Citation Nr: 21039817 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 19-10 992 DATE: July 1, 2021 ORDER Entitlement to a disability rating in excess of 20 percent for degenerative disc disease of the lumbar spine (low back disorder) is denied. Entitlement to a separate 20 percent disability rating for left lower extremity radiculopathy, as secondary to service-connected low back disorder, is granted from April 10, 2017 (the date of receipt of the Veteran's claim for an increased rating for his thoracolumbar spine disability); subject to the applicable regulations concerning the payment of monetary benefits. Entitlement to a compensable disability rating for hearing loss, left ear, is denied. Entitlement to a compensable disability rating for sinusitis is denied. REMANDED Entitlement to service connection for lung cancer, to include as due to in-service asbestos exposure, is remanded. Entitlement to service connection for bone cancer, to include as secondary to lung cancer, is remanded. Entitlement to service connection for the cause of the Veteran's death is remanded. FINDINGS OF FACT 1. The service-connected low back disorder was not manifested by forward flexion of the lumbar spine limited to 30 degrees or less, any form of ankylosis of the spine, or incapacitating episodes having a total duration of at least four weeks. 2. The Veteran's low back disorder was manifested in moderate radiculopathy of his left lower extremity. 3. The Veteran's left ear hearing loss was manifested by a hearing loss pattern with no worse than a Level I designation. 4. Throughout the appeal period, there is no evidence that the Veteran's sinusitis manifested in one to two incapacitating episodes per year requiring prolonged antibiotic treatment or three to six non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 20 percent for degenerative disc disease of the lumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5293. 2. The criteria for a separate disability rating of 20 percent for radiculopathy of the lower left extremity associated with service-connected low back disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124a, Diagnostic Code 8520. 3. The criteria for entitlement to a compensable disability rating for hearing loss, left ear, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. § 4.1, 4.85, 4.86, Diagnostic Code 6100. 4. The criteria for entitlement to a compensable disability rating for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.97, Diagnostic Code 6513. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1981 to November 2001. He died in July 2017. The appellant is his surviving spouse and has been substituted in this matter. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2017 decision by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the appellant and the Veteran's daughter testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. The Board has considered the appellant's claim and decided entitlement based on the evidence. Neither the appellant nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to her claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Increased Ratings VA has adopted a Schedule for Rating Disabilities (Schedule) to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. Disability evaluations assess the ability of the body as a whole, the psyche, or a body system or organ to function under the ordinary conditions of daily life, to include employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Id. The Schedule assigns Diagnostic Codes to individual disabilities. Diagnostic Codes provide rating criteria specific to a particular disability. If two Diagnostic Codes are applicable to the same disability, the Diagnostic Code that allows for the higher disability rating applies. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the claimant. 38 C.F.R. § 4.3. The Schedule recognizes that a single disability may result from more than one distinct injury or disease; however, rating the same disability or its manifestation(s) under different Diagnostic Codes-a practice known as pyramiding-is prohibited. Id. & 38 C.F.R. § 4.14. Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent they are sufficient to warrant changes in the evaluations assignable under the applicable rating criteria. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). For increased-rating claims, where a claimant seeks a higher evaluation for a previously service-connected disability, it is the present level of disability that is of primary concern, and VA considers the level of disability for the period beginning one year prior to the claim for a higher rating. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); 38 C.F.R. § 3.400(o)(2). In evaluating disabilities of the musculoskeletal system, consideration must be given to functional loss, including due to weakness and pain, affecting the normal working movements of the body in terms of excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40; see Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011) (holding that pain "must actually affect some aspect of 'the normal working movements of the body' [under] 38 C.F.R. § 4.40 in order to constitute functional loss" warranting a higher rating). With respect to disabilities of the joints, it must be considered whether there is less movement or more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement, as well as swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. These provisions thus require a determination of whether a higher rating may be assigned based on functional loss of the affected joint on repeated use as a result of the above factors, including during flare-ups of symptoms, beyond any limitation reflected on one-time measurements of range of motion. DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995) (holding that the provisions of 4.40 and 4.45 are not subsumed by the DC's applicable to the affected joint). However, a higher rating based on functional loss may not exceed the highest rating available under the applicable diagnostic code(s) pertaining to range of motion. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Entitlement to a disability rating in excess of 20 percent for low back disorder The regulations provide that back disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.71a. As will be explained below, there is no indication that the Veteran experienced incapacitating episodes which required prescribed bed rest. See 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes, Note (1) ("an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician"). Therefore, the Formula for Rating IVDS Based on Incapacitating Episodes does not provide an adequate basis to assign an increased disability rating. The General Rating Formula for Diseases and Injuries of the Spine provides, in pertinent part, a 20 percent rating for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. 38 C.F.R. § 4.71a. A 40 percent disability rating is provided for forward flexion of the thoracolumbar spine 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. Id. The above criteria are to be applied irrespective of whether there are symptoms such as pain (whether or not it radiates), stiffness, or aching in the affected area of the spine. Id. This is because the criteria "are meant to encompass and take into account the presence of pain, stiffness, or aching, which are generally present when there is a disability of the spine." 68 Fed. Reg. 51, 454, 51,455 (August 27, 2003) (Supplementary Information). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is from 0 to 90 degrees, extension is from 0 to 30 degrees, left and right lateral flexion are from 0 to 30 degrees, and left and right lateral rotation are from 0 to 30 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243, Note (2). Unfavorable ankylosis is defined, in pertinent part, as "a condition in which the entire thoracolumbar spine is fixed in flexion or extension." Id., Note (5). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. The General Rating Formula also provides that associated neurologic abnormalities will be separately rated. See id., Note (1). This matter is addressed below. The Veteran's low back disorder was rated as 20 percent disabling under Diagnostic Code 5003-5293. 38 C.F.R. § 4.71a. See also 38 C.F.R. § 4.27 (hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen). Diagnostic Code 5235 pertains to degenerative arthritis. Diagnostic Code 5243 pertained to IVDS at the time of the initial grant of service connection in October 2003. During the pendency of the appeal, VA issued a final rule revising the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a. 85 Fed. Reg. 76,453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). The final rule went into effect February 7, 2021. A change in the rating criteria during an appeal period requires consideration of the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. The new rating criteria did not make any substantive changes to Diagnostic Code 5003. A July 2003 VA examination report reflected that the Veteran's lumbar flexion was normal, extension was limited to 5 degrees, and lateral flexion was limited to 25 degrees bilaterally. See July 2003 VA General Medical Examination. A September 2003 examination report reflected that his lumbar flexion was limited to 40 degrees, extension was limited to 10 degrees, and lateral flexion was limited to 10 degrees bilaterally. See September 2003 C&P Examination Report. The Veteran died before an examination could be scheduled to evaluate the severity of his service-connected low back disorder. Prior to his demise, he stated that his musculoskeletal system was affected by osteoarthritis and a "bad back." See May 2016 Pulmonary & Critical Care Associates Patient Questionnaire. An October 2016 radiology report reflects that the Veteran's lumbosacral spinal alignment was maintained. Mild degenerative changes a L4-L5 were noted with mild diffuse disc bulge. See October 2016 MRI Lumbar Spine. The appellant and the Veteran's daughter testified that the Veteran experienced physical symptoms associated with his low back disorder following his active duty service. The appellant elaborated that the Veteran was unable to sit up straight or walk long distances. He was also unable to lift heavy objects or even hold his grandchild. See January 2021 Hearing Transcript. Based on the foregoing, the Board finds that a rating in excess of 20 percent is not warranted at any point during the appellate period. In this regard, the evidence does not show that the forward flexion of the Veteran's lumbar spine was ever limited to 30 degrees or less, or that he had favorable ankylosis of the spine. Rather, the evidence shows the Veteran's forward flexion was, at worst, limited to 40 degrees and that there is no evidence of ankylosis. 38 C.F.R. § 4.71a. The appellant and the Veteran's daughter reported the Veteran experienced pain and restricted physical activity prior to his death. They are both certainly competent to report pain and observable symptomatology, and the Board finds their reports credible. Nevertheless, the Veteran's pain and functional loss did not result in limited motion severe enough to warrant an increased rating. See Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011) (holding that pain "must actually affect some aspect of 'the normal working movements of the body' [under] 38 C.F.R. § 4.40 in order to constitute functional loss" warranting a higher rating). Further, the Veteran's 20 percent disability rating considered his painful motion. In conclusion, a rating in excess of 20 percent is not warranted at any time. 38 C.F.R. § 4.71a. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Entitlement to a separate compensable disability rating for radiculopathy of the left lower extremity, as due to service-connected low back disorder As stated above, the General Rating Formula for Diseases and Injuries of the Spine provides for assignment of a separate rating for any associated objective neurological abnormalities. See 38 C.F.R. § 4.71a, Note (1). In December 2003, the Veteran underwent an electromyogram study (EMG) to address the pain and tingling numbness he experienced in his left lower extremity. The EMG study reflects the Veteran's low back disorder caused moderate, chronic radiculopathy of his left lower extremity. See December 2003 EMG Report. Accordingly, the Board finds that a 20 percent rating under Diagnostic Code 8520 pertaining to incomplete paralysis of the sciatic nerve is appropriate for the left lower extremity throughout the appeal period from April 10, 2017, the date of receipt of the Veteran's claim for an increased rating for his service connected low back disorder. Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis; a 20 percent rating is warranted for moderate incomplete paralysis; a 40 percent rating is warranted for moderately severe paralysis; a 60 percent rating is warranted for severe paralysis, with marked muscular atrophy; and a maximum 80 percent rating for complete paralysis (the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost). 38 C.F.R. § 4.124a. The terms "mild," "moderate," and "severe" under applicable diagnostic codes are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The term "incomplete paralysis," with these and other peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. See "note" at "Diseases of the Peripheral Nerves" in 38 C.F.R. § 4.124a. As the December 2003 EMG study reflected that the Veteran experienced moderate, chronic radiculopathy of his left lower extremity due to his low back disorder, the Board finds that a separate compensable rating of 20 percent is warranted based on moderate incomplete paralysis of the sciatic nerve of his left leg. A higher rating is denied, as there is no evidence of record which reflects the Veteran's left lower extremity radiculopathy was manifested by moderately severe incomplete paralysis of the left sciatic nerve. 38 C.F.R. § 4.124a. Entitlement to a compensable disability rating for left ear hearing loss Hearing impairments are evaluated pursuant to 38 C.F.R. § 4.85, Diagnostic Code 6100. Ratings for hearing impairments are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations for defective hearing are based upon organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, along with the average hearing threshold level as measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000, and 4000 Hertz. 38 C.F.R. § 4.85, Tables VI, VII. To evaluate the degree of disability for service-connected bilateral hearing loss, the rating schedule establishes eleven auditory acuity levels, designated from level I for essentially normal acuity, through level XI for profound deafness. Table VI is used to determine the Roman numeric designation, based on test results consisting of puretone thresholds and Maryland CNC test speech discrimination scores. The numeric designations are then applied to Table VII to determine the appropriate rating for hearing impairment. Id. If impaired hearing is service-connected in only one ear, as is the case here, the law allows for compensation for hearing loss as if both ears were service-connected if the service-connected hearing loss is ratable as at least 10 percent disabling and the non-service-connected hearing loss meets the standard for a hearing loss disability for VA purposes under 38 C.F.R. § 3.385, unless the non-service-connected hearing loss is the result of the Veteran's willful misconduct. See 38 C.F.R. § 3.383. To determine the percentage evaluation from Table VII, the non-service-connected ear will be assigned a Roman Numeral designation for hearing impairment of I, subject to the provisions of 38 C.F.R. § 3.383. 38 C.F.R. § 4.85(f). A July 2003 VA examination report reflects the Veteran's Maryland CNC Word List speech recognition score and pure tone thresholds, in decibels, were as follows: July 23, 2003 HERTZ 1000 2000 3000 4000 Avg CNC RIGHT 5 5 5 5 8 100 LEFT 35 35 45 35 38 100 The Board notes that the Veteran's nonservice-connected right ear hearing loss does not meet the standard for a hearing loss disability under 38 C.F.R. § 3.385. Accordingly, his right ear will be assigned a Roman Numeral designation for hearing impairment of I. 38 C.F.R. § 4.85(f). Applying the results to Table VI, the findings yield a numeric designation of Level I in the left ear. Entering the resulting bilateral numeric designation of Level I for the right ear and Level I for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a noncompensable disability rating under Diagnostic Code 6100. An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 was not shown. Significantly, no more recent audiological evidence (prior to the Veteran's demise) contradicts these findings. The Board has carefully considered the lay statements of record and in no way discounts the asserted difficulties that were associated with the Veteran's service-connected left ear hearing loss. The statements from the appellant are both competent and credible in regard to reporting worsening hearing acuity and functional effects. However, in essence, lay statements are of limited probative value. As a layperson, the appellant is competent to report difficulties with hearing but is not competent to assign particular speech recognition scores or puretone decibel readings to hearing acuity problems. Of greatest probative value is the July 2003 VA examination, as it was conducted in accordance with the requirements for a hearing impairment examination for VA purposes. See 38 C.F.R. § 4.85(a). More probative of the degree of the disability are the results of testing prepared by skilled professionals because the schedular criteria are predicated on audiological findings rather than subjective reports of severity of hearing loss. Additionally, it must be emphasized that the assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Hence, the Board has no discretion in this matter and must predicate its determination on the basis of the results of the audiology studies of record. See Lendenmann, 3 Vet. App. 345. In other words, the Board is bound by law to apply VA's rating schedule based on the audiometry results. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Board, thus, finds that a compensable disability rating for the Veteran's left ear hearing loss is not warranted. The evidence preponderates against the claim and the benefit-of-the-doubt standard of proof does not apply. 38 U.S.C. § 5107(b). Entitlement to a compensable disability rating for sinusitis The Veteran's sinusitis is rated under 38 C.F.R. § 4.97, Diagnostic Code 6513 for maxillary sinusitis. Sinusitis is to be evaluated under the General Rating Formula for Sinusitis which provides for a noncompensable evaluation when there is evidence of chronic maxillary sinusitis detected by x-ray only. A 10 percent rating is warranted when there are one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted when there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent disability rating is warranted following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. A note following these rating criteria indicates that an "incapacitating episode" of sinusitis means one that requires bed rest and treatment by a physician. Id. Purulent is defined as "consisting of or containing pus." See Dorland's Illustrated Medical Dictionary 1391 (28th ed. 1994). The criteria for rating sinusitis are conjunctive, meaning that each element of the criteria is needed to meet the requirements for the specified evaluation. See Camacho v. Nicholson, 21 Vet. App. 360 (2007); see also Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision means that all the conditions listed in the provision must be met). After a review of the evidence of record, the Board finds that a compensable rating is not warranted at any time during the period on appeal. A July 2003 VA examination report reflects the Veteran experienced year-round nasal stuffiness and itchy eyes due to allergies. He also reported occasional sinus headaches, but no problems with sinus infections. See July 2003 VA General Medical Examination. Significantly, the most recent medical evidence of record (prior to the Veteran's demise) reflects that he denied experiencing chronic sinus problems. See May 2016 Pulmonary & Critical Care Associates Patient Questionnaire. Accordingly, the Board finds that the severity of the symptoms and disability picture of the Veteran's sinusitis does not warrant a compensable rating at any point during the appeal period. In this regard, there is no evidence indicating the Veteran experienced one or two incapacitating episodes of sinusitis per year requiring prolonged (4 to 6 weeks) antibiotic treatment. In addition, there is no evidence which suggests the Veteran experienced any non-incapacitating episodes characterized by headaches, pain, and purulent discharge. 38 C.F.R. § 4.97. The Board has also considered the applicability of alternative diagnostic codes for rating the Veteran's service-connected sinusitis; however, because maxillary sinusitis has its own Code and is rated under the General Rating Formula for Sinusitis, rating by analogy under other codes is not permissible. Copeland v. McDonald, 27 Vet. App. 333, 338 (2014). The Board acknowledges the appellant's testimony that the Veteran experienced difficulty breathing and had to use Dristan every day in order to breathe. See January 2021 Hearing Transcript. The appellant is competent to report lay observable symptoms, including the Veteran's daily use of Dristan and difficulty breathing. See Layno v. Brown, 6 Vet. App. 465 (1994). However, whether or not there is underlying pathology constituting increased disability, or whether there is a symptom related to a disability, is a medical question beyond the capability of the appellant's own lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). There is no evidence to demonstrate the appellant has the training and expertise to determine the underlying pathology or symptomology of the Veteran's service-connected chronic sinusitis disability. In adjudicating this appeal, the Board finds that the most probative evidence regarding the severity of the Veteran's sinusitis is the medical evidence of record which considers his reported symptoms, including the frequency and severity thereof, but also provides clinical evaluation of the disability, as well as evaluation of functional impairment caused thereby. In sum, the Board finds that a compensable rating for sinusitis is not warranted at any time during the appeal period. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the appellant's claim, the appeal as to this matter must be denied. 38 U.S.C. § 5107. REASONS FOR REMAND Service connection for lung cancer, to include as due to asbestos exposure Service connection for bone cancer, to include as secondary to lung cancer The appellant asserts that the Veteran's lung cancer was caused by his in-service asbestos exposure. Specifically, she stated that the Veteran was stationed at several Air Force Bases which had used asbestos in building materials and that his military occupational specialty (MOS) of maintenance data systems analysis craftsman placed him in small computer rooms. See January 2021 Hearing Transcript. The appellant's representative stated that the three Air Force Bases at which the Veteran was stationed each had subsequent remedial measures taken to reduce the risk of asbestos exposure following the Veteran's service. See April 2021 Attorney Brief. In support of this statement, the appellant's representative referenced The Mesothelioma Center's website which addresses the use of asbestos in military bases and aircraft. See www.asbestos.com/veterans/air-force/ (last visited June 16, 2021). This website does not specifically list which Air Force Bases have had remedial measures taken, nor does it provide conclusive evidence that the Veteran was exposed to asbestos during his active duty service. Despite the appellant's assertions regarding the Veteran's exposure to asbestos, development has not been completed to determine whether the Veteran's job duties actually required him to handle asbestos or whether he was otherwise exposed to asbestos during service. VA Manual M21-1 provides that VA must determine whether military records demonstrate evidence of asbestos exposure during service, develop whether there was pre-service and/or post-service occupational and other asbestos exposure, and determine whether there is a relationship between asbestos exposure and the claimed disease. See VA Adjudication Procedure Manual, M21-1 MR, Part IV, Subpart ii, Chapter 2, Section C, para. 9 (December 13, 2005). For many asbestos-related diseases, the latency period varies from 10 to 45 or more years between first exposure and development of the disease. Id. Accordingly, a remand is required to determine whether the Veteran was exposed to asbestos during his active duty service. Service connection for the cause of the Veteran's death Since the cause of death claim is inextricably intertwined with the remaining service connection claims, it is also being remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered); Ephraim v. Brown, 82 F.3d 399 (Fed. Cir. 1996) (claims are inextricably intertwined when they have common parameters, such as when the outcome of one may affect the outcome of the other. And to avoid piecemeal adjudication of these types of claims, they should be considered together). Accordingly, these matters are REMANDED for the following action: The AOJ should take appropriate action to develop evidence of whether the Veteran was exposed to asbestos during service. Such development should include seeking information as to whether his job duties involved working with, or near, asbestosas well as a decision regarding the extent to which his duties would have exposed him to asbestos. In addressing this matter, the Board notes that the Veteran was stationed at Griffiss Air Force Base from 1982 to 1986, Vandenberg Air Force Base from 1990 to1995, and Scott Air Force Base from 1996 to 2001. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Stedman, 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.