Citation Nr: 0924079 Decision Date: 06/26/09 Archive Date: 07/01/09 DOCKET NO. 06-02 922 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for residuals of open heart surgery. 4. Entitlement to service connection for residuals of cancer of the retina (eye), status post eye removal, to include as secondary to exposure to radiation and/or asbestos. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. Eckart, Counsel INTRODUCTION The Veteran served on active duty from November 1944 to October 1947. This case comes before the Board of Veterans' Appeals (Board) from a rating decision of September 2005 from the St. Petersburg, Florida Regional Office (RO) of the Department of Veterans Affairs (VA), which denied service connection for all the enumerated disorders. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2008). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran's claim seeking entitlement to service connection for an eye disability is REMANDED to the Agency of Original Jurisdiction (AOJ) via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. FINDINGS OF FACT 1. There is no competent medical evidence showing the Veteran has bilateral hearing loss related to service. 2. There is no competent medical evidence showing the Veteran has a current disability of hypertension. 3. There is no competent medical evidence showing the Veteran has residuals of open heart surgery related to service. CONCLUSIONS OF LAW 1. Bilateral hearing loss was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2008). 2. Hypertension was not incurred in or aggravated by active service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2008). 3. Residuals of heart surgery were not incurred in or aggravated by active service, nor may residuals of heart surgery be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2008). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to notify and assist The VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. For claims pending before VA on or after May 30, 2008, 38 C.F.R. § 3.159 was recently amended to eliminate the requirement that VA request that a claimant submit any evidence in his or her possession that might substantiate the claim. See 73 FR 23353 (Apr. 30, 2008). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the U.S. Court of Appeals for Veterans Claims (Court) held, in part, that a VA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim for VA benefits. In the present case, the Veteran's claim on appeal was received in October 2004 and a duty to assist letter was sent in December 2004 prior to the September 2005 denial of this claim on the merits. This letter provided initial notice of the provisions of the duty to assist as pertaining to entitlement to service connection, which included notice of the requirements to prevail on these types of claims, and of his and VA's respective duties. The duty to assist letter, specifically notified the Veteran that VA would obtain all relevant evidence in the custody of a federal department or agency. He was advised that it was his responsibility to either send medical treatment records from his private physician regarding treatment, or to provide a properly executed release so that VA could request the records for him. The Veteran was also asked to advise VA if there were any other information or evidence he considered relevant to this claim so that VA could help by getting that evidence. Additional notice was sent in February 2005. VA must also make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate the claim for the benefit sought, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). Service treatment records were previously obtained and associated with the claims folder. Furthermore, VA and private medical records were obtained and associated with the claims folder. Assistance shall also include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. There is no need for a VA examination to address the hypertension and heart surgery claims in this instance where the records show no evidence of the claimed problems in service, and none shown until many years after service (or not at all for the hypertension), with no evidence of record suggesting a link between currently claimed problems and service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Regarding the claim for bilateral hearing loss, a VA examination for this disorder was conducted in September 2005, and included review of the claims folder and examination of the Veteran. During the pendency of this appeal, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim, including the degree of disability and the effective date of an award. However, since service connection is being denied for the enumerated disorders from issues 1 through 3, the failure to send such a letter is harmless error. For the above reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide the appeal. See Conway v. Principi, 353 F.3d 1369 (Fed. Cir. 2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Sutton v. Brown, 9 Vet. App. 553 (1996); Bernard v. Brown, 4 Vet. App. 384 (1993); see also 38 C.F.R. § 20.1102 (2008) (harmless error). II. Service Connection Generally, applicable law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C.A. § 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for certain chronic diseases, including hypertension and sensorineural hearing loss, when such diseases are manifested to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2008). In order to establish service connection, a claimant must generally submit (1) medical evidence of a current disability, (2) medical evidence, or in certain circumstances lay testimony, of service incurrence or aggravation of an injury or disease, and (3) medical evidence of a nexus or relationship between the current disability and the in- service disease or injury. Pond v. West, 12 Vet. App. 341, 346 (1999). In the case of a Veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, the Secretary of the VA shall accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). When all the evidence is assembled VA is then responsible for determining whether the evidence supports the claims or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claims, in which case the claims must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107. The Veteran maintains he is entitled to service connection for bilateral hearing loss, hypertension and residuals of heart surgery. He alleges hearing loss as a result of exposure to acoustic trauma from working in loud engine rooms without protection. He also alleged exposure to large gun noise as described in his September 2005 VA examination. He also alleged that he developed cardiovascular problems resulting in high blood pressure and the heart problems resulting in surgery due to exposure to what he describes as "continuous shrilling noise from the engines and contact with running/controlling many generators" during service. He expressed his belief that this continuous battering of the nervous system resulted in problems with his circulatory system. The Veteran's DD Form 214 reflects World War II service, with medals earned including the Asiatic Pacific Medal, American Area Medal and World War II Victory Medal. His military occupational specialty (MOS) was electrician's mate, Third Class. Service treatment records are absent for any evidence of hearing problems, or cardiovascular problems of any nature. His November 1944 entrance examination revealed hearing of 15/15 for both ears, with heart and blood vessels normal. His pulse was 72 before exercise, 100 after exercise and 76 after resting. His blood pressure was 136/68. He repeatedly was found physically qualified for various duties including PT and sub duty in June 1945, for transfers in July 1945 and August 1947 and for diving school in September 1948. His separation examination of October 1947 revealed hearing of 15/15 for both ears, with heart and veins/arteries normal. His pulse was 72 before exercise, 94 after exercise and 74 at 3 minutes after exercise. His blood pressure was 112/68. Summary of defects was none. Private records reveal that in September 1996 the Veteran was admitted to the hospital for chest discomfort consistent with angina, with history of pain and shortness of breath associated with exertion for the past 2 months. His past medical history was absent for any mention of his military service. Physical examination revealed his blood pressure was 110/70, pulse was 70 and regular, with a 4th heart sound, otherwise normal. Electrocardiogram (EKG) showed T-wave inversions. The impression was that history was very suggestive of angina pectoris and abnormal EKG suggestive of inferior ischemia. He underwent subsequent cardiac workup and surgical procedures in October 1996, with including cardiac catheterization with coronary arteriogram and left ventriculography. The same day as this procedure, he also underwent quintuple coronary artery bypass grafting (CABG). The diagnoses from these procedures included normal left ventricular systolic function, 70 percent ostial left main coronary artery lesion, 40-50 percent narrowing in the left circumflex and left anterior descending arteries; and very high grade and complex 99 percent lesion in the mid right coronary with very slow flow noted in distal vessel. The final diagnosis on discharge from the hospital following these procedures was coronary artery disease (CAD) and intraoperative myocardial infarction (MI). The Veteran submitted private records from 2000 consisting of uninterpreted audiograms from December 2000, along with accompanying paperwork reflecting that he was purchasing hearing aids. Follow-up records from cardiology revealed that in December 2002 he had no cardiac complaints with the past medical history of coronary disease status post MI and CABG. Physical examination revealed his blood pressure to be 126/68, with his heart normal S1, S2 without murmurs, rubs, gallops or clicks. EKG revealed sinus rhythm and inferior Q waves were noted with inferior MI of undetermined age could not be ruled out. Minimal T wave abnormality was noted but no acute changes were seen. The impression was CAD status post MI and CABG, stable. For the most part he seemed to be doing well. A subsequent physical examination from December 2003 revealed similar cardiovascular findings to those shown in December 2002, with blood pressure noted to be 120/66 and the impression was unchanged from December 2002. Chest X-rays from December 2002, June 2003, and December 2003 all revealed a normal sized heart without infiltrates or effusions and no active disease present. A February 2003 letter from the Veteran's cardiologist noted that the Veteran was seen for follow-up stress tests with known atherosclerotic CAD, status post CABG done in October 1996. He was doing very well from a cardiac standpoint, with only minimal chest pain. Blood pressure reading was noted to be 140/74 with heart rate at 70 beats per minute with regular rate and normal S1, S2 without evidence of S3 or S4, gallops or rubs. He did the exercise test without chest discomfort and stopped after 10 minutes exercise due to fatigue. His peak blood pressure was 158/96 during peak stress and resting EKG showed ST-T changes and evidence of old inferior wall MI. No ischemic EKG changes were reported during the exercise test and the cardiologist opined that he clearly had another normal stress test and was 6 and 1/2 years after bypass surgery. Plans were made for one year follow-up with treadmill. On follow-up treadmill test in April 2004 by the same cardiologist it was noted that his test results clearly looked similar to his treadmill tests over the past several years. It was noted that his blood pressure went from 126/66 at rest to 172/80 on peak stress, and his heart rate peaked from 70 at rest to 126 at peak which was 80 percent maximum predicted rate for his age. Resting EKG showed sinus rhythm with evidence of old MI. Again no ischemic changes were noted during stress test and the doctor was very encouraged by his results. A May 2004 letter from the Veteran's private audiologist stated that the Veteran had a hearing evaluation with enclosed results and stated that he has moderate to severe sensorineural hearing loss bilaterally. This type and degree of hearing impairment is consistent with difficulty in hearing and understanding speech. His hearing acuity has decreased since last evaluation in June 2003. Also enclosed were uninterpreted audiology results. None of the records documenting treatment and follow-up for cardiovascular problems and for hearing loss gave an opinion as to the etiology of these problems. Also it is noted that none of the cardiology records reflect that a diagnosis of hypertension was ever given, or that the resting blood pressure was at a rate that would meet the VA criteria for hypertension. The report of a September 2005 VA examination for hearing loss included review of the claims file with the normal whisper tests at 15/15 noted for both ears on the November 1944 and October 1947 examinations on entrance and separation. The Veteran was noted to report a difficulty understanding soft voices and speech for over 10 years. He wore hearing aids which helped. He gave a history of noise exposure in the service from 1944 to 1947 with exposure to 16 inch and 5 inch gunfire. He also worked in an engine room without hearing protection. He also reported civilian exposure to noise from diesel engines. He denied recreational noise exposure. He reported a history of left perforated left tympanic membrane at age 16. He denied tinnitus. Physical examination revealed audiometric test results as follows. From 500, 1000, 2000, 3000 and 4000 Hertz the right ear measured 45, 45, 65, 80 and 85 decibels and the left ear measured 45, 25, 45, 80 and 80 decibels. The Maryland CNC voice recognition score was 72 percent for the right ear and 84 percent for the left ear. The diagnosis for the right ear was moderate to severe sensorineural hearing loss and for the left ear was moderate sensorineural hearing loss at 0.5 kilohertz (500 Hertz) and moderate to severe mid and high frequency mixed hearing loss. The examiner stated that without detailed audiometric records from the time this Veteran had been in the military, this examiner cannot assess the relationship between his hearing loss and his military noise exposure without resorting to mere speculation. Based upon review of the evidence, the Board finds that service connection is not warranted for bilateral hearing loss, high blood pressure or residuals of heart surgery. In regards to the hearing loss, the Board accepts the Veteran's lay contentions of inservice noise exposure as he is competent to testify to such exposure and it is consistent with his duties and the nature of his service shown to have taken place aboard ships, and with duty that included service in the Pacific during World War II, as confirmed by his medals. See 38 U.S.C.A. § 1154(b) and 38 C.F.R. § 3.304. However there has not been a medical link between such noise exposure and his current hearing loss disability which according to the available medical evidence was manifested at its earliest time in December 2000 when he was shown to be purchasing hearing aids. He does not allege hearing loss actually took place in service at the time of the acoustic trauma, but indicates having had hearing loss for "many years." There has been no competent medical evidence submitted which provides a nexus between the current hearing loss disorder and the inservice acoustic trauma. Of note, the VA examination conducted in September 2005 to address this question specifically noted that the evidence of record was insufficient to form such an opinion and without detailed audiometric records from the time the Veteran had been in the military, this examiner cannot assess the relationship between his hearing loss and his military noise exposure without resorting to mere speculation. The Veteran's contentions that his current hearing loss disability is related to service are not shown to be competent medical evidence to address this question requiring medical expertise. Where as in this instance there is no evidence showing that he has medical training or expertise, he is not competent to offer a medical opinion as to the existence of an etiological relationship between his hearing loss and his acoustic trauma in service. See 38 C.F.R. § 3.159(a)(2); Jandreau v. Nicholson, 492 F.3d 3371, 1376-1377; Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Overall, post- service medical evidence to include the 2005 VA examination offer no evidence in support of his lay assertions. Thus, absent evidence that the Veteran had a hearing loss in service, or was manifested within a year from his discharge from service, and absent evidence showing that his current hearing loss is the result of his exposure to acoustic trauma in service, service-connection is not warranted for bilateral hearing loss. In regards to his heart disorder and hypertension, the Board notes that the service treatment records were completely silent for any cardiovascular problems in service, with blood pressure readings well within the normal range. Post-service records are also silent for a heart disorder or hypertension having manifested itself within 1 year of discharge. There was no evidence of a heart disorder shown until September 1996 when the Veteran was admitted to the hospital for chest discomfort consistent with angina and subsequently underwent heart surgery including bypass surgery in October 1996 as described above. There is no medical evidence of hypertension whatsoever, with none of the medical evidence either during service or after service showing a diagnosis of hypertension. Although the Veteran has alleged that his exposure to the acoustical trauma of noise from the engine room, along with vibrations from the engine room during service has resulted in cardiovascular system disturbance, he has not presented any medical evidence to support his lay contentions of this alleged nexus. Again, while he is competent to describe his exposure to sounds and vibrations from the engine room, he is not shown to be competent to provide a medical opinion as to the existence of an etiological relationship between his claimed residuals of heart surgery and hypertension and his acoustic trauma from working in the engine room in service. Furthermore in the case of hypertension, there has not been any such disability diagnosed by a medical professional. While he is competent to identify certain symptoms which may be present with hypertension, he is not competent to render an actual diagnosis of hypertension. See Espiritu, supra at 492, 494 (a lay person is not competent to render an opinion regarding the diagnosis or etiology of a disease or injury). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (indicating service connection presupposes a current diagnosis of the condition claimed). As a preponderance of the evidence is against the award of service connection for the enumerated disorders from issues 1 through 3, the benefit of the doubt doctrine is not applicable in the instant appeal. 38 U.S.C.A. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert, supra. ORDER Service connection for bilateral hearing loss is denied. Service connection for hypertension is denied. Service connection for residuals of open heart surgery is denied. REMAND The Veteran claims entitlement to service connection for eye cancer in his left eye that resulted in removal of this eye. He alleges that this cancer is due to radiation exposure that he received during active service. Specifically, he alleges that he had exposure to ionizing radiation due to helping refuel ships coming out of a radiation zone from July 1946 to August 1946 during Operation Crossroads near Eniwetok in the Marshall Islands. He further described having been anchored in Kwiatelein Atoll about 250 miles from the test site and in Kwatalien Harbor for all 3 above ground tests and below water. He indicated that some of the ships that were left after the tests were sent to Pearl Harbor but before being towed to Pearl Harbor, they came to Kwatalien Harbor for refueling. The available copies of his service personnel records do not provide any pertinent information about his service duties or locations during this time period. No further attempt has been made to verify his claimed exposure to radiation. Thus, the Board finds that further development is necessary to attempt to verify whether he received exposure to ionizing radiation from July 1946 to August 1946. Pursuant to 38 C.F.R. § 3.311, when a claimant contends that a radiogenic disease, which first became manifest after service though not to a compensable degree within any other applicable presumptive period, is the result of exposure to ionizing radiation in service, an assessment is made as to the size and nature of the radiation dose. 38 C.F.R. § 3.311(a). A "radiogenic disease" means a disease that may be induced by ionizing radiation, and includes most forms of cancer. 38 C.F.R. § 3.311(b)(2). Except as otherwise provided, the radiogenic disease must become manifest five years or more after exposure. 38 C.F.R. § 3.311(b)(5). If these threshold requirements are met, an assessment as to the size and nature of the radiation dose must be made. 38 C.F.R. § 3.311(a)(1). In order to do so, the RO must request dose information as provided by 38 C.F.R. § 3.311(a)(2). 38 C.F.R. § 3.311(a)(2)(i) requires that in claims based upon participation in atmospheric nuclear testing that dose data must be requested from the appropriate office of the Department of Defense. Thereafter, the RO should refer the claim to the Undersecretary for Benefits for further consideration, if appropriate. 38 C.F.R. § 3.311(b)(1)(iii). In short, according to the medical records, the Veteran has a radiogenic disease within the meaning of 38 C.F.R. § 3.311(b)(2) (xxiv) and it manifested more than five years after exposure. The appellant has contended that it was the result of ionizing radiation exposure. These facts are sufficient to trigger the obligation to obtain a radiation dose estimate from the Defense Threat Reduction Agency under 38 C.F.R. § 3.311(a)(1). Again, the appellant has indicated that at the time of the Veteran's alleged exposure, he was assigned to fuel up ships returning from Operation Crossroads. Requests should be made to acquire any unit records, e.g., from U.S. Army and Joint Services Records Research Center (JSRRC), that would document radiation-related activities, since that would assist in the preparation of a dose estimate. The file should be forwarded to the Defense Threat Reduction Agency for the dose estimate. If radiation exposure is reported in the dose estimate, the file should then be forwarded to the Under Secretary for Benefits for an opinion. In addition, the Board notes that the Veteran is alternately claiming service-connection for this eye cancer on the basis of being secondary to inservice exposure to asbestos. This argument was stated in the original claim of October 2004. He further alleged asbestos exposure while serving aboard the U.S.S. Iowa and the U.S.S. Atlanta. His service personnel records on file confirm service aboard both ships as well as aboard the H.S.S. Yog 82 in November 1945 and he was stationed at U.S.N. TADCEN between July 1945 and September 1945. To date the RO has not addressed the possibility of asbestos exposure when adjudicating the eye cancer claim. Further development is needed to afford proper adjudication of this matter. As to claims of service connection for asbestosis or other asbestos-related diseases, VA has issued a circular on asbestos-related diseases. This circular, DVB Circular 21- 88-8, Asbestos- Related Diseases (May 11, 1988) (DVB Circular), provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular were included in a VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, para. 7.68 (Sept. 21, 1992). Subsequently, the M2-1 provisions regarding asbestos exposure were amended. The new M21-1 guidelines were set forth at M21-1, Part VI, para. 7.21 (Oct. 3, 1997). The guidelines provide, in part, that the clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal disease; that VA is to develop any evidence of asbestos exposure before, during and after service; and that a determination must be made as to whether there is a relationship between asbestos exposure and the claimed disease, keeping in mind the latency period and exposure information. See Ashford v. Brown, 10 Vet. App. 120 (1997); McGinty v. Brown, 4 Vet. App. 428 (1993). The applicable section of Manual M21-1 also notes that some of the major occupations involving exposure to asbestos include mining, milling, work in shipyards, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, manufacture and installation of roofing and flooring materials, asbestos cement and pipe products, military equipment, etc. High exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers, and this is significant considering that, during World War II, U.S. Navy Veterans were exposed to chrysotile, amosite, and crocidolite that were used extensively in military ship construction. Furthermore, it was revealed that many of these shipyard workers had only recently come to medical attention because the latent period for asbestos-related diseases varies from 10 to 45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease). See Department of Veterans Affairs, Veteran's Benefits Administration, Manual M21-1, Part 6, Chapter 7, Subchapter IV, § 7.21 b. In Dyment v. West, 13 Vet. App. 141, 145 (1999), the Court found that provisions in former paragraph 7.68 (predecessor to paragraph 7.21) of VBA Manual M21-1, Part VI, did not create a presumption of exposure to asbestos. Medical nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. VAOPGCPREC 4-00. In this case, the service personnel records reflect service aboard World War II ships. The RO in developing this claim, must consider such shipboard service in light of the above described provisions from the M21-1, which suggest that asbestos was used in the construction of World War II era ships. Additionally, during the pendency of this appeal, the United States Court of Appeals for Veterans Claims (Court) issued a decision in the consolidated appeal of Dingess v. Nicholson, 19 Vet. App. 473 (2006), which held that the VA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service-connection claim, including the degree of disability and the effective date of an award. In the present appeal, the Veteran was provided with a generic notice pursuant to Dingess, supra. In light of the need to remand these matters for further development, additional notice should specifically address the issues on appeal. Accordingly, this matter is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2008). Expedited handling is requested.) 1. The AOJ must also send the Veteran a corrective notice addressing the service connection claim, that includes: an explanation as to the information or evidence needed to establish a disability rating and an effective date, if service connection is granted. The notice must also (1) inform him of what he needs to provide; and (2) what information VA has or will provide that pertains to these claims. The claims file must include documentation that there has been compliance with the VA's duties to notify and assist a claimant as specifically affecting the issues on appeal. 2. The AOJ should consider the service personnel records showing active service aboard the U.S.S. Iowa including between August 1947 and October 1947 and the U.S.S. Atlanta from April 1947 to May 1947, in addition to additional service aboard the H.S.S. Yog 82 in November 1945 and being stationed at U.S.N. TADCEN from July 1945 to September 1945. This service aboard World War II era ships and facilities should be considered in conjunction with the provisions of the VBA Manual M21-1, Part VI, pertaining to asbestos exposure, and a determination should be made as to whether it is as likely as not such shipboard service caused asbestos exposure. (A) If further investigation is necessary to make such a determination regarding asbestos exposure, the AOJ should prepare a letter asking the United States Army and Joint Services Records Research Center (JSRRC) to provide any information that might corroborate the Veteran's claimed in-service asbestos exposure from working aboard the above described ships. Copies of the Veteran's available service treatment records and service personnel records, and his contentions regarding exposure to asbestos should be forwarded to the JSRRC. If indicated by the JSRRC, the AOJ should contact the United States Navy and/or the National Archives and request copies of the ship logs to help answer these questions. (B) The AOJ must also contact the Joint Services Records Research Center (JSRRC) to request whether there are records to confirm the Veteran's exposure to ionizing radiation due to helping refuel ships coming out of a radiation zone from July 1946 to August 1946 during Operation Crossroads near Eniwetok in the Marshall Islands and having been anchored in Kwiatelein Atoll about 250 miles from the test site and in Kwatalien Harbor for all 3 above ground tests and below water. 3. After the foregoing development relative to radiation exposure has been completed, pursuant to the procedure outlined in 38 C.F.R. § 3.311(a)(2)(iii), the Veteran's complete claims file must be referred to the Under Secretary for Health to obtain a radiation dose estimate. 4. After the file is returned with the radiation dose estimate from the Under Secretary for Health, and if exposure as claimed has been confirmed, the AOJ must refer the file to the Under Secretary for Benefits for further consideration of the Veteran's claim of exposure to ionizing radiation pursuant to the procedures outlined in 38 C.F.R. § 3.311(c), (d) & (e). 5. After the above development is completed and if deemed appropriate, the AOJ should arrange to have the Veteran undergo an examination of his residuals of eye cancer by an appropriate VA specialist. The claims file, along with all additional evidence obtained pursuant to the instructions above, must be made available to and reviewed by the physician. The reviewer should examine the entire claims file and provide opinions on the following questions: (a) Does the Veteran currently suffer from any his residuals of eye cancer, and if so, what is the correct diagnosis for each such disorder? (b) Is any of the Veteran's current residuals of eye cancer etiologically related to exposure to asbestos? (c) If there is current residuals of eye cancer caused by exposure to asbestos, is it at least as likely as not that said pathology is etiologically related to exposure to asbestos occurring during the Veteran's periods of active military service? The reviewer should discuss the Veteran's lifetime history of exposure to asbestos, if any (d) Is there is current eye pathology that is not related to exposure to asbestos? If so, is it at least as likely as not that said pathology is etiologically related to any incident of the Veteran's period of active military service. 6. After undertaking any other development deemed appropriate, the AOJ must re-adjudicate the Veteran's claims for service connection for residuals of eye cancer to include as secondary to asbestos exposure in service as well as due to exposure to ionizing radiation. With regard to the claimed exposure to ionizing radiation, in addition to consideration of the development and opinions obtained pursuant to 38 C.F.R. § 3.311, the AOJ must also consider whether the Veteran is otherwise eligible for service connection, including consideration of direct service. If the benefit sought on appeal remains denied, the appellant and his representative should be provided a supplemental statement of the case (SSOC). The SSOC must contain notice of all relevant actions taken on the claim for benefits, to include a summary of the evidence and applicable law and regulations considered pertinent to the remaining fissue currently on appeal. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration. No action by the Veteran is required until he receives further notice; however, the Veteran is advised that failure to cooperate by reporting for examination without good cause may result in adverse consequences. 38 C.F.R. § 3.655 (2008). The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2008). ____________________________________________ A. BRYANT Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs