose of reopening the claim. Consequently, the claim of entitlement to service connection for an acquired psychiatric disorder, to include an unspecified adjustment disorder, PTSD, a neurobehavioral disorder, trouble sleeping, and bipolar disorder, is reopened. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either caused by or aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). 2. Entitlement to service connection for a TBI, to include as secondary to service-connected sleep apnea, brain disease, and/or acquired psychiatric disorder, and/or to include as due to exposure to toxic contaminants The Veteran asserts that his TBI was caused by his in-service exposure to toxic contaminants while serving at Tyndall Air Force Base (AFB). He also indicated that he experienced a TBI while performing his duties during adverse hurricane conditions. Alternatively, he generally asserts that his TBI was caused by his service-connected sleep apnea, or his brain disease or acquired psychiatric disorder. The question before the Board is whether the Veteran has a current diagnosis for TBI. Based on a careful review of all the subjective and clinical evidence, the Board finds that the preponderance of the evidence weighs against finding service connection for a TBI is warranted. The Veteran’s service treatment records (STRs) do not document any complaints, treatment, or diagnosis for any findings related to a head injury. Post-service treatment records are also silent concerning any complaints or treatment for any head injury. At a July 2014 VA examination, the Veteran reported that he broke his nose during service when a door flew in his face during a hurricane. No loss of consciousness or permanent residuals from the injury were noted. The VA examiner performed an objective evaluation of the Veteran and found that there was no evidence of a TBI or residuals of a TBI. While the Veteran is certainly competent to report his history of a head injury, he has not demonstrated that he has the requisite specialized knowledge or training to diagnosis a TBI. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has not presented any competent and credible evidence of a current diagnosis for a TBI, and the available evidence does not support that the Veteran has any persistent symptomatology that would suggest that he has an underlying chronic disability. Accordingly, the Veteran’s assertions that he has a diagnosis for a TBI have little probative value. No underlying disability has been clinically diagnosed during the appeal period or proximate thereto. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s service connection claim for a TBI. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for brain disease (claimed as white matter disease), to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants The Veteran asserts that his brain disease is caused by his in-service exposure to toxic contaminants while serving at Tyndall AFB. Alternatively, he generally asserts that his brain disease was caused by his service-connected sleep apnea. The question before the Board is whether the Veteran has a current diagnosis for brain disease. Based on a careful review of all the subjective and clinical evidence, the Board finds that the preponderance of the evidence weighs against finding service connection for brain disease is warranted. The Veteran’s service treatment records (STRs) do not document any complaints, treatment, or diagnosis for any findings related to brain disease. A January 2016 private hospital record documents that the Veteran underwent an MRI of his brain in November 2012. Those results showed white matter disease more extensive than expected in a patient his age and basal ganglia infarct bilaterally. The impression was small vessel occlusive disease. The Veteran was admitted following complaints of a pain in his left eye and an inability to talk. During his hospital stay, the Veteran underwent a CT scan of his brain which revealed newly seen acute to early subacute-cortical infarction in left parietal lobe. The Veteran was diagnosed with an unspecified cerebral infarction. In February 2016 and March 2016, the Veteran was hospitalized again after complaining of confusion, a headache, an inability to remember his wife’s name, and an inability to find words. A CT scan of his brain revealed that the Veteran had a recurrent stroke. See March 2016 Discharge Summary. In March 2020, the Veteran underwent a VA examination to address his claimed conditions for residuals of bilateral basal ganglia infarction/stroke and brain disease/white matter disease. His claimed headache was addressed in a separate examination. The VA examiner summarized the January, February and March 2016 private hospital records documenting the Veteran’s complaints and the findings of his diagnostic testing. Upon performing an objective evaluation, the VA examiner diagnosed the Veteran with cerebral infarction and cerebral arteriosclerosis. No diagnosis for brain disease or white matter disease was identified, as the VA examiner found that there was no evidence to support these diagnoses. While the Veteran is certainly competent to report symptoms of confusion, difficulty speaking, remembering names and words, he has not demonstrated that he has the requisite specialized knowledge or training to attribute those symptoms to his claimed brain disease or white matter disease. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has not presented any competent and credible evidence of a current diagnosis for brain disease or white matter disease, and the available evidence does not support that the Veteran has any persistent symptomatology that would suggest that he has an underlying chronic disability. Accordingly, the Veteran’s assertions that he has a diagnosis for brain disease or white matter disease have little probative value. No underlying disability has been clinically diagnosed during the appeal period or proximate thereto. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Notably, the March 2020 VA examiner attributed the findings associated with the Veteran’s brain MRI and CT scan to the diagnoses of cerebral infarction and cerebral arteriosclerosis, which the Veteran has separately claimed service connection for as a stroke. The record does not include any clinical evidence to suggest that the Veteran had an additional disability for his claimed brain disease or white matter disease. In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s service connection claim for brain disease. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for chronic fatigue, to include as secondary to service-connected sleep apnea and/or to include as due to exposure to toxic contaminants The Veteran asserts that his chronic fatigue is caused by his in-service exposure to toxic contaminants while serving at Tyndall AFB. Alternatively, he generally asserts that his chronic fatigue was caused by his service-connected sleep apnea. The question before the Board is whether the Veteran has a current diagnosis for chronic fatigue. Based on a careful review of all the subjective and clinical evidence, the Board finds that the preponderance of the evidence weighs against finding service connection for chronic fatigue is warranted. The Veteran’s STRs document that his November 1976 separation examination noted that he had trouble sleeping, but the examiner attributed the symptoms to his shift work. The Veteran associated his trouble sleeping to his nervous problems. No other complaints, treatment, or diagnosis for symptoms related to chronic fatigue were documented. Post-service treatment records do not document any complaints, treatment, or diagnosis for any findings related to chronic fatigue. In July 2014, the Veteran underwent a VA examination. Noting the Veteran’s report of having longstanding subjective fatigue symptoms, the VA examiner explained that fatigue was a nonspecific symptom with many possible etiologies. Based upon a medical literature review, clinical experience, a review of the medical record, and an evaluation of the Veteran, the VA examiner determined that a diagnosis of chronic fatigue syndrome was not found and that the Centers for Disease Control criteria for a diagnosis of chronic fatigue syndrome were not met. The Veteran submitted a July 2014 independent physician’s opinion addressing his chronic fatigue. The independent physician, Dr. T.G., noted that fatigue and daytime drowsiness were the hallmark symptoms of sleep apnea in its untreated state. Dr. T.G. did not discuss that the Veteran had a specific diagnosis for chronic fatigue syndrome. While the Veteran is certainly competent to report symptoms of fatigue, he has not demonstrated that he has the requisite specialized knowledge or training to attribute those symptoms to a diagnosis for chronic fatigue syndrome. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran has not presented any competent and credible evidence of a current diagnosis for chronic fatigue, and the available evidence does not support that the Veteran has any persistent symptomatology that would suggest that he has an underlying chronic disability. Accordingly, the Veteran’s assertions that he has a diagnosis for chronic fatigue have little probative value. No underlying disability has been clinically diagnosed during the appeal period or proximate thereto. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Notably, the Veteran presented an opinion from an independent physician who did not diagnose chronic fatigue syndrome. Rather, the independent physician explained that the Veteran’s chronic fatigue was a symptom of his service-connected sleep apnea, not a separate and distinct disability. In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s service connection claim for chronic fatigue. Therefore, the benefit-of-the-doubt rule does not apply, and the service connection claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Evaluation 5. Entitlement to an evaluation in excess of 10 percent for allergic rhinitis The Veteran generally asserts that his allergic rhinitis is worse than his current evaluation reflects. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. The veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). The Veteran’s allergic rhinitis has been currently evaluated as 10 percent disabling, effective March 19, 2009, under 38 C.F.R. § 4.97, Diagnostic Code 6522. Under Diagnostic Code 6522, a 10 percent disability rating is assigned for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A maximum 30 percent disability rating is assigned for allergic or vasomotor rhinitis with polyps. Based on a careful review of all the subjective and clinical evidence, the Board finds that throughout the appeal period, the Veteran’s allergic rhinitis does not warrant a higher 30 percent evaluation under Diagnostic Code 6522. In other words, the Veteran does not manifest allergic rhinitis with polyps. Viewing the evidence in the light most favorable to the Veteran, the clinical findings at June 2012, July 2014, and September 2020 revealed no active symptoms for rhinitis. Given the available evidence, there is no basis upon which to award a higher 30 percent evaluation for allergic rhinitis at any time during the appeal period. Therefore, the Board finds that the Veteran’s allergic rhinitis is no more than 10 percent disabling. In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s higher than 10 percent evaluation claim for allergic rhinitis. Therefore, the benefit-of-the-doubt rule does not apply, and the higher evaluation claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for cerebral infarction/cerebral arteriosclerosis (claimed as stroke), to include as secondary to hypertension and/or service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. 3. Entitlement to service connection for an acquired psychiatric disorder, to include an unspecified adjustment disorder, PTSD, a neurobehavioral disorder, trouble sleeping, and bipolar disorder, to include as secondary to service-connected sleep apnea, brain disease, hypertension, and/or cerebral infarction/cerebral arteriosclerosis, and/or to include as due to exposure to toxic contaminants, is remanded. 4. Entitlement to service connection for headaches, to include as secondary to service-connected sleep apnea, and/or to include as due to exposure to toxic contaminants, is remanded. The Veteran contends that he was exposed to toxic contaminants while serving as an Electrical Power Production Specialist at Tyndall AFB and that such exposure caused him to develop a stroke, hypertension, an acquired psychiatric disorder, and headaches. The record includes evidence indicating that Tyndall AFB is an Environmental Protection Agency Superfund site and that operations at the AFB resulted in releases of contaminants to the environment. Contaminants, including pesticides, solvents, and chemicals, were identified in the soil, sediment, surface water and ground water at Tyndall AFB. To support his claim that he was exposed to toxic contaminants during service, the Veteran made multiple requests of the Agency Original Jurisdiction (AOJ) to obtain any and all records concerning area 6000 at Tyndall AFB, including information pertaining to the closure of any base wells and the rerouting of any base water systems due to known contamination. See March 2014 Report of General Information, February 2016 attorney correspondence, and June 2019 Report of General Information. Although the AOJ indicated that these records may exist at Langley AFB, the record does not include any documented attempts by the AOJ to locate these records. Accordingly, on remand, the AOJ should perform the necessary steps to research and locate records associated with the contamination at Tyndall AFB. Given the Veteran’s contentions that his exposure to a variety of contaminants caused his disabilities, the Board finds that further development is required. The record currently includes VA etiological opinions specifically addressing whether the Veteran’s exposure to trichlorethylene (TCE) caused his disabilities; however, no opinions address whether any other toxic contaminants caused his disabilities. VA has an obligation to address all of the Veteran’s contentions. Accordingly, a remand is required to obtain supplemental VA opinions. In a March 2020 VA examination report for central nervous system (CNS) and neuromuscular disease, the VA examiner indicated that the Veteran had “depression, cognitive impairment or dementia, or any other mental health conditions attributable to CNS disease and/or its treatment.” However, the VA examiner did not identify the specific mental health condition, even though the examination report specifically requests that information. Because the March 2020 VA examination report did not include a complete assessment of the Veteran’s condition, the Board finds that the examination is inadequate for adjudicative purposes. A remand is required to ask the March 2020 VA examiner to provide that information. In a March 2020 VA opinion, the VA examiner opined that the Veteran’s hypertension and headaches were less likely than not due to or the result of his service-connected sleep apnea. In that regard, the VA examiner relied on the findings that the Veteran’s hypertension caused his stroke, and his stroke caused his sleep apnea. On that basis, the VA examiner determined that the Veteran’s sleep apnea did not cause his hypertension and headaches. The Board finds that the March 2020 VA opinion is inadequate. First, the March 2020 VA examiner’s conclusion that the Veteran’s sleep apnea was caused by his hypertension conflicts with other medical evidence of record. According to private opinions in March 2014 and July 2014, the Veteran’s sleep apnea was caused by his service-connected allergic rhinitis. The Veteran was awarded service connection for sleep apnea on the basis of these private opinions. Because the March 2020 VA examiner’s conclusion concerning the etiology of his hypertension contradicts with other medical evidence without any explanation, the Board finds that the opinion is inadequate. Second, the March 2020 VA examiner’s opinion that the Veteran’s headaches was not caused by his sleep apnea is conclusory, because the VA examiner did not provide a supporting rationale. A remand is required to obtain a supplemental VA opinion for the Veteran’s hypertension and headaches. 5. Entitlement to a TDIU is remanded. 6. Entitlement to basic eligibility to DEA under 38 U.S.C. Chapter 35 is remanded. The claims for entitlement to a TDIU and basic eligibility to DEA benefits may be affected by the outcome of the service connection claims for a stroke, hypertension, an acquired psychiatric disorder, and headaches. It would be premature to adjudicate the TDIU and basic eligibility to DEA benefits claims until the service connection claims have been considered. Therefore, the issues are inextricably intertwined, and the TDIU and basic eligibility to DEA benefits claims must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Respond to the Veteran’s request to obtain any and all records concerning area 6000 at Tyndall AFB, including information pertaining to the closure of any base wells and the rerouting of any base water systems due to known contamination. Perform the necessary steps and contact the appropriate sources to obtain the relevant federal records, to include a search of relevant records located at Langley AFB. All steps taken to obtain such records should be documented in the claims file. If such records are not obtainable, the Veteran and his representative should be notified. 2. Obtain all the outstanding treatment records for the Veteran’s stroke, hypertension, acquired psychiatric disorder, and headaches that are not currently of record. 3. After completing the above development, obtain addendum opinions by an appropriately qualified clinician to determine the nature and etiology of the Veteran’s stroke, hypertension, acquired psychiatric disorder, and headaches. The examiner should provide opinions addressing whether it is at least as likely as not that the Veteran’s stroke, hypertension, acquired psychiatric disorder, and headaches are related to his exposure to toxic contaminants while serving at Tyndall AFB. In providing the above opinions, the examiner should consider all the available information of record concerning the various toxic contaminants identified at Tyndall AFB and assume that the Veteran was exposed to those contaminants. A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. 4. Ask the March 2020 VA examiner who conducted the CNS and neuromuscular diseases examination to identify the specific mental health condition that was attributed to the Veteran’s central nervous system disease and/or its treatment, as indicated in the March 2020 examination report. If such response cannot be provided by the examiner, the examiner must explain why. 5. Obtain an addendum opinion from an appropriately qualified clinician to determine the etiology of the Veteran’s hypertension and headaches. The examiner must respond to the following: (a.) Is it at least as likely as not the Veteran’s hypertension was caused by his service-connected sleep apnea? (b.) Is it at least as likely as not that the Veteran’s headaches were caused by his service-connected sleep apnea? The examiner must resolve the conflicting medical opinions by the March 2014 and July 2014 private physicians, who found that the Veteran’s sleep apnea was caused by his service-connected allergic rhinitis, and the March 2020 VA examiner, who found that the Veteran’s hypertension caused his stroke, and then his stroke caused his sleep apnea. The examiner must note that service connection was awarded for the Veteran’s sleep apnea based on the findings of the March 2014 and July 2014 private opinions. (Continued on the next page)   A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. 6. After the above development has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to a TDIU and entitlement to basic eligibility to DEA benefits. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Journet Shaw, 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.