Citation Nr: 21004995 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 16-28 895 DATE: January 28, 2021 ORDER Service connection for obstructive sleep apnea is granted. REMANDED The service connection claim for respiratory conditions, to include chronic obstructive pulmonary disease (COPD), and to include as secondary to exposure to asbestos and/or other chemical materials, is remanded. The service connection claim for rheumatoid arthritis, to include as secondary to exposure to asbestos and/or other chemical materials, is remanded. Entitlement to a total disability rating based on an individual unemployability (TDIU) is remanded. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, his obstructive sleep apnea is causally related to his active service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea have been met. 38U.S.C. 1131, 5107; 38C.F.R. 3.102, 3303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1978 to February 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2015 and October 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. In March 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. Service Connection for Obstructive Sleep Apnea Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Veteran asserts that his obstructive sleep apnea is causally related to his active military service. At his March 2020 videoconference hearing, the Veteran testified that during his time in service, he manifested symptoms of obstructive sleep apnea, and specifically, for example, he stated that there were comments about his tendency to fall asleep, while on duty, on several occasions; and also, he fell asleep in the middle of conversations, as well as while he was standing up. He reported that he was diagnosed with obstructive sleep apnea in the 80s, early 90s, although treatment records, reflecting this, had not been associated with the claims file, at the time of this hearing. The medical evidence reflects a current diagnosis of obstructive sleep apnea, which was diagnosed no earlier than May 2000. See May 2000 Nursing Emergency Department Note. Although some of the Veteran’s service treatment records (STRs) are currently unavailable for review, the Veteran has submitted several buddy statements from family member and fellow service members, which constitute as evidence of in-service manifestations and complaints of symptoms that are related to obstructive sleep apnea. Specifically, in a July 2017 buddy statement, a fellow service member, J.P., who served with the Veteran at two separate duty locations, indicated, in pertinent part, that he noticed the Veteran falling asleep on benches in front of the flight line; and that he slept so hard, that he often began snoring loudly. In an August 2017 buddy statement, the Veteran’s sister, A.H., reported that she witnessed, during family visits, that the Veteran had symptoms of loud snoring, grasping for air, and periods of no respiration, while sleeping. She further indicated that the Veteran would awaken abruptly, several times during the night, and then complain about fatigue during the daytime. She explained that these symptoms began while the Veteran was on active duty, and after being deployed in 1980, continuing to the present day. Another sister, P.R.H., made a similar testimony in an August 2017 buddy statement. In another August 2017 buddy statement, the Veteran’s brother, D.B., testified that after deployment from his ship, he observed his brother, the Veteran, had symptoms which included loud snoring, gasping for air, and periods of a lack of breathing, while sleeping and napping. He further explained that the Veteran would also be awaken abruptly, at times, during the night, and had always looked tired, complaining of fatigue during the day. He also clarified that he had observed these symptoms since the Veteran served on active duty and that they continue today. In another August 2017 buddy statement, a fellow service member, S.J.B., explained that he was deployed with the Veteran on the U.S.S. Coral Sea in 1979. He testified that their berthing was adjacent to each other and they were in tight quarters; and that while there was a fair amount of ambient noise in their berth, “one of the complaints by [him] and many others was [the Veteran] and his snoring.” S.J.B. also explained that the Veteran snored to decibel levels above normal. In another buddy statement, also dated August 2017, another service member, D.A.P., who served with the Veteran aboard the U.S.S. Coral Sea from November 1979 to June 1980, also reported that the Veteran would fall asleep at the drop of a hat; and that on numerous times, he often observed the Veteran sit on a beach and simply nod off, as aircrafts were running, taxing, taking off, and landing; and that his snoring at the time would be so bad it would occasionally wake him or he would have to be physically shaken to get him moving again. D.A.P. also indicated that when they were deployed to Nellis Airforce Base, Nevada around January 1981, him and the Veteran were roommates, both on base and for two weeks at off-post lodging, the Veteran’s snoring was so pronounced and loud that he had difficulty sleeping. In an October 2017 buddy statement, R.M., another service member who served with the Veteran on the U.S.S. Coral Sea, noted that from 1978 to 1981, the Veteran “had a hell of a time sleeping”, and that he would snore like he had something wrong with him. In an April 2019 buddy statement, another service member, S.A., who also served with the Veteran aboard the U.S.S. Coral Sea, stated that he slept a few feet away from each other; and that on several occasions, as the Veteran slept, he witnessed the Veteran waking up, gasping for air. He also stated that at times, he could hear him snore and stop halfway through a snore, as if he had stopped breathing. He also stated that the Veteran would then wake up breathing heavily and go back to sleep; and that he would often seem fatigued at work, during the days that followed through those troubled nights. The Veteran was afforded a VA examination for obstructive sleep apnea in February 2016. This VA examination report notes that the Veteran has had a history of sleep apnea, with prescription for CPAP, which started approximately in 2005, and additionally, notes that a June 2015 sleep study reflected extremely, severe sleep apnea with an AHI of 113. After this examination, a VA examiner opined that the Veteran’s sleep apnea was not incurred in or caused by an in-service injury, event or illness. As the rationale for this opinion, the VA examiner stated that the Veteran’s sleep apnea is not caused by exposure to asbestos and MEK from his period of service, and that rather, the Veteran’s sleep apnea is more likely than not caused by his BMI of 37.31 percent, which is considered obese Class II, and the anatomy of his neck. However, even though the VA examiner had not untaken a review of all of the Veteran’s STRs, which were unavailable, the VA examiner presumed that the Veteran did not exhibit any signs or symptoms of sleep apnea, while on active service. However, to the contrary, the Veteran has submitted evidence, and specifically, several buddy statements, as discussed above, which indicate that the Veteran manifested sleep apnea symptoms during his active service. Thus, this opinion is not particularly probative of the issue at hand. In support of his claim, the Veteran has also submitted a private medical opinion from Dr. M.R. In this March 2020 private opinion, Dr. M.R. stated that the Veteran started to have heavy snoring and heaving breathing during his sleep, during his active military service, and that his lay statements are corroborated by family members and fellow service members, which include his bunkmates. While this opinion acknowledges that the Veteran was diagnosed with obstructive sleep apnea in Spring 2000, several years after his separation from service, Dr. M.R. clarified that the “peer reviewed literature regarding [obstructive sleep apnea] corroborates the lengthy delays in diagnosis[,] such as occurred with [the Veteran,] are the norm and not exception for patients who have [obstructive sleep apnea].” Citing an article from the National Institute of Health, National Library of Medicine (National Center for Biotechnology Information), “Delayed Diagnosis of Obstructive Sleep Apnea Don’t Ask Don’t Tell”, https://pubmed.ncbi.nlm.nih.gov/11898119/, Dr. M.R. explained the following: the “average time elapsed between first recognition by the patient of a major feature of OSAS to sleep center referral was 87.5 months (range, 1 to 480 months). Only 4% of referrals were made as a result of the clinician eliciting a history of sleep-related complaints. Once OSAS-related features were apparent to the clinician, the average time to referral for diagnostic testing was 7.9 months (range, 0 to 128 months). These data suggest that both a lack of reporting of symptoms by OSAS patients and a lack of obtaining appropriate sleep history by health care providers contribute to a significant delay in diagnosis of OSA.” Reasoning that there is extensive documentation from the Veteran, his family members and multiple colleagues from the UMSC, that the Veteran suffered from symptoms of obstructive sleep apnea, dating back to his military service, Dr. M.R. opined that it is more likely than not that the Veteran’s obstructive sleep apnea is etiologically related to his active service. Given that this opinion is supported by the Veteran’s medical history and probative evidence of record; it accounts for the buddy statements of the Veteran’s family and service members as competent, credible evidence; and it is supported by medical literature, the Board finds that it is adequate and it is the most probative medical opinion on the etiology of the Veteran’s obstructive sleep apnea. Despite missing STRs, the Veteran has provided several buddy statements from family members and fellow service members, which establish sufficient evidence of the onset of symptoms of obstructive sleep apnea, in service, as well as continuous symptoms to the present day. Therefore, the Board finds that the evidence is in at least relative equipoise, and by resolving all reasonable doubt in favor of the Veteran, service connection for obstructive sleep apnea is granted. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND In a March 2020 appellate brief, the Veteran, through his representative, posited that “VA should not schedule the Veteran for any further examinations because there is already sufficient medical evidence to decide the claim, and thus, a VA examination is not required under 38 [U.S.C.] § 5103A(d).” He further suggests that the “private opinion is sufficient for the VA to adjudicate the claim because it was conducted by a qualified expert and is based on a thorough review of the record, considers all previous examinations and opinions of records, and contains a sufficient rationale to fully inform the Agency on the remaining issues germane to this appeal.” However, it is not for the Veteran, or his representative, to determine whether the medical evidence is sufficient for deciding the claims. Rather, it is incumbent on the Board to make this determination, contingent on whether evidence submitted, in support of the Veteran’s claims, is sufficient enough for the Board to make fully informed decision. As part of VA’s duty to assist a claimant, it must provide a medical examination or obtain a medical opinion “when such an examination or opinion is necessary to make a decision on the claim”, and more so, when VA undertakes to provide an examination or obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 – 312 (2007). Additionally, the assertions of the Veteran’s representative, that “VA would be acting in an adversarial fashion if it obtained additional medical opinion to contradict the favorable private opinion”, see March 2020 Appellate Brief, are not completely accurate. Rather, and for clarification, “[it] would not be permissible for VA to undertake . . . additional development if a purpose was to obtain evidence against an appellant's case.” See Mariano v. Principi, 17 Vet. App. 305, 312 (2003) (Emphasis Supplied). Thus, “VA must provide an adequate statement of reasons or bases for its decision to pursue further development where such development reasonably could be construed as obtaining additional evidence for that purpose.” Id. In this regard, and although the Board regrets further delay, it finds that additional developments are necessary before a decision may be rendered on the remaining issues on appeal, including obtaining outstanding STRs, to the extent possible, and obtaining an adequate opinion addressing the etiology of the Veteran’s disabilities. 1. Outstanding Service Treatment Records The Veteran has consistently maintained that his STRs are missing. See e.g. May 2016 Statement in Support of Claim; see also August 2016 Statement in Support of Claim. At the Veteran’s videoconference hearing, the Veteran, through his representative, also testified that there are no service records in the Veteran’s file. He suggested that they have been either lost or destroyed. See March 2020 Videoconference Hearing Transcript. However, based on a review of the claims file, the Board finds that the RO has not fulfilled its duty to assist the Veteran with the procurement of outstanding STRs. The claims file indicates that in January 2015, the RO initiated an expedited request for service records, via e-mail, and in March 2015, the request was submitted to records management center (RMC). In a March 2015 response, available requested records were provided, with an attached memorandum from October 1991, noting that field, health and dental records were missing. A September 2015 deferred rating decision noted that there was a need to complete the development of STRs, clarifying that it was in possession of STRs dated in 1973, 1977, and 1978, which only contained the report of medical examination, and further indicating that a February 2015 notification from the Headquarters of the United States Marine Corps indicated that field, health, and dental records were missing. The deferred rating decision additionally instructed that the Veteran’s social security disability (SSA) records be obtained. Accordingly, in October 2015, a request for SSA records was submitted by the RO. However, it does not appear that further efforts or developments for searching for outstanding STRs were undertaken, per the instructions of this deferred rating decision. On May 11, 2016, the RO notified the Veteran, via letter, that it had requested for U.S. Marine Corps STRs; and that it had determined that STRs, for the period of February 1978 to February 1982, could not be located and that they are unavailable for review. In this letter, the RO described all the efforts it undertook to obtain the outstanding treatment records. In pertinent part, this letter stated that on “May 5, 2016, we submitted a request for records via Defense Personnel Records Information Retrieval System [(DPRIS)]. On October 5, 2016, we received a negative response.” As this May 2016 letter suggests that the RO received a negative response from DPRIS on a future date, in October 2016, which is after the date of this letter, it does not appear that the RO actually undertook this development, as there is no response from DPRIS that has been associated with the claims file, nor has a May 5, 2016 request to DPRIS for the Veteran’s STRs been associated with the claims file. Rather, the only May 5, 2016 correspondence that has been associated with the claims file is an e-mail correspondence from VA’s appeals team, which indicates that it “just needs” a ten-day letter sent for missing STRs, thereby indicating a draft letter was attached to the e-mail; and further indicating if anything else was needed, “or if it is good to go and has been sent out to the Veteran”, the sender of this May 5, 2016 e-mail should be notified. Therefore, the Board finds that the RO has not fulfilled its duty to assist the Veteran in exhausting all efforts to locate the STRs. Accordingly, a remand is required for the RO to undertake additional efforts at locating the Veteran’s STRs. 2. Service Connection Claims The Veteran asserts that he was exposed to asbestos and other chemicals, to include methyl ethyl ketone MEK), as well as benzene and PCP, during his period of active service in the United States Marine Corps, while stationed at El Toro, California, and aboard the U.S.S. Coral Sea. See April 2015 Correspondence; see also August 2015 Correspondence; see too, March 2020 Videoconference Hearing Transcript. Further, the Veteran clarified that he was stationed at Marine Air Station in El Toro, California, and that it has come to his attention that “MCAS El Toro was shut down in 1999 and listed as an EPA Superfund site.” The Veteran explained that its “ground water clogged with toxic waste volatile organic compounds”, TCE Trichloroethene and benzene, which the Veteran described as a product of “fuel to produce a toxic soup.” The Veteran further asserted that his research indicated that those chemical compounds “produce the same symptoms as asbestos and MEK. He additionally asserted that this “continued exposure to detrimental chemicals are responsible for the debilitating effects of a severe rheumatoid arthritis, pulmonary disease and obstructive breathing.” See June 2016 Board Appeal. In support of his claims, the Veteran has also submitted evidence pertaining to chemical exposure, including and not limited to, literature and/or reports pertaining to water contamination at MCAS El Toro. See March 2018 Correspondence. VA has conceded exposure to asbestos. See September 2015 Deferred Rating Decision. However, no developments have been undertaken about his assertions about his exposure to MEK, water contamination, and/or other chemicals. Thus, on remand, the RO shall undertake additional developments to verify whether the Veteran was exposed to other chemicals, to include MEK, PCP, and/or water contamination during his active service. A. Respiratory Conditions, to include COPD, and to Include as Secondary to Exposure to Asbestos and Other Chemical Materials The Veteran was afforded a VA examination of his respiratory conditions in February 2016. The VA examination report indicates that the Veteran has been diagnosed with a respiratory condition, and specifies that the pertinent respiratory condition is extremely severe COPD, with a diagnosis date of March 2014. However, a VA examiner opined that the Veteran’s condition was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness. On the one hand, the VA examiner provided a rationale to support his opinion that the Veteran’s diagnosis of COPD is less likely than not caused by exposure to MEK, and additionally, reasoned that the Veteran’s COPD is more likely than not caused by his 36 pack-year smoking of cigarettes. He further explained that the Veteran left service in 1982, and that subsequent to that, he worked as a mechanic and also as a crop duster, which also has hazards of causing respiratory conditions as well. On the other hand, however, the VA examiner did not provide a rationale to support the opinion that the Veteran s COPD was not caused by his in-service exposure to asbestos. Thus, the Board finds that this opinion is inadequate. Additionally, medical treatment records indicate that the Veteran is also diagnosed with asthma. See e.g. February 2015 Primary Care Provider Note; see also August 2015 Problem List; see too February 2020 Sleep Medicine Note. However, the VA examiner did not account for all of the Veteran’s respiratory conditions, and specifically, his asthma condition. In doing so, the VA examiner failed to render an opinion on the etiology of all of the Veteran’s respiratory conditions, including asthma. Thus, this VA opinion is insufficient because it does not account for all of the Veteran’s currently diagnosed respiratory conditions. In support of his claim, the Veteran has submitted a private opinion from Dr. M.R. In this March 2020 private opinion, Dr. M.R. stated that the Veteran was exposed to MEK solvent, which was used in cleaning airplane parts, as well as asbestos, which she explained, is “widely reported in news reports to have been present on the USS Coral.” Dr. M.R. further notes that the Veteran did not have asthma or allergies, prior to active service; he smoked cigarettes, but quit in January 2013; and that the Veteran, in an October 2015 statement in support of claim, reported that “asthma and difficulties with allergies began during active duty military service; and were specifically related to handling MEK and/or asbestos.” She further noted that the Veteran, in a November 2014 statement in support of claim, documented cough, with production of phlegm and mucous, when exposed to asbestos and MEK, while on active duty; and that in VA records, he complained of chronic shortness of breath, nasal congestion and wheezing in the spring. Citing medical literature, Dr. M.R. also noted that medical literature documents that exposure to asbestos in the workplace results in obstructive small airway disease. In her discussion and conclusion, Dr. Mr. indicated that ‘available C File, VA and civilian records document that he had extensive exposure to asbestos and MEK solvent during his active duty service. She opined that based on her training, experience and professional qualifications, it is more likely than not that the Veteran’s asthma/reactive airways disease/allergies is a “secondarily service-connected [disability], as [it] resulted from his heavy exposure to MEK and asbestos while on active duty. A medical opinion is adequate when it is based upon consideration of the veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. Barr, 21 Vet App. at 311 (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994); and Green v. Derwinski, 1 Vet. App. 121, 124 (1991). In this case however, Dr. M.R.’s opinion is primarily based on the Veteran’s statements, which she often conflates with medical records. Specifically, for example, Dr. M.R. noted: The Veteran’s medical records document the following physical conditions: 1. Exposure to MEK and Asbestos – The Veteran was stationed on the aircraft carrier USS Coral Sea. His SSOC detail asbestos exposure on board the ship . . . Per SSOC, the Veteran was also exposed in the course of his job as an aviation mechanic during his active service to Methyl Ethyl Ketone (MEK) a solvent used to clean airplane parts. The Veteran recalls extensive exposure to MEK including washing his hands with the MEK due to lack of availability of handwashing sinks on-board the aircraft carrier USS Coral Sea. . . . The Veteran also reports exposure to various other chemicals in his role as an aircraft technician and states in SSOC of 11/25/14, that he noted the onset of respiratory symptoms in relation to chemical exposure.” However, the pertinent document that Dr. M.R. cites is a November 2014 statement in support of claim, which solely consists of the Veteran’s statements about his claims, and thus, is not a medical record. Additionally, in the “discussion and conclusion” part of her medical opinion, Dr. M.R. stated that the Veteran’s C File, VA and civilian records document that he had extensive exposure to Asbestos and MEK during his active service.” Although exposure to asbestos has been conceded by VA, exposure to chemicals, including and not limited to MEK, has not been conceded and/or verified by VA. Therefore, this opinion is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (Holding that a medical opinion based on an inaccurate factual premise has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (“If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely.”) (citing Reonal) Thus, as there is no adequate medical opinion, of record, a remand is required for a new VA examination and opinion on the etiology of the Veteran’s respiratory conditions. The Veteran is certainly free, and is encouraged to attempt to obtain a supplemental opinion from Dr. M.R. B. Rheumatoid Arthritis, and to Include as Secondary to Exposure to Asbestos and Other Chemical Materials The Veteran was afforded a VA examination of rheumatoid arthritis in February 2016. The VA examination report reflects that the Veteran currently has rheumatoid arthritis, and that this condition was diagnosed in October 2007. A VA examiner opined that the Veteran’s diagnosis of rheumatoid arthritis is less likely than not incurred in service, or caused by exposure to asbestos and MEK during service. As the rationale for this opinion, the VA examiner reasoned that there is no known causal relationship to exposure to MEK/asbestos and rheumatoid arthritis. The VA examiner suggested that the Veteran’s rheumatoid arthritis is most likely hereditary, as the Veteran stated that his grandfather had very crooked hands when he was approximately the Veteran’s age, and that disfiguring arthritis of the hands is a distinct characteristic of rheumatoid arthritis. Further, the VA examiner also reasoned that the Veteran did not display any symptoms of rheumatoid arthritis while serving on active duty. However, this opinion is inadequate as it renders a speculative rationale that presumes that the Veteran did not display any symptoms of rheumatoid arthritis while serving on active duty, even though the VA examiner did not conduct a review of all of the Veteran’s STRs, as some of them are unavailable and have not been associated with the claims file. In support of his claim, the Veteran has submitted a private opinion from Dr. M.R. In this March 2020 private opinion, Dr. M.R. stated, in pertinent part, that the Veteran was diagnosed with rheumatoid arthritis in November 2007. Citing medical literature, Dr. M.R. noted that “peer reviewed medical literature documents that exposure to MEK and other types of organic solvent increases the risk of autoimmune disorders, such as rheumatoid arthritis. In the “discussion and conclusion” part of her medical opinion, Dr. Mr. indicated that the Veteran’s available C File, VA and civilian records document that he had extensive exposure to asbestos and MEK solvent during his active duty service, and that two decades later, the Veteran later developed complications of both MEK and asbestos exposure, including and not limited to, rheumatoid arthritis. She opined that based on her training, experience and professional qualifications, it is more likely than not that the Veteran’s inflammatory rheumatoid arthritis is a “secondarily service-connected [disability], as [it] resulted from his heavy exposure to MEK and asbestos while on active duty. However, this opinion is inadequate and has no probative value, as it is based on an inaccurate factual premise. See Reonal, 5 Vet. App. at 461; see also Monzingo, 26 Vet. App. at 107. Specifically, and as noted above, Dr. M.R. stated that the Veteran’s C File, VA and civilian records document that he had extensive exposure to Asbestos and MEK during his active service. However, while exposure to asbestos has been conceded by VA, exposure to chemicals, including and not limited to MEK, has not been conceded and/or verified by VA. Rather, Dr. M.R.’s opinion is wholly reliant on the Veteran assertions that he was exposed to chemicals, including MEK, during his active service. Thus, as there is no adequate medical opinion, of record, a remand is required for a new VA examination and opinion on the etiology of the Veteran’s rheumatoid arthritis. 3. TDIU The Veteran asserts that obstructive sleep apnea prevents him from securing or following substantial gainful employment. See March 2020 Videoconference Hearing Transcript; see also April 2020 Application for Individual Unemployability. Thus, the issue of TDIU is inextricably intertwined with the service connection claim for obstructive sleep apnea. As the Board has now granted the service connection claim for obstructive sleep apnea, the assignment of a disability evaluation, as well as an effective date for such rating, are pending a determination by the RO. Thus, as this newly service-connected obstructive sleep apnea disability could impact the intertwined issue of TDIU, a remand is required. The matters are REMANDED for the following action: 1. After assigning a rating and effective date for the service-connected obstructive sleep apnea, the RO should conduct any additional developments that are necessary for the development of the TDIU claim, and readjudicate this claim. 2. Submit a request with DPRIS for all outstanding STRs, as well as any other pertinent source that may be the custodian of the Veteran’s STRs. a. All attempts to fulfill the development specified above, including the mandatory response to the request, must be documented in the claims file. b. If, after making as many requests as are necessary to obtain these records, it is determined that the records sought do not exist or that further efforts to obtain these records would be futile, issue a Formal Finding of Unavailability of Records Memorandum to the Veteran, and associate a copy of this memorandum with the claims file. 3. Additionally, attempt to verify the Veteran’s claims of exposure to chemicals, including and not limited to MEK, benzene, PCP, and water contamination aboard the USS Coral Sea, and while stationed at El Toro, California, during his period of active service from February 1978 to February 1972. 4. After the above-mentioned developments have been undertaken, schedule the Veteran for a new VA examination with a physician (VA examiner) to determine the etiology of his respiratory conditions, including and not limited to, COPD and asthma. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must be made available to the VA examiner. The VA examiner must undertake the following: a. Identify all of the Veteran’s respiratory conditions since June 25, 2014 (one year prior to the date the claim for respiratory conditions was filed), even if the condition has resolved. b. For each respiratory condition identified, opine whether it is at least as likely as not (50 percent probability or greater) that the pertinent respiratory condition is the result of an exposure to water contamination, asbestos, and/or chemical exposure, to include MEK, benzene and/or PCP; an in-service injury, illness, disease, or event; and/or is otherwise related the Veteran’s active service. c. In rendering an opinion, consider the Veteran’s statements about exposure, onset, and continuity of symptoms. If any of the Veteran’s STRs are unavailable, the VA examiner must consider the relevant lay history and may state whether such is medically consistent with the other evidence of record. d. Also, the VA examiner must consider medical literature and/or reports, submitted as evidence by the Veteran. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. 5. Also, schedule the Veteran for a new VA examination with a physician (VA examiner) to determine the etiology of his rheumatoid arthritis. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must be made available to the VA examiner. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s rheumatoid arthritis is the result of an exposure to water contamination, asbestos, and/or chemical exposure, to include MEK, benzene and/or PCP; an in-service injury, illness, disease, or event; and/or is otherwise related the Veteran’s active service. b. In rendering an opinion, consider the Veteran’s statements about exposure, onset, and continuity of symptoms. (Continued on the next page)   c. Also, the VA examiner must consider the medical literature and/or reports, submitted as evidence by the Veteran. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V-N. Pratt 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.