Citation Nr: 21011141 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 19-00 702 DATE: March 1, 2021 REMANDED Service connection for epistaxis is remanded. Service connection for hypoxemia is remanded. Service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1961 to May 1981. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge in November 2020. A transcript is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900 (c).   1. Service connection for epistaxis is remanded 2. Service connection for hypoxemia is remanded 3. Service connection for obstructive sleep apnea is remanded The Veteran asserts he has epistaxis and hypoxemia due to his military service. During the November 2020 Board hearing, he asserted that epistaxis and hypoxemia may be symptoms of an underlying current respiratory or lung condition related to his active service. The Veteran also asserts his sleep apnea is related to service. In a September 2017 VA Form 21-4138, the Veteran asserted all the conditions claimed on appeal are a result of his in-service exposure to asbestos, lead paint, and fire extinguishing substances. The appeal is remanded for further development. First, the RO does not appear to have conducted development the Veteran’s reported exposure to fire extinguishing substances and asbestos as a result of his duties. This should be accomplished on remand. The Veteran asserted in his September 2017 VA Form 21-4138 that he was exposed to asbestos and other hazardous materials on board U.S.S. Oriskany from 1961 to 1965. He stated that the exposure occurred while fighting fires in asbestos wrapped pipes as well as handling firefighting foams commonly utilized for fires of heavy equipment, ships, and aircrafts. During the November 2020 Board hearing, he reported that in early 1960s, he was on temporary assignment to a place in Pearl Harbor called Inactive Service Facilities. He stated that part of his duties was cleaning out the innards of an old ferry boat, chipping paint, and removing asbestos lagging from the pipes. He reported he later went onboard U.S.S. Oriskany as a damage controlman, and fought fires, removed asbestos lagging around the piping, and was exposed to fire suppressant substances. The Veteran’s claims file shows multiple Form DD 214s. Most of his DD 214s note military occupational specialty (MOS) of data processing or computer programmer. However, the Form DD 214 for the period from January 1964 to November 1964 notes his MOS was “Fire Inspector.” The Veteran’s military personnel records indicate he was stationed at the claimed Inactive Service Facilities. A May 1961 record shows the Veteran was transferred to ‘N. VST. FFT 01c INACT SERCRAFT FAC PEARL,’ for the purpose of ‘FORDU AS HSKPG ROTATORS.’ It noted the Veteran reported at ‘INACT SERCRAFT FAC PEARL.’ The records, however, did not indicate any exposure to asbestos or lead paint. The Veteran’s military personnel records include performance evaluations that note his firefighting and damage control tasks. An evaluation dated in May 1964 for service on board U.S.S. Oriskany wrote, ‘[the Veteran] is able to do all phases of Damage Control work. He puts in many extra hours on his own.’ A November 1964 evaluation for service on board U.S.S. Oriskany noted, ‘[the Veteran] works in all phases of damage control.’ A May 1965 evaluation for service on board U.S.S. Piedmont noted, ‘As leading P.O. [Petty Officer] in the D.C. [Damage Control] shop he assists the chief with assignments and supervision of periodic tests, inspections and maintenance of damage control and firefighting equipment throughout the ship… Supervises routine work such as tile laying, insulation, shop maintenance and upkeep.’ A November 1965 evaluation for service aboard U.S.S. Piedmont wrote, ‘Petty Office in charge of Damage Control shop. Makes watch list for sounding and security.’ A May 1966 evaluation for service on U.S.S. Piedmont noted, ‘[the Veteran] is PO in charge of the D[.]C[.] Shop, section leader of his section, key man in duty fire party, makes out and maintains MDC system for D.C. Shop and maintains a high status of readiness of all repair lockers. He has a knowledge of fire main, pumps, main drain and ballast system and maintains logs and hull reports and repair to D.C. PO.’ Second, there may be additional, relevant records to obtain. At the hearing, the Veteran indicated there are additional medical records available. These include records from Gunnison Valley Family Medical Center dated since October 2017. He also indicated that he received treatment at the Walter Reed Medical Center in either 1981-1982. The appeal is remanded to allow the Veteran to submit and/or authorize VA to obtain updated relevant medical records from VA and private facilities. Third, and finally, an addendum opinion is necessary regarding the nature and etiology of the claimed conditions. The Veteran’s service treatment records (STRs) are silent as to any complaints or diagnosis of epistaxis, nose bleeding, hypoxemia, or sleep apnea. Review of his post-service medical records reflects complaints and findings of nose bleeding and epistaxis began in 2015; the complaints were of recent onset. The first documentation of hypoxemia is also in 2015. Records dated in 2016 record from Montrose ENT Center show the Veteran underwent cauterization for the epistaxis. Other private medical records show findings of hypoxemia treated by the Veteran’s continuous positive airway pressure (CPAP) therapy. The Veteran underwent a VA examination in February 2018. The examiner evaluated the Veteran, performed clinical test, and reviewed the claims file. She indicated the epistaxis-resolved status post cauterization. The examiner also stated there is no objective evidence to support a current hypoxemia diagnosis. The examination report reflects no current hematologic or lymphatic condition was found. The examiner did not provide a nexus opinion for the obstructive sleep apnea. On remand, an addendum opinion should be obtained regarding the link between his claimed respiratory/lung conditions, to include the currently diagnosed obstructive sleep apnea, and the reported in-service exposures to fire extinguishing foam or like substances and asbestos. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from March 2018 to the present. Obtain relevant records from the Walter Reed Medical Center between 1981 and 1982. 2. Ask the Veteran to complete a VA Form 21-4142 for Gunnison Valley Family Medical Center for records dated after October 2017, and any other private facility that has treated his claimed conditions for which he has not already provided. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Attempt to verify the Veteran’s asserted in-service exposure to asbestos. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to asbestos, 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 asbestos exposure. 4. Following the foregoing development, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s claimed respiratory and/or lung conditions to include epistaxis, hypoxemia, and obstructive sleep apnea. The need for an in-person examination is left to the examiner’s discretion. The claims file, including a copy of this Remand, should be made available to the clinician. a) The examiner should identify any and all respiratory and/or lung disorders present during the pendency of this appeal (which is since June 2017). Clarify whether the claimed epistaxis and hypoxemia are clinical disabilities, as opposed to symptoms/manifestations of underlying chronic respiratory or lung disorders. b) The examiner should opine whether any respiratory and lung disorder found present, to include the currently diagnosed obstructive sleep apnea, are at least as likely as not related to an in-service injury, event, or disease. A complete rationale for the requested opinions should be provided. The rationale should reflect consideration of the contentions that the Veteran had in-service exposure to fire extinguishing substances and asbestos, and has experienced recurring, intermittent bouts of bronchitis after discharge. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jake Choi 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.