Citation Nr: 21013584 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 20-07 978 DATE: March 9, 2021 ORDER The claim for service connection for arthritis of the bilateral hands is denied. The claim for service connection for a low back disability is denied. The claim for an effective date earlier than August 17, 2018, for the award of service connection for asbestosis is denied. REMANDED The claim for an initial rating higher than 10 percent for asbestosis is remanded. The claim for service connection for hypertension is remanded. The claim for service connection for a subarachnoid hemorrhage is remanded. The claim for service connection for a disability manifested by loss of balance is remanded. The claim for service connection for radiculopathy of the left lower extremity is remanded. The claim for service connection for radiculopathy of the right lower extremity is remanded. FINDINGS OF FACT 1. The Veteran does not have arthritis of the bilateral hands which began during active service, was manifest to a compensable degree within one year of separation, or is otherwise related to an in-service injury or disease. 2. The Veteran’s chronic low back disability, currently diagnosed as spinal stenosis, loss of disc space, and degenerative changes, was not shown as chronic in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The Veteran’s intent to file was received by VA on August 17, 2018. CONCLUSIONS OF LAW 1. The criteria for service connection for arthritis of the bilateral hands have not been met. 38 U.S.C. §§ 1101, 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for an effective date earlier than August 17, 2018, for the award of service connection for asbestosis are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.159, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1954 to April 1957. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in November 2020. A transcript of the hearing is associated with the claims file. Service Connection Claims Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases, including arthritis, cardiovascular-renal disease, and an organic disease of the nervous system, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of an established service-connected disability. 38 C.F.R. § 3.310. Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the nonservice-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In cases of aggravation of a veteran’s nonservice-connected disability by a service-connected disability, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322. The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for arthritis of the bilateral hands. The Veteran contends that service connection is warranted for arthritis of the hands as it had its onset during active service as evidenced by his recollections of having experienced aching after use. The Board concludes that the Veteran does not have a current bilateral hand disability, to include arthritis of the bilateral hands, which began during active service, was manifest to a compensable degree within one year of separation, or is otherwise related to an in-service injury or disease. Service treatment records are entirely negative for any complaints or abnormalities pertaining to either of the Veteran’s hands. At his April 1957 separation examination, the Veteran’s upper extremities were examined and determined to be normal, establishing that neither arthritis nor a bilateral hand disability was present at that time. The Board has considered the Veteran’s testimony to the effect that he experienced aching in his hands in service from all of the work that he did. See November 2020 hearing transcript. The record, however, contains no probative evidence attributing those symptoms to arthritis or any other chronic disability. For the reasons set forth below, the Veteran is not competent to attribute his symptoms to arthritis or any other chronic disability. The post-service medical evidence is similarly silent for a diagnosis of a chronic disability affecting the bilateral hands, to include arthritis. The record contains private treatment records submitted by the Veteran in support of his multiple claims, but none of these records contains any indication of a current disability of the hands, to include arthritis. The Veteran has not received any VA medical treatment for any disabilities, including his hands. The Veteran submitted a December 2020 medical opinion in support of his claims, but the orthopedic surgeon who completed the report did not diagnose any chronic disability of the bilateral hands, to include arthritis. The Board further observes that there is no other probative evidence of a current bilateral hand disability, to include arthritis. Although the Veteran claims to have arthritis, as a layperson, he lacks the competency to provide such a diagnosis as this would require medical expertise such as interpretation of diagnostic test results. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The record contains no indication, nor has the Veteran contended, that he is relaying a diagnosis of arthritis of the bilateral hands as provided to him by a medical professional. Moreover, the record contains no showing of a functional impairment of earning capacity related to the Veteran’s claimed hand disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran told a December 2020 private clinician that he had trouble opening and closing his hands. The December 2020 private clinician, however, did not diagnose a bilateral hand disability, identify any chronic impairment or disability of the hands, or provide any additional detail beyond noting the Veteran’s report. In addition, the Veteran has provided no specific testimony or statements further describing the type of impairment he claims to experience beyond these vague reports. He has offered no evidence tending to show that his claimed symptoms rise to a level to affect earning capacity, no statements regarding the severity, frequency, and duration of his symptoms, or any other information with which to establish that his symptoms would cause impaired earning capacity or affect his ability to function under the ordinary conditions of life. Wait v. Wilkie, 33 Vet. App. 8 (2020). Finally, even assuming arguendo the presence of a current disability, the record contains no indication that any current disability is associated with service. The Veteran testified at his November 2020 Board hearing that he experienced aching in his hands during active duty and that they became tired from all the work that he did. He also indicated that after his separation from service, he had worked in labor throughout his career. There is no indication that the in-service symptoms were indicative of a chronic disability as opposed to temporary fatigue and aching from use. This is particularly so as he testified to a post-service career in labor with no apparent limitations due to hand symptoms. And there is nothing in the record to suggest that any current disability is otherwise causally related to service. The Board notes that during the November 2020 Board hearing, the Veteran’s attorney argued that a VA examination was necessary with respect to all claims on appeal. The undersigned advised the Veteran’s attorney “that in order to trigger VA's duty to get a VA examination, there has to be some sort of indication that the current disability might be associated with service,” and that the record currently contained no such indication. At the request of the Veteran’s attorney, the undersigned held the record open for a period of 60 days to allow her the opportunity to submit additional evidence and a legal brief. The undersigned advised the attorney that the brief should include “why you think that there’s enough evidence in the file to at least trigger VA's duty to get that examination under McClendon.” Unfortunately, no such argument was received with respect to this claim. Absent any indication that the claimed post-service disability is associated with service, the Board finds that an examination is not necessary. In summary, the Board finds that the most probative evidence establishes that arthritis of the bilateral hands was not present during active duty or manifest to a compensable degree within one year of separation. Moreover, the record contains no indication that any current disability of the hands is otherwise etiologically related to an in-service injury or disease. Accordingly, the Board finds that the elements of service connection are not met, and the Veteran's claim is denied. 2. Entitlement to service connection for a low back disability. Neither the Notice of Disagreement nor the VA Form 9 submitted by the Veteran’s attorney contains any specific contentions with respect to this claim, nor does either document identify any specific error of fact or law in the rating decision being appealed. At his November 2020 Board hearing, the Veteran appeared to contend that service connection is warranted for a low back disability as he performed a lot of activities during active duty which affected his lower back such as crawling under buildings. He clarified that he did not experience problems with his back while performing his duties, although at the end of his week his back felt sore and he would take a couple of Aspirin. See Transcript at pages 6-7. The question for the Board is whether the Veteran has a current low back disability that began during service or is otherwise related to an in-service injury or disease. After review of the evidence, the Board finds that the preponderance of the evidence is against the claim. As a preliminary matter, the Board finds that the first element of service connection, a current disability, is established. The private treatment records submitted by the Veteran in connection with his claims demonstrate a diagnosis of a low back disability. Private MRIs in July 2016 and April 2018 showed severe lumbar stenosis, disc bulges, and foraminal stenosis, as well as post-surgical changes due to previous lumbar laminectomies. With respect to the second element of service connection, service treatment records are entirely negative for complaints or findings of a low back disability. In fact, his service treatment records show that the Veteran’s spine was examined at his April 1957 separation examination and affirmatively determined to be normal, establishing that a chronic back disability was not present at that time. Indeed, the Veteran does not contend that he was diagnosed as having a low back disability during active duty. The Board has considered the Veteran’s November 2020 testimony that his military duties required him to perform tasks such as crawling under buildings and removing asbestos from pipes and that, although he did not have back pain while performing these tasks, at the end of the week his back sometimes felt sore. He indicated that he did not get treatment for back pain in service because it was not manly. The record, however, contains no probative evidence attributing those symptoms of soreness to arthritis or any other chronic low back disability. For the reasons set forth below, the Veteran is not competent to attribute his symptoms to arthritis or any other chronic disability. There is also no post-service clinical evidence of a low back disability for decades after service. With respect to the third element of service connection, a nexus between the current disability and an in-service disease or injury, the Veteran has submitted a December 2020 opinion from a private orthopedic surgeon in support of his claim. This opinion links his low back disability to “multiple falls” resulting in mid and low back injuries during service. The Board finds that this medical opinion is of no probative value as it is not accompanied by an adequate rationale and is not based on the accurate facts of the case. The private physician stated that the Veteran experienced low back pain during service due to multiple falls, but did not seek treatment during active duty because doing so was considered “unmanly.” The physician also stated that the Veteran did not seek treatment after service until his back pain became “severe.” These statements from the Veteran form the sole basis for the examiner’s opinion linking the current lumbar spine disability to service. However, these statements are not consistent with the actual contents of the Veteran’s medical records. Again, service records are negative for any complaints or treatment related to the back, including falls, the Veteran did not describe any in-service low back injuries at his November 2020 hearing, nor has he previously reported in-service low back injuries in clinical settings. To the extent the Veteran contends that he did not seek treatment for low back symptoms or injuries in service because it would indicate weakness or would not be manly, service treatment records document multiple instances where the Veteran sought treatment for complaints and injuries less severe than the newly-reported falls and back injuries. For example, in March 1957, the Veteran was seen on several occasions for a headache and upset stomach. In 1956 he sought medical treatment at least 10 times for various ailments including cold sores on his upper lip, allergies, a sore throat, and a lip abrasion. These findings contradict the Veteran’s reports that he did not want to seek medical treatment during service. The Board also notes that the Veteran’s spine was examined and found to be normal at the April 1957 separation examination. The December 2020 private physician did not discuss or address any of these facts in the medical opinion report. Similarly, while the examiner noted that there was a delay between service and the Veteran’s first treatment for low back pain, the examiner did not address that the delay stretches over a 50-year period. The Board finds that it is facially implausible that the Veteran would experience low back pain in service, intermittent pain since that time for more than 50 years, and not mention it to a healthcare provider, especially as private medical records document treatment for other disabilities after service well before a low back condition is mentioned. The failure of the December 2020 private examiner to discuss the contents of the service and post-service records renders the provided medical opinions of no probative value, particularly as they contradict the Veteran’s statements that form the sole basis for the examiner’s conclusions. As the December 2020 private report is of no probative value, the Board finds no indication of a link between the current disability and an established in-service disease or injury. None of the Veteran’s treating physicians have identified a link between his low back disability and an established in-service disease or injury, the Veteran never reported a history of injuries in service while undergoing post-service treatment for the disabilities on appeal, and to the extent the Veteran now claims he had continuous back symptoms since service, those assertions are not credible as they are inconsistent with the contemporaneous records. The Board’s credibility determination is further strengthened after having had the opportunity to observe his demeanor at a hearing. The Board has also considered the Veteran’s contentions regarding service connection, but notes that as a lay person, he is not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board acknowledges that the Veteran is competent to report observable symptoms, but finds that his opinion as to the cause of these symptoms simply cannot be accepted as competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006). In sum, the Board finds that the most evidence establishes that a chronic low back disability, to include spinal stenosis, loss of disc space, and degenerative changes, was not present during active service and did not manifest to a compensable degree within one year of separation; continuity of symptomatology is not established; and there is no indication that the current disability is otherwise etiologically related to an established in-service injury or disease. Accordingly, the Board must conclude that the preponderance of the evidence is against the claim and it is denied. 38 U.S.C. § 5107(b). In reaching this decision, the Board finds that a VA medical examination or opinion is not necessary, absent competent and credible evidence establishing that an event, injury, or disease involving the low back occurred in service, that a chronic low back disability was manifest during the first post-service year, or that the current disability may be associated with an established in-service event, injury, or disease. Effective Date Claim 3. Entitlement to an effective date earlier than August 17, 2018, for the award of service connection for asbestosis. The Veteran’s theory of entitlement with respect to this claim is unclear. Neither the Veteran nor his attorney has provided any specific argument in support of the claim for an earlier effective date. Neither the Notice of Disagreement nor the VA Form 9 submitted by the Veteran’s attorney contains any specific contentions with respect to this claim, nor does either document identify any specific error of fact or law in the rating decision being appealed. Following receipt of the Notice of Disagreement, the Veteran’s attorney requested and was granted a conference with a Decision Review Officer (DRO). According to the report of that February 2020 conference, the DRO explained that the effective date of the award of service connection for asbestosis corresponded to the date the Veteran’s initial intent to file was received. Following the DRO conference, VA provided the Veteran and his attorney with a February 2020 Statement of the Case again clearly explaining that the effective date of the award of service connection for asbestosis corresponded to the date of receipt of the Veteran’s first intent to file and that there was no earlier claim for benefits. Despite this, the Veteran’s attorney filed a VA Form 9 perfecting an appeal of this issue, but again failed to explain the basis for the appeal. At his November 2020 Board hearing, the undersigned asked the Veteran’s attorney if she wished to provide any argument on the earlier effective date issue, as none had been received. She responded that “I’ll take a look at that and I’ll address that in my post-hearing memo.” At the request of the Veteran’s attorney, the undersigned held the record open for a period of 60 days to allow her the opportunity to submit additional evidence and argument. Despite this, the January 2021 evidence and argument subsequently provided by the Veteran’s attorney contains no reference to the effective date issue. The Veteran’s attorney is reminded of her ethical responsibilities as an attorney to provide competent representation to her client which requires the thoroughness and preparation reasonably necessary for such representation. See Barela v. Peake, 22 Vet. App. 155, 159 (2008) (noting that an attorney has the ethical duty to educate himself about the relevant law, analyze the factual and legal elements of a case, adequately prepare, and zealously represent his client's interest); Model Rules of Professional Conduct, Rule 1.1. She is also reminded that her ethical duties as an attorney preclude her from bringing or defending a proceeding unless there is a basis in law and fact for doing so that is not frivolous, which includes a good faith argument for an extension, modification, or reversal of existing law. Model Rules of Professional Conduct R. 3.1. Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of an application therefor. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. A claimant, or another person acting on behalf of a claimant, may indicate to VA a claimant’s desire to file a claim for benefits by submitting an intent to file a claim with VA. An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. If VA receives a complete application form prescribed by the Secretary appropriate to the benefit sought within 1 year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b). The record in this case shows that a VA Form 21-0966 (“Intent to File a Claim for Compensation and/or Pension) was received by VA on August 17, 2018. The Veteran’s formal claim for service connection for pulmonary asbestosis was received several weeks later on September 8, 2018. The record does not contain any earlier communications from the Veteran indicating an intent to claim service-connected compensation benefits for asbestosis or any other respiratory or pulmonary disability. Again, neither the Veteran nor his attorney has argued otherwise, despite being given multiple opportunities to do so. Under the undisputed facts of this case, therefore, there is no legal basis for an earlier effective date. Service connection has been awarded from August 17, 2018, the date the Veteran’s intent to file was received by VA. See 38 C.F.R. § 3.155(b). Absent any indication or allegation of an earlier claim or intent to file, an earlier effective date is not warranted. REASONS FOR REMAND 1. Entitlement to an initial rating higher than 10 percent for asbestosis. The Board regrets further delay in this case, but finds that a remand is necessary to obtain an examination to determine the current severity of the Veteran’s service-connected asbestosis. During the November 2020 hearing, the Veteran claimed that his respiratory condition had worsened since his last examination in December 2018. In light of these representations, a new VA examination should be scheduled. Additionally, the Board notes that in a November 2020 letter, the Veteran’s attorney indicated that she generally objected to an unidentified VA compensation and pension examination and requested the VA examiner’s curriculum vitae (CV) showing the examiner’s education, training, experience, and any discipline imposed by the VA or a licensing board. Although the Veteran’s attorney failed to identify the examination report at issue, the record on appeal reflects that the only examination report currently of record is the December 2018 VA examination which resulted in an award of service connection for asbestosis. Nonetheless, as the Veteran’s attorney has raised a challenge to the competency of the examiner who provided that favorable opinion, a remand is necessary to obtain information regarding the examiner’s qualifications. See Francway v. Wilkie, 930 F.3d 1377 (2019) (holding that once a challenge to an examiner’s competency is raised, the presumption of competency is rebutted, and VA must satisfy its burden of persuasion as to the examiner’s qualifications and respond to the challenge by providing information about the qualifications of a medical examiner to the veteran). 2. Entitlement to service connection for hypertension. Neither the Notice of Disagreement nor the VA Form 9 submitted by the Veteran’s attorney contains any specific contentions with respect to this claim, nor does either document identify any specific error of fact or law in the rating decision being appealed. At the Veteran’s November 2020 Board hearing, the Veteran’s attorney appeared to contend that service connection is warranted for hypertension as the Veteran had an elevated blood pressure reading during active service. See November 2020 Hearing transcript at page 20. Specifically, the Veteran’s attorney pointed to a single blood pressure reading of 130/80 in December 1956 which she states “is considered to be high.” She asserted that the Veteran’s blood pressure was not measured at any other point during active duty. See November 2020 hearing transcript at page 20. The Veteran’s attorney, who acknowledges that she is not a medical professional, has provided no basis for her contention that a reading of 130/80 is considered to be high or is otherwise indicative of the onset of hypertension. In that regard, the Board notes that the Veteran’s blood pressure was recorded as 124/82 at his April 1954 enlistment examination, substantially similar to the reading recorded in December 1956 which the attorney characterizes as “high.” It is further noted that for VA purposes, hypertension means that the diastolic blood pressure is predominantly 90 mm or greater, and isolated systolic hypertension means the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. 38 C.F.R. § 4.104. Despite the contentions of the Veteran’s attorney that his blood pressure was measured only once during service, his service treatment records contain additional blood pressure readings and none was indicative of hypertension. At his April 1957 separation examination, his blood pressure reading was 128/60. Hypertension was not diagnosed at any point during active duty, nor is there any indication that hypertension was manifest to a compensable degree within one year of separation. Indeed, the Veteran does not contend otherwise. Although the record currently on appeal contains no indication that hypertension had its onset in service or otherwise supports the theory of entitlement raised by the Veteran’s attorney at the hearing, following the hearing, the Veteran’s attorney submitted additional evidence and argument. Unfortunately, she provided no argument with respect to the hypertension claim. The evidence submitted, however, consisted of a December 2020 letter from a private orthopedic surgeon who stated that the Veteran was exposed to multiple toxic substances during service such as silica dust, sand, smoke, cleaning solvents, aromatic hydrocarbons, persistent organic pollutants, insecticides, and asbestos. The examiner then found that the Veteran’s hypertension is more likely than not related to these toxicant exposures. The service treatment records do not document exposure to silica dust, sand, smoke, cleaning solvents, aromatic hydrocarbons, persistent organic pollutants, or insecticides. The Veteran’s exposure to asbestos, however, has been conceded. The Board finds that the December 2020 medical opinion is of no probative value as the orthopedic surgeon provided no information regarding how he reached the conclusion that the Veteran had been exposed to these substances, nor did he provide any information regarding in what amounts these exposure purportedly occurred or in what timeframe, nor does he provide any information describing the mechanism that forms a link between the Veteran’s claimed exposures and the formation of hypertension. There is no reference to medical studies, literature, or any other basis for the stated conclusion that the Veteran’s hypertension is due to exposure to the delineated environmental hazards. Nonetheless, as VA has conceded the Veteran’s exposure to asbestos during active duty, the December 2020 opinion raises an indication that the Veteran’s hypertension may be associated with that exposure. Under these circumstances, a VA opinion is necessary. 3. Entitlement to service connection for a subarachnoid hemorrhage. In the December 2020 opinion referenced above, the orthopedic surgeon indicated that “[t]he presence of hypertension is more likely than not causal to his subarachnoid hemorrhage.” The Board finds that this issue is inextricably intertwined with the issue of service connection for hypertension. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). Therefore, this claim must also be remanded. The Board also notes that during the November 2020 hearing, the Veteran’s attorney referenced a study purporting to note a higher incidence of mortality from cerebral vascular and ischemic heart disease among British asbestos workers than the general population. However, despite being twice advised to send in a copy of the study, she failed to do so. She is advised that there is currently no basis in the record upon which to rely on this study. 4. Entitlement to service connection for radiculopathy of the left lower extremity. 5. Entitlement to service connection for radiculopathy of the right lower extremity. 6. Entitlement to service connection for a disability manifested by loss of balance. In the December 2020 opinion, the orthopedic surgeon indicated that the Veteran’s lower extremity radiculopathy was a complication of his nonservice-connected low back disability. However, he also indicated that the Veteran had “[a] separate diagnosis of peripheral neuropathy which is more likely than not related to toxicant exposures but does combine with low back motor and sensory neuropathy from the lumbar spinal region with neurogenic claudication.” He stated that the toxicants to which the Veteran was exposed in service “are more likely than not causally significant to his condition of bilateral lower extremity neuropathy sensory motor with gait pattern changes and disruption of balance.” For reasons previously discussed, the Board finds that the December 2020 medical opinion is of no probative value with regard to whether the Veteran’s claimed disabilities are causally related to purported in-service exposure to toxicants such as silica dust, sand, smoke, cleaning solvents, aromatic hydrocarbons, persistent organic pollutants, or insecticides. As the opinion also appears to suggest that the claimed disabilities are also related to asbestos exposure, and because VA has conceded asbestos exposure, a VA opinion is necessary. The matters are REMANDED for the following action: 1. Provide the Veteran and his attorney information regarding the qualifications of the December 2018 VA examiner, to include a CV and/or other similar material. A copy of this information should also be included in the Veteran’s claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected asbestosis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 3. Obtain a medical opinion from an appropriate clinician with regard to the etiology of the Veteran’s hypertension and subarachnoid hemorrhage. The claims file must be made available to the clinician rendering the requested opinion. If the clinician determines that an examination is necessary, one should be scheduled. Following review of the claims file, the clinician should provide an opinion, with supporting rationale, as to whether it is at least as likely as not that the Veteran’s current hypertension had its inception during service or is otherwise causally related to an in-service injury or disease active service, to include exposure to asbestos. The clinician’s attention is directed to the relevant evidence of record, to include (a) the Veteran’s service treatment records, including a blood pressure reading of 130/80 in December 1956; and (b) the December 2020 opinion from the private orthopedic surgeon. 4. Obtain a medical opinion from an appropriate clinician with regard to the etiology of the Veteran’s radiculopathy of the lower extremities and disability manifested by loss of balance. The claims file must be made available to the clinician rendering the requested opinion. If the clinician determines that an examination is necessary, one should be scheduled. Following review of the claims file, the clinician should provide an opinion, with supporting rationale, as to whether it is at least as likely as not that the Veteran’s lower extremity radiculopathy and/or disability manifested by loss of balance had their inception during active service or are otherwise causally related to an in-service injury or disease active service, to include exposure to asbestos. The clinician’s attention is directed to the relevant evidence of record, to include the December 2020 opinion from the private orthopedic surgeon. K. Conner Veterans Law Judge Board of Veterans’ Appeals M. Riley, Attorney for the Board Department of Veterans Affairs 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.