Citation Nr: 22015704 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 14-15 406A DATE: March 18, 2022 REMANDED Entitlement to service connection for postural tachycardia syndrome (POTS), to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for endometriosis, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for bilateral breast fibroadenomas status-post lumpectomies, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for residual bilateral breast scars status-post lumpectomies is remanded. Entitlement to service connection for a right forearm lipoma, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for chronic iron deficiency anemia, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for Sjogren's syndrome, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for a bilateral eye disorder, to include as due to chemical and herbicide exposure, is remanded. Entitlement to service connection for a dental disorder due to dry mouth (also claimed as decaying teeth), to include as due to chemical and herbicide exposure, for treatment purposes is remanded. Entitlement to special monthly compensation (SMC) for the loss of use a creative organ is remanded. REASONS FOR REMAND The appellant served in the Oregon Army National Guard and had a period of active duty for training (ACDUTRA) from January 1978 to April 1978. This case comes before the Board of Veterans' Appeals (Board) on appeal from May 2012, October 2012, and May 2016 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2017, the appellant testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In March 2018 and May 2020, the Board remanded the case for further development. The case has since been returned to the Board for appellate review. Upon review, the Board finds that additional development is needed prior to adjudication of the issues. In a July 2021 statement, the appellant's representative asserted that the issues remanded in May 2020 were related to herbicide exposure. In a February 2022 statement, the appellant stated that herbicides were sprayed in her barracks, mess hall, and throughout the base. The Board notes that the case was remanded in May 2020, in pertinent part, to obtain VA medical opinions to address the nature and etiology of the appellant's claimed disorders. However, the VA medical opinions of record do not address the relationship, if any, between the appellant's POTS, endometriosis, bilateral breast fibroadenomas, right forearm lipoma, chronic iron deficiency anemia, Sjogren's syndrome, bilateral eye disorder, and dental disorder, and her claimed exposure to herbicides. In addition, in a February 2022 statement, the appellant challenged the adequacy of the VA examinations and medical opinions. Therefore, a remand is necessary to obtain VA medical opinions that address this theory of entitlement. The Board also notes that decisions on the claims for service connection for endometriosis and bilateral breast fibroadenomas could affect the outcome of the claims for service connection for residual breast scars and special monthly compensation. Therefore, the claims are inextricably intertwined, and a remand is required. Moreover, in the May 2020 remand, the Board noted that the evidence of record suggested that various environmental hazards were present at Fort McClellan. However, it was unclear whether the appellant had actual exposure to those hazards. For example, the August 2013 combined environmental exposure report referenced evidence regarding the presence and use of pesticides at Fort McClellan. However, the report did not clearly indicate that pesticides were dispersed over Fort McClellan while the appellant was on active duty for training at the base or otherwise suggest that she had actual exposure to any such chemical. However, it did not appear that any further development has been conducted to verify the appellant's claimed exposures. Therefore, on remand, the agency of original jurisdiction (AOJ) was directed to conduct all necessary development to verify the appellant's potential exposure to environmental hazards at Fort McClellan. Following the remand, the AOJ sent letters to the appellant requesting information about her claimed exposure; however, she did not respond to the requests. However, again, it does not appear that any further development has been conducted to verify the appellant's claimed exposures with the exception of a negative September 2020 Personnel Information Exchange System (PIES) response to a request for documents showing exposure to herbicides. Therefore, on remand, the AOJ should conduct all necessary development to verify the appellant's potential exposure to environmental hazards at Fort McClellan. The matters are REMANDED for the following action: 1. The AOJ should conduct all necessary development to verify the appellant's potential exposure to herbicides and other environmental hazards during a period of active duty for training (ACDUTRA) from January 1978 to April 1978 at Fort McClellan, Alabama. The AOJ should document all efforts undertaken and the responses received. 2. The AOJ should request that the appellant provide the names and addresses of any and all health care providers who have provided treatment for POTS, endometriosis, breast fibroadenomas, breast scars, a right forearm lipoma, anemia, Sjogren's syndrome, an eye disorder, and a dental disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file. 3. After the above development has been completed, the AOJ should obtain a VA medical opinion to determine the nature and etiology of any claimed disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the appellant's post-service medical records and assertions, to specifically include a September 2015 private medical opinion and the appellant's January 2017 hearing testimony. It should be noted that the appellant's complete service treatment records appear to be unavailable. The examiner should note that the appellant is competent to attest to matters of which she has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should provide a medical opinion regarding the etiology of the following claimed disorders: (a) POTS (b) Endometriosis (c) Bilateral breast fibroadenomas, status-post lumpectomies (d) Residual breast scars, status-post lumpectomies (e) Right forearm lipoma (f) Chronic iron deficiency anemia (g) Sjogren's syndrome (h) A bilateral eye disorder, to include dry eyes (i) A dental disorder due to dry mouth For any current diagnosis of each of these claimed disorders, examiner should opine as to whether it is at least as likely as not that the disorder is causally or etiologically related to the appellant's military service, to include any possible chemical or herbicide exposure therein. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Osegueda, 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.