Citation Nr: 21007536 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 18-22 400 DATE: February 9, 2021 REMANDED Entitlement to service connection for a psychiatric disorder, to include as due to a chemical sensitivity, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to June 1970. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in a June 2020 hearing. Entitlement to service connection for a psychiatric disorder, to include as due to a chemical sensitivity, is remanded. First, remand is required for addendum VA medical opinions. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). When a Veteran has provided competent lay statements of an in-service injury, the examiner must consider and address them when developing his rationale. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that when the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records). The Veteran underwent a VA examination in January 2017 where the examiner provided a diagnosis of adjustment disorder with anxiety and provided a negative nexus opinion. The examiner explained that the Veteran experiences acute anxiety during periods of stress in his life, such as working on board a ship, working at the airport after service, and caring for his ailing parents, and that he last experienced a panic attack in 1984; however, the examiner opined that it is less likely than not that the adjustment disorder with anxiety was caused by military service. Based on a February 1968 in-service mental health examination which detailed his childhood insecurities and diagnosed him with immature personality, the examiner found that the Veteran has a life-long disposition toward anxiety with acute episodes of intensified anxiety when confronted with significant life stressors. The examiner explained that the current episode of adjustment disorder with anxiety represents a discrete episode unrelated to military service. However, the examiner failed to provide any further supporting rationale. At his June 2020 Board hearing, the Veteran asserted that his anxiety is due to a chemical sensitivity that began in service and has continued to this day. He explained that while in-service, he served on an oiler, which was used to refuel ships, where he experienced panic attacks and hyperventilation. Indeed, February 1968 service treatment records confirm these assertions. The Veteran explained that years after service he worked at the airport where he again began to have panic attacks due to exposure to jet fuel exhaust. After seeking treatment from numerous doctors, a private allergist informed him that he had a chemical sensitivity. The Veteran asserted that his chemical sensitivity affects him to this day and recounted a recent story of going to a pizza restaurant with his wife and suffering from a panic attack, after which he realized was due to the propane fueled pizza oven. The Veteran submitted copies of letters from the private allergist, including a June 1984 letter indicating that the Veteran has multiple chemical sensitivities that very likely had onset when he served on an oiler in the Navy, setting the stage for the likelihood of developing a significant chemical sensitivity at some time in the future. An October 1984 letter indicates that the Veteran has chemical allergies due to jet fuel exposure while working at the airport that have caused him to be significantly disabled and impaired. Although the June 1984 letter states that the chemical sensitivities are very likely due to service, it does not address any of his psychiatric symptoms, explain exactly what the chemical sensitivities entail, or how they are connected to service. The Veteran submitted a March 2018 opinion from a private treatment provider. The examiner explained that although the Veteran asserts that anxiety and obsessive-compulsive disorder are related to his military service, these psychiatric symptoms may be part of a cluster of symptoms evident with multiple chemical sensitivity. The examiner opined that the Veteran’s in-service treatment for anxiety episodes may be more accurately attributable to a chemical sensitivity reaction. Referencing his exposure to jet fuel exhaust at the airport, and the pizza restaurant incident, the examiner concluded that the Veteran has an ongoing documented history of chemical sensitivity which can manifest in anxiety symptoms, and that his primary condition appears to be attributable to chemical sensitivity reaction rather than a psychiatric condition; however, the examiner failed to provide any supporting rationale. Further, although the examiner attributed the in-service psychiatric episodes to a chemical sensitivity reaction, they failed to connect the present psychiatric disorders to service. Other diagnoses of record during the appeal period are also absent from each of these medical opinions. September 2017 VA treatment records indicate a positive screening for posttraumatic stress disorder (PTSD). November 2017 VA treatment records provided diagnoses of generalized anxiety disorder, specific phobia situational type, unspecified depressive disorder, and obsessive-compulsive disorder. Although these were all diagnosed following the January 2017 VA examination, they should still be addressed. In April 2018, the Veteran also submitted several articles linking mental health issues with chemical sensitivity. These have yet to be addressed by VA. Due to the complicated nature of this claim, the Board finds it would be appropriate to obtain two medical opinions, a psychiatric opinion, and an opinion from an examiner who is able to address chemical sensitivities. Accordingly, remand is required for addendum VA medical opinions. Second, remand is required to obtain missing medical records. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2019). This includes making as many requests as are necessary to obtain relevant records from a Federal department or agency, including, but not limited to, military records, VA medical records, records from facilities with which the VA has contracted, and records from Federal agencies. 38 C.F.R. § 3.159(c)(2). VA will end its efforts to obtain records only where it concludes that the records sought do not exist or that further efforts to obtain those records would be futile, such as where the Federal department or agency advises VA that the requested records do not exist or the custodian does not have them. 38 C.F.R. § 3.159(c)(2). VA’s duty to assist claimants to obtain evidence needed to substantiate a claim includes making reasonable efforts to obtain relevant private medical records. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). At the June 2020 Board hearing, the Veteran stated that while in service, he also sought private psychiatric treatment, and that while he believed VA already has a copy of these records, if not, he can provide them himself. A careful review of the claims file finds no copies of any private psychiatric treatment records during service. Additionally, although the Veteran submitted medical opinions from private providers, including letters Dr. GE in 1984 and 1986, and Dr. MK in 2018, he did not submit any corresponding treatment records, and it does not appear that VA made any efforts to obtain these. Also, during the June 2020 Board hearing, the Veteran stated that he went on disability through the Department of Labor as a result of his chemical sensitivity. In February 2018, he submitted a copy of a statement of disability in connection with disability retirement under the Civil Service Retirement System. The records surrounding this disability claim are not part of the claims file and need to be obtained. Finally, VA treatment records in November 2017 and June 2018 indicate that outside treatment records were scanned into Vista imaging. The Board does not have access to Vista imaging. Accordingly, remand is required to obtain missing medical records. The matters are REMANDED for the following action: 1. Contact the Department of Labor and obtain a copy of that agency’s decision concerning the Veteran’s claim for disability benefits from the Civil Service Retirement System, including any medical records used to make the decision. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 2. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment, specifically outside treatment records scanned into Vista imaging. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 3. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records, to include the in-service private psychiatric treatment records, and corresponding medical records from Drs. GE and MK. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 4. After any additional records are associated with the claims file, obtain two separate addendum opinions regarding the etiology of the psychiatric disorders. The first should be from an appropriate examiner for psychiatric disorders. The second should be from an examiner who is able to address chemical sensitivity. The entire claims file must be made available to and be reviewed by the examiners. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a) First, the examiner must determine all of the Veteran’s diagnosed psychiatric disorders. The examiner must specifically determine if anxiety, PTSD, depression, adjustment disorder, OCD, and/or specific phobia situational type are present. If not found, the examiner must address the prior diagnoses during the appeal period. (b) Second, for each diagnosed psychiatric disorder, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the disorder had onset in, or is otherwise related to, active service, to include as due to a chemical sensitivity. (c) The examiner must address the following: 1) the 1968 STRs regarding the Veteran’s hyperventilation, panic attacks, and diagnosis of immature personality; 2) the 1984 and 1986 private letters from Dr. GE regarding chemical sensitivity; 3) the January 2017 VA medical opinion; 4) the September 2017 VA treatment record showing a positive screen for PTSD; 5) the November 2017 VA treatment record showing diagnoses for anxiety, situational type specific phobia, depression, and OCD; 6) the Veteran’s February 2018 statement; 7) the March 2018 private medical opinion; 8) the articles submitted by the Veteran in April 2018 regarding the connection between chemical sensitivity and mental health; 9) the statement on the April 2018 VA Form 9; and 10) the June 2020 Board hearing testimony. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rogos 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.