Citation Nr: 21062276 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-25 070 DATE: October 6, 2021 ORDER Service connection for exposure to toxic chemical solvents is denied. REMANDED Entitlement to service connection for anemia is remanded. Entitlement to service connection for a kidney disorder, to include nephrolithiasis, is remanded. Entitlement to service connection for a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear, is remanded. Entitlement to service connection for residuals of plastic reconstruction of the left ear is remanded. FINDING OF FACT Exposure to toxic chemical solvents is not a disability for which service connection may be granted. CONCLUSION OF LAW The criteria for service connection for exposure to toxic chemical solvents have not been met. 38 U.S.C. §§ 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from January 1981 to January 1985. This matter is before the Board of Veterans' Appeals (Board) on appeal of a September 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and for residuals of plastic reconstruction of the left ear. An April 2016 statement of the case listed issues of entitlement to service connection for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and for residuals of plastic reconstruction of the left ear, as well as an issue of entitlement to service connection for exposure to toxic chemical solvents. Exposure to Toxic Chemical Solvents Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Veteran contends that he was exposed to toxic chemical solvents during service. He specifically maintains that he was exposed to toxic chemical solvents, including Trichloroethylene, jet fuel, and hydraulic fluid, without protection, while serving as an aviation mechanic during his period of service. The Veteran served on active duty in the Navy from January 1981 to January 1985. His DD Form 2014 lists his occupational specialties as an aviation structural mechanic, and as an A7E systems organizational maintenance technician for nine months. The Veteran's service treatment records indicate that he was exposed to chemicals, including Trichloroethylene. A January 1983 occupational health branch, preventive medicine service, Trichlorethylene screening evaluation, report, notes that Veteran stated that he was currently exposed to Trichloroethylene. The Veteran indicated that he had experienced irritation of the eyes on the job, as well as solvent in the eyes or on the skin. He reported that he had not experienced dryness of the throat; light headedness; dizziness; nausea; sleepiness and fatigue, and/or irritation of the skin, on the job. The Veteran indicated that he had worked with the solvent without a respirator because it was faster to work without a respirator. The Veteran maintained that he did not have liver disease; a drinking problem; renal disease; heart disease; diabetes; and/or a weight problem. The examiner indicated that the Veteran's eyes, mucus membranes, and skin, were within normal limits. It was noted that the Veteran had no abnormalities of the eyelids or eyebrows; no cracking or ulceration, or other abnormalities, of the mucus membranes; and no rashes, excessive dryness or cracking, or other abnormalities, of the skin. The examiner stated that the Veteran also did not have abnormalities of the fingernails. The examiner reported that the Veteran's ears were irrigated in January 1983 at sick call, that an audiogram was performed in January 1983, and that medium ear plugs, bilateral, were issued and fitted for the Veteran. The examiner indicated that in accordance with BUMED 6260.22 and BUMED 6260.12A, the Veteran had received a pre-placement, periodic, pre-termination, evaluation for work involving halogenated Hydrocarbons, Trichloroethylene. The examiner reported that there were no significant findings. A January 1983 occupational health branch, preventive medicine service, respiratory protection program, report, on that same day, reflects, as to a medical history, that the Veteran reported that he did not have trouble breathing or lung troubles; asthma or chronic bronchitis; any allergies or sensitivities; pain or pressure in his chest; recurring pneumonia; tuberculosis; an abnormal chest x-ray; heart or heart valve surgery; chest or lung surgery; and/or difficulty wearing a mask. The Veteran also stated that he did not begin to cough after lying down, that he didn't take any prescribed medication, and that he had not been on a scuba dive. The Veteran maintained that he sometimes would get short of breath, with a notation from the examiner that the Veteran was a heavy smoker. The examiner reported that the Veteran smoked a half a pack per day for two years. The examiner stated that the Veteran's pulmonary function test was within normal limits. The examiner maintained that the Veteran was able to use respiratory protection equipment. An October 1984 occupational health branch, preventive medicine service, Trichlorethylene screening evaluation, report, notes that Veteran stated that he was currently exposed to Trichloroethylene. He reported that he had not experienced irritation of the eyes; dryness of the throat; light headedness; dizziness; nausea; sleepiness and fatigue; irritation of the skin; and/or solvent in the eyes or on the skin, on the job. He indicated that he worked with the solvent without a respirator. The Veteran maintained that he did not have liver disease; a drinking problem; renal disease; heart disease; diabetes; and/or a weight problem. The examiner indicated that the Veteran's eyes and mucus membranes were within normal limits. It was noted that the Veteran had no abnormalities of the eyelids or eyebrows; no cracking or ulceration, or other abnormalities, of the mucus membranes; and no skin problems, rashes, excessive dryness or cracking, or other abnormalities, of the skin. The examiner related that the Veteran did not have abnormalities of the fingernails. The examiner stated that in accordance with BUMED 6260.22 and BUMED 6260.12A, the Veteran had received a periodic evaluation for work involving halogenated Hydrocarbons, Trichloroethylene. The examiner maintained that there were no significant findings. Post-service private and VA treatment records, include references to reports from the Veteran that he was exposed to chemicals, including Trichloroethylene, while serving as a mechanic in the Navy. An April 2018 lay statement from D. H., who served with the Veteran, notes that he oversaw the Veteran between 1983 and 1985 at the Aviation Intermediate Maintenance Department as a lead supervisor, at that time. D. H. stated that during the Veteran's employment, at that location, he was exposed to multiple chemicals that were know then, and have since been scientifically acknowledged, to be detrimental health hazards. D. H. indicated that the Veteran was exposed to PD 680, a dry-cleaning solvent that was canceled in 1999 due to its hazards; JP4 Jet fuel; two types of MIL-H-5606 hydraulic fluid, and possibly other chemicals. It was noted that the Veteran was exposed on a daily basis for a minimum of four hours a day, and that his exposure involved continual breathing and dousing on bare skin, from the head to the feet, by full immersion or splashing. D. H. stated that the exposure was a daily occurrence and job requirement for repairing aircraft hydraulic pneumatic components. D. H. stated that the Veteran was also exposed to Trichloroethylene and other Naval aviation use chemicals, which had been proven to cause health problems. The Board observes that the Veteran's service treatment records clearly indicate that he was exposed to Trichloroethylene. The Board notes, however, that exposure to toxic chemical solvents is not, in and of itself, a disability, for which service connection may be granted. The Veteran has claimed service connection for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear, and for residuals of plastic reconstruction of the left ear, to include as due to chemical exposure. The Board observes, however, that those claims will be addressed in the remand portion of this decision. The Board notes that, to the extent that the Veteran does not have a diagnosable disability, the VA must consider whether he has functional impairment for which service connection may be granted. See Saunders v. Wilkie, 886 F.3d 1356, 1363-64 (Fed. Cir. 2018) (indicating that the term "disability" refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). The Board observes that, as exposure to toxic chemical solvents is not a disability for which service connection may be granted, the Veteran has not been shown to have any functional impairment. Therefore, the preponderance of the evidence is against the claim for service connection for exposure to toxic chemical solvents; there is no doubt to be resolved; and service connection is not warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and for residuals of plastic reconstruction of the left ear. The Veteran contends that he has anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and residuals of plastic reconstruction of the left ear, that are all related to service, to include as due to chemical exposure. He asserts that he was exposed to chemicals, including Trichloroethylene, jet fuel, and hydraulic fluid, without protection, while serving as an aviation mechanic during his period of service. The Veteran also asserts that he has residuals of plastic reconstruction of the left ear, as a result of basal cell carcinoma of the left ear. The Veteran served on active duty in the Navy from January 1981 to January 1985. His DD Form 2014 lists his occupational specialties as an aviation structural mechanic, and as an A7E systems organizational maintenance technician for nine months. The Veteran's service treatment records do not show treatment for anemia; kidney problems, to include nephrolithiasis; and/or for left ear problems. Such records do indicate that the Veteran was treated for numerous skin problems, but not specifically basal cell carcinoma. His service treatment records further reflect that he was exposed to chemicals, including Trichloroethylene. A May 1981 treatment entry notes that the Veteran requested that warts be removed from his left foot. The examiner reported that there was a raised skin tag on the left foot. The assessment was wart removal. A June 1981 entry notes that the Veteran complained of an infection of his left great toe. The examiner reported that the Veteran had cellulitis of the first toe. The assessment was an ingrown nail. An August 1981 entry indicates that the Veteran was seen for an infection of the left great toe. The examiner stated that the Veteran had infection present, with edema and redness, of the left great toe. The assessment was cellulitis. An October 1981 treatment entry reflects that the Veteran complained of a ruptured blister of the left great toe. It was noted that the Veteran was treated with Betadine soaks. A diagnosis was not provided at that time. A subsequent October 1981 entry notes that the Veteran had a left toe infection, with a blister of the side left big toe. The assessment was a blister. A November 1981 entry notes that the Veteran was seen for a rash in the groin for five days. The diagnosis was tinea cruris. A December 1981 entry indicates that the Veteran was seen for a shaving irritation, with oozing. The assessment was impetigo. A January 1982 entry reflects that the Veteran complained of a rash in the groin area, as well as on the first digit of the right foot. The impression was tinea cruris and tinea pedis. A January 1983 occupational health branch, preventive medicine service, Trichlorethylene screening evaluation, report, notes that Veteran stated that he was currently exposed to Trichloroethylene. The Veteran indicated that he had experienced irritation of the eyes on the job, as well as solvent in the eyes or on the skin. He reported that he had not experienced dryness of the throat; light headedness; dizziness; nausea; sleepiness and fatigue, and/or irritation of the skin, on the job. The Veteran indicated that he had worked with the solvent without a respiratory because it was faster to work without a respirator. The Veteran maintained that he did not have liver disease; a drinking problem; renal disease; heart disease; diabetes; and/or a weight problem. The examiner indicated that the Veteran's eyes, mucus membranes, and skin, were within normal limits. It was noted that the Veteran had no abnormalities of the eyelids or eyebrows; no cracking or ulceration, or other abnormalities, of the mucus membranes; and no rashes, excessive dryness or cracking, or other abnormalities, of the skin. The examiner stated that the Veteran also did not have abnormalities of the fingernails. The examiner reported that the Veteran's ears were irrigated in January 1983 at sick call, that an audiogram was performed in January 1983, and that medium ear plugs, bilateral, were issued and fitted for the Veteran. The examiner indicated that in accordance with BUMED 6260.22 and BUMED 6260.12A, the Veteran had received a pre-placement, periodic, pre-termination, evaluation for work involving halogenated Hydrocarbons, Trichloroethylene. The examiner stated that there were no significant findings. A January 1983 occupational health branch, preventive medicine service, respiratory protection program, report, on that same day, reflects, as to a medical history, that the Veteran reported that he did not have trouble breathing or lung troubles; asthma or chronic bronchitis; any allergies or sensitivities; pain or pressure in his chest; recurring pneumonia; tuberculosis; an abnormal chest x-ray; heart or heart valve surgery; chest or lung surgery; and/or difficulty wearing a mask. The Veteran also stated that he did not begin to cough after lying down, that he didn't take any prescribed medication, and that he had not been on a scuba dive. The Veteran maintained that he sometimes would get short of breath, with a notation from the examiner that the Veteran was a heavy smoker. The examiner reported that the Veteran smoked a half a pack per day for two years. The examiner stated that the Veteran's pulmonary function test was within normal limits. The examiner stated that the Veteran was able to use respiratory protection equipment. A May 1983 treatment entry notes that the Veteran complained of red ant bites of the left hand for four days, with itching. The assessment was ant bites. A July 1983 entry indicates that the Veteran was provided with Calamine lotion for relief of symptomatic poison ivy. A subsequent July 1983 entry reflects that the Veteran was seen for a rash of the arms and hands, which was spreading between his fingers. The Veteran stated that the rash was also on his legs. The assessment was contact dermatitis. A September 1983 entry notes that the Veteran complained of ant bites, with swelling and pain in the left foot. The assessment was insect bites versus early cellulitis. Another September 1983 entry indicates that the Veteran was seen for follow-up of cellulitis. It was noted that the Veteran was still having swelling, but that there was no marked erythema. The examiner reported that the Veteran would be returned to light duty. An October 1984 occupational health branch, preventive medicine service, Trichlorethylene screening evaluation, report, notes that Veteran stated that he was currently exposed to Trichloroethylene. He reported that he had not experienced irritation of the eyes; dryness of the throat; light headedness; dizziness; nausea; sleepiness and fatigue; irritation of the skin; and/or solvent in the eyes or on the skin, on the job. He indicated that he worked with the solvent without a respirator. The Veteran maintained that he did not have liver disease; a drinking problem; renal disease; heart disease; diabetes; and/or a weight problem. The examiner indicated that the Veteran's eyes and mucus membranes were within normal limits. It was noted that the Veteran had no abnormalities of the eyelids or eyebrows; no cracking or ulceration, or other abnormalities, of the mucus membranes; and no skin problems, rashes, excessive dryness or cracking, or other abnormalities, of the skin. The examiner related that the Veteran did not have abnormalities of the fingernails. The examiner stated that in accordance with BUMED 6260.22 and BUMED 6260.12A, the Veteran had received a periodic evaluation for work involving halogenated Hydrocarbons, Trichloroethylene. The examiner maintained that there were no significant findings. Post-service private and VA treatment records show treatment for anemia and for variously diagnosed kidney problems, including kidney stones; renal stones, with colic; pyelonephritis; and hydronephrosis, etc. The Veteran was also treated for variously diagnosed skin problems, including a neoplasm of the skin; actinic keratoses; skin cancer, not otherwise specified; basal cell carcinoma of the chest, back, and scalp; basal cell carcinoma of the left ear pinna; and left ear basal cell carcinoma, status post local flap. An April 2018 statement from E. S., M.D., notes that he had reviewed the Veteran's medical history (personal medical file). Dr. E. S., also stated that he had reviewed the Veteran's military claims file and noted the circumstances that he believed were initiated during his service in the Navy from 1981 to 1985. Dr. E. S., reported that the Veteran's military file shows that he was screened numerous times for Trichloroethylene, which the Veteran researched and found that such chemical can cause health hazards. It was noted that the Veteran further claimed that he was exposed to multiple dangerous chemicals while performing duties as an aviation hydraulic mechanic. Dr. E. S. indicated that the Veteran had been under his care since December 2011. Dr. E. S. stated that the Veteran had been diagnosed with basal cell carcinoma of the chest, back, arms, head, and ears. Dr. E. S. maintained that the Veteran's other conditions included nephrolithiasis; chronic anemia; lung granulomas; and chronic respiratory infections. Dr. E. S. related that he was familiar with the Veteran's history, and that he had examined him often while he was under his care. Dr. E. S. indicated that it was his opinion that it was at least as likely as not that the Veteran's conditions were a direct result of hazardous chemical exposure due to his military service. The Board observes that Dr. E. S., stated that he reviewed the Veteran's medical history (personal medical file) and his military claims file. The Board notes that it is unclear whether Dr. E. S., reviewed the Veteran's entire claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, the Board notes that Dr. E. S., indicated that it was his opinion that it was at least as likely as not that the Veteran's conditions, (which were listed as basal cell carcinoma of the chest, back, arms, head, and ears; nephrolithiasis; chronic anemia; lung granulomas; and chronic respiratory infections), were a direct result of hazardous chemical exposure due to his military service. The Board observes, however, that Dr. E. S., did not provide much in the way of a rationale for his opinion. The Board notes that the Veteran has not been afforded VA examinations, as to his claimed anemia; kidney disorder, to include nephrolithiasis; skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and residuals of plastic reconstruction of the left ear. In light of the above, the Board finds that Veteran has not been afforded VA examinations, with the opportunity to obtain responsive etiological opinions, following a thorough review of the entire claims file, as to his claims for service connection for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and for residuals of plastic reconstruction of the left ear. Such examinations must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for anemia; a kidney disorder, to include nephrolithiasis; a skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and for residuals of plastic reconstruction of the left ear, since March 2021. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed anemia; kidney disorder, to include nephrolithiasis; skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear; and residuals of plastic reconstruction of the left ear. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed anemia and kidney disorder, to include nephrolithiasis. The examiner must diagnose all current kidney disorders, to include nephrolithiasis. The examiner must also specifically indicate if the Veteran has currently diagnosed anemia. The examiner must opine as to whether it is at least as likely as not that any currently diagnosed anemia and kidney disorders, to include nephrolithiasis, are related to, and/or had their onset during, the Veteran's period of service, to include exposure to chemicals such as Trichloroethylene. The examiner must specifically acknowledge and discuss any reports by the Veteran of symptoms he thought were due to anemia and kidney problems, during service and since service. The examiner must further opine as to whether the Veteran's service-connected disabilities caused or aggravated any currently diagnosed anemia and kidney disorders, to include nephrolithiasis. 4. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed skin disorder, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear, and residuals of plastic reconstruction of the left ear. The examiner must diagnose all skin disorders, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear, as well as all residuals of plastic reconstruction of the Veteran's left ear. The examiner must opine as to whether it is at least as likely as not that any currently diagnosed skin disorders, to include basal cell carcinoma of the right temple, back, trunk, chest, and left ear, and residuals of plastic reconstruction of the Veteran's left ear, are related to, and/or had their onset during, the Veteran's period of service, to include exposure to chemicals such as Trichloroethylene. The examiner must specifically acknowledge and discuss the Veteran's treatment for numerous skin problems during service, and any reports by the Veteran of skin problems, to include of the left ear, during service and since service. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.