Citation Nr: 21026772 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 17-57 039 DATE: May 4, 2021 REMANDED Service connection for a respiratory condition, other than bronchial asthma, is remanded. Service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1964 to September 1967. This matter originally came before the Board of Veterans' Appeals (Board) from a September 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the matter for further development in October 2018. The matter is again before the Board and has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). The Board notes that the Veteran's service connection claim for a skin condition was denied by a rating decision in 1971. However, relevant service department records were associated with the claims file in 2019, which included a study related to the Veteran's skin. As relevant service department records were added to the Veteran's claims file that were in existence and not previously associated with the claims file at the time of the 1971 rating decision, 38 C.F.R. § 3.156(c) applies and the claim for service connection will be reconsidered on the merits, without any threshold issue of whether new and material evidence has been received to reopen the claim. 1. Service connection for a respiratory condition, other than bronchial asthma, is remanded. The Veteran believes that service connection for a respiratory condition, other than bronchial asthma, is warranted. See June 2016 Fully Developed Claim. Generally, a VA examination is required for a service connection claim when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service; but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Medical records show that the Veteran has allergic rhinitis, nasal congestion, and a nasal polyp. See August 2020 CAPRI; March 2017 CAPRI. As such, the Board finds that the first prong is met. The Veteran reported that during service, he was exposed to hydrochloric acid vapors without any protection, had JP-4 jet engine fuel spilt all over his body, and ingested JP-4 jet engine fuel. See June 2016 Correspondence; November 2015 Statement in Support of Claim. Immediately after exposure, the Veteran had difficulty breathing. See May 2015 Correspondence. The Veteran further reported that such exposure could result in serious respiratory problems, including in the nose, throat, and lungs. See April 2016 Medical Treatment Record; May 2015 Correspondence. Medical records state that the Veteran was exposed to chemicals, including hydrochloric acid, during service. See August 2020 CAPRI. Service records also show throat problems, sinusitis, lung problems, and other respiratory problems. See July 2019 STR Medical; December 1967 STR - Medical. As such, the Board finds that the second and third prongs are met. Given these facts, the Board finds that a remand is necessary to obtain a VA examination to determine the etiology of the Veteran's respiratory condition. See McLendon, 20 Vet. App. at 83. 2. Service connection for a skin condition is remanded. The Veteran believes that service connection for a skin condition is warranted. See June 2016 Fully Developed Claim. The Veteran underwent an examination for a skin condition in January 1971. See January 1971 VA Examination. The examination found, among other things, that the Veteran had diagnoses of chronic folliculitis of the beard, dry skin on the arms, a mole on the scrotum, and warts by history. The Board finds the January 1971 examination inadequate because it did not provide an opinion as to whether the Veteran's skin conditions were related to service, which is crucial information for a service connection claim. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When VA provides an examination, it must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Therefore, a remand is needed for a new VA examination. The matter is REMANDED for the following action: 1. Provide the Veteran with an opportunity to identify any relevant outstanding private and/or VA treatment records. After obtaining any necessary authorizations from the Veteran, make all reasonable attempts to obtain the outstanding records in accordance with 38 C.F.R. § 3.159. 2. Contact any and all appropriate entities and request that a search be made of the records of the Shepard Field Air Force medical facility for the year 1964. If no records are located, document that fact in the claims file. 3. Attempt to obtain all of the Veteran's Social Security records, including all underlying medical records, in accordance with 38 C.F.R. § 3.159. 4. Update VA and private treatment records. VA treatment records appear current up to September 2019. 5. Schedule one or more appropriate VA examinations for the Veteran's respiratory and skin conditions. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all respiratory conditions (other than bronchial asthma) and all skin conditions (other than residual scars from the excision of the left scrotum cyst and the excision of the tumor above the umbilicus) existing at any point during the pendency of the appeal (i.e. since June 2016 for the respiratory condition and since October 1970 for the skin condition), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is related to service, including but not limited to, if it had its onset during service? (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities)? (D) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was aggravated beyond its natural progression by any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities)? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (E) Is it at least as likely as not (a 50 percent or greater probability) that any or all of the Veteran's service-connected disabilities (including any medications taken for the service-connected disabilities) caused or aggravated the Veteran's obesity/being overweight including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (F) If yes, is it at least as likely as not (a 50 percent or greater probability) that the obesity/being overweight caused or aggravated any or all of the Veteran's identified respiratory and/or skin conditions including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. If yes, which ones? In addition to the other relevant evidence of record, the examiner is asked to consider and address as appropriate the following information with a caution that this list is not a substitute for a review of the record: Respiratory (1) A list of the Veteran's service-connected disabilities. See March 2017 Rating Decision Codesheet. (2) Medical records from 2018 showing clear nasal drip that did not dry up, exposure to chemicals like hydrochloric acid during service, and an assessment of allergic rhinitis. See August 2020 CAPRI. (3) Service records apparently showing a throat culture identifying rare strep and that the Veteran was on something due to a positive throat culture result. Further information is provided. See July 2019 STR Medical. (4) Medical records from 2015 and 2018 showing a soft tissue colored polyp in both nasal airways with a slit opening airway, constant clearing of the nose, ongoing allergy symptoms, and clear nasal discharge. The symptoms worsened in the spring and fall. See May 2019 CAPRI. (5) The Veteran's report concerning hydrochloric acid during service. See November 2018 VA 21-0820. (6) The Veteran's report that breathing in hydrochloric acid could cause problems, including shortness of breath. Further information is provided. See October 2017 Form 9. (7) The Veteran's report that he did not have respiratory problems before service. Further information is provided. See April 2017 NOD. (8) Medical records from 2001 showing chest CT scan findings which suggested a previous granulomatous process. See March 2017 CAPRI. (9) Medical records from 2004 showing an impression of heavily calcified subcarinal nodes. Medical records from 2015 showed that the Veteran had been having rhinitis symptoms with nasal congestion, rhinorrhea, and sneezing for years. The Veteran reported that he was not naturally a sick person but was injured by hydrochloric acid during service and the doctors did not completely understand the complications of his injuries. Id. (10) Medical records from 2016 and 2017 showing nasal congestion and a nasal polyp. The Veteran reported breathing problems which were not helped with asthma medications. The Veteran had a cough with yellowish phlegm, hay fever symptoms, nasal congestion, and sneezing. Id. (11) Medical records from 2016 showing a history of HLD. The Veteran reported being exposed to hydrochloric acid vapors during service. He was told that he would not get better. His health had only gone downhill since. See February 2017 CAPRI. (12) Medical records from 2004 showing an assessment of COPD and allergic rhinitis. See September 2016 CAPRI. (13) Medical records from 2002 showing a history of lung abnormality related to hydrochloric acid exposure and a body mass index of 29.7. Id. (14) Medical records from 2015 showing that the inferior turbinates were slightly boggy/enlarged. There was a history of intermittent nasal congestion and a nasal mass. The nasal congestion moved from one side to the other. The Veteran was told that he may have had a mass in the back of the nose. The Veteran had sinus problems for years, but the current episode had been going on for six weeks. There was sinus congestion, sinus pain/pressure, nasal mucus varied from white to yellow, and there was an assessment of nasal sinus congestion. See June 2016 CAPRI. (15) The Veteran's report of suffering from the occasional loss of breath. He inhaled hydrochloric acid vapors during service without a face mask and without safety instruction. It caused him to pass out. See June 2016 Correspondence. (16) The Veteran's report that he nearly died from the hydrochloric acid vapors. He had symptoms of a chewed-up tongue with blood matted between his face and pillow during service. He had pulmonary damage as well. The Veteran did not drink or smoke. He came into contact with fuel and other toxic chemicals daily during service. Further information is provided. See April 2016 Correspondence. (17) The Veteran's report that symptoms related to hydrochloric acid included inflammation of the nose, throat, and upper respiratory tract; pulmonary edema; and serious exposure could result in pneumonia, damaged lungs, and breathing difficulty, among other things. See April 2016 Medical Treatment Record. (18) Medical records from 2015 showing the Veteran's report of constant nasal congestion since 1965. Further information is provided. See February 2016 CAPRI. (19) The Veteran's report that he ingested JP-4 jet engine fuel during service. See November 2015 Statement in Support of Claim. (20) The Veteran's report of still having respiratory damage from when he had unprotected exposure to jet engine fuel during service. Further information is provided. See November 2015 Correspondence. (21) Service records showing that the Veteran was a jet engine mechanic during service. See November 2015 Military Personnel Record. (22) The Veteran's report that he inhaled and was covered in hydrochloric acid during service. He also was soaked in JP-4 jet engine fuel during service. He immediately began to have trouble breathing after these incidents. See May 2015 Correspondence. (23) The Veteran's report that immediately after unprotected exposure to hydrochloric acid, he started having respiratory problems, which continue to this day. During service, he was told that he could never be cured of the effects from exposure to it. See June 2014 Correspondence. (24) Medical records from 2004 showing allergic rhinitis and shortness of breath. See July 2004 Medical Treatment Record. (25) A medical record from 2004 showing the Veteran's report that loss of appetite, coughing up thick yellow sputum, and sleeping upright due to shortness of breath daily since 1965 were not related to asthma. There was an impression of a questionable soft tissue nodule in the right hilar region. See June 2004 Medical Treatment Record. (26) The Veteran's report that he had lung scarring based on x-ray results. See March 2004 Medical Treatment Record. (27) The Veteran's report that inhaling hydrochloric acid during service caused permanent damage to the lungs and respiratory system. Further information is provided. See October 2003 Statement in Support of Claim. (28) Medical records from 1975 showing a diagnosis of allergic rhinitis. See May 1977 Medical Treatment Record. (29) Medical records from 1976 showing prominent hilar and parahilar calcifications. Further information is provided. See August 1976 Medical Treatment Record. (30) The Veteran's report of spots on his lungs based on x-ray results. See September 1971 Form 9. (31) A medical record from 1971 showing a history of respiratory infection in 1967 with wheezing, coughing, and a fever. There was a mention of right hilar enlargement and an acute respiratory infection during service. See January 1971 VA Examination. (32) The Veteran's report of severe respiratory disease, beginning in 1966. See October 1970 Veterans Application for Compensation. (33) Service records showing pharyngitis, an impression of an upper respiratory infection, a severe sore throat, sinusitis for the past several years, year-round chronic colds, shortness of breath, chest pressure, enlargement of the right hilum, and strep. Further information is provided. See December 1967 STR Medical. (34) Medical records from 1967 showing that the Veteran was told that something was wrong with his chest upon discharge. See November 1967 Medical Treatment Record. (35) All other relevant lay and medical evidence. Skin (1) A list of the Veteran's service-connected disabilities. See March 2017 Rating Decision Codesheet. (2) Medical records from 2018 showing exposure to chemicals like hydrochloric acid during service. See August 2020 CAPRI. (3) Service records dealing with epithelia. Further information is provided. See July 2019 STR Medical. (4) The Veteran's report concerning hydrochloric acid during service. See November 2018 VA 21-0820. (5) The Veteran's report that hydrochloric acid could cause severe damage upon contact. If it touched skin, it could cause blisters, burns, and pain. The Veteran had blisters on his hands with pain that came and went over the years. See October 2017 Form 9. (6) The Veteran's report that he did not have skin problems prior to service. Further information is provided. See April 2017 NOD. (7) Medical records from 1999 showing a mass in the left inguinal area. See March 2017 CAPRI. (8) Medical records from 2016 and 2017 showing problems with the eyes, including scarring. Id. (9) Medical records from 2000 showing a lump on the arch of the Veteran's foot. Medical records from 2001 showed a lump on the left thumb and a history of recurrent cysts to multiple areas of the body. Medical records from 2002 showed a body mass index of 29.7. Medical records from 2009 showed a history of lumps, apparently following surgery. See September 2016 CAPRI. (10) Medical records from 2015 showing the Veteran's report that hydrochloric acid damaged the right eye and an assessment of different eye problems. See June 2016 CAPRI. (11) The Veteran's report that he suffered from itching on many areas of his skin. He inhaled vapors from hydrochloric acid without a face mask and without safety instructions during service and had a surgery during service due to skin irritations from having JP-4 jet engine fuel spilt all over his body. Further information is provided. See June 2016 Correspondence. (12) The Veteran's report that he had contact with fuel and other toxic chemicals daily during service. See April 2016 Correspondence. (13) The Veteran's report that hydrochloric acid could cause eye damage. See April 2016 Medical Treatment Records. (14) Medical records from 2016 showing problems with an ear canal. See February 2016 CAPRI. (15) The Veteran's report that he ingested JP-4 jet engine fuel during service. The area around where he had stomach surgery was constantly painful and uncomfortable. See November 2015 Statement in Support of Claim. (16) The Veteran's report that he still had skin damage from service. During service, he had unprotected exposure to jet engine fuel. He also had right eyelid discharge and swelling during service. See November 2015 Correspondence. (17) Service records showing that the Veteran was a jet engine mechanic. See November 2015 Military Personnel Record. (18) The Veteran's report that he inhaled and was covered in hydrochloric acid during service. He also was soaked in JP-4 jet engine fuel during service. Immediately after getting soaked in fuel, bumps broke out all over his body. Further information is provided. See May 2015 Correspondence. (19) The Veteran's report that he almost died from unprotected exposure to hydrochloric acid and passed out from it. He was told that he could never be cured from the effects of exposure. See June 2014 Correspondence. (20) Medical records from 2004 showing the Veteran's report that after being drenched in jet engine fuel, growths immediately started appearing on his skin. He still suffered from them. See March 2004 Medical Treatment Record. (21) The Veteran's report that the exposures in service created a skin condition which required him to periodically have cysts removed. See October 2003 Statement in Support of Claim. (22) A medical record from 1971 showing white spots on the Veteran's skin and diagnoses of chronic folliculitis of the beard, dry skin on the arms, a mole on the scrotum, and warts. The Veteran had a wart on his hand during service and had a wart on his scrotum, which had continued. The chronic folliculitis developed during service. The Veteran had a pale, dry spot on his right forearm and reported having others like it that were associated with pigment loss during service. The doctors during service did not know what it was. The spots lasted for about a year and disappeared. Further information is provided. See January 1971 VA Examination. (23) The Veteran's report of a skin disorder involving pigmentation in 1967. See October 1970 Veterans Application for Compensation. (24) Service records showing a wart on the right hand, a venereal wart on the scrotum, boils on the groin, an infected sebaceous cyst along the scrotal area, and something on the left buttock. Further information is provided. See December 1967 STR Medical. (25) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community's knowledge or due to the limits of the examiner's medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 6. Readjudicate the issues on appeal. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Dougan, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.