Citation Nr: 18148710 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 17-39 452 DATE: November 8, 2018 REMANDED Service connection for multinodular goiter, to include as due to exposure to ionizing radiation, is remanded. Service connection for a right knee disability is remanded. Service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1985 to June 1990 in the United States Army. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The appeal must be remanded for further development of the claims. As for multinodular goiter, the Veteran reports she was exposed to radiation resulting from the Chernobyl, Ukraine nuclear accident in April 1986. Her personnel records show that she had foreign service in Eura-Germany from February 1986 to January 1988. Current medical records show she has non-malignant thyroid nodular disease, a radiogenic disease under 38 C.F.R. § 3.311(b)(2), which was diagnosed in 1998, within the applicable time period under 38 C.F.R. § 3.311(b)(5). The record does not contain sufficient evidence regarding her asserted radiation exposure, and the claim must be developed as directed under 38 C.F.R. § 3.311. As for both the right knee and right shoulder claims, initially, any outstanding service treatment records (STRs) must be requested. The Veteran reports she sustained orthopedic injuries in a motor vehicle accident in service in 1986, and her Report of Medical History on separation makes note of this accident. However, the current STRs do not contain any inpatient hospitalization records or otherwise document the accident. Additionally, a further medical opinion is needed for the right knee claim. The Veteran has osteoarthritis and degenerative arthritis of the right knee, documented on VA examination in January 2016. STRs show right knee traumatic patellofemoral syndrome in September 1985, with a referral to physical therapy. The January 2016 examiner provided a negative nexus opinion, finding there was no documentation of chronicity of the disability in the STRs. In doing so, however, the examiner did not adequately consider her lay statements regarding chronic symptoms in and since service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that a VA examination was inadequate because the examiner relied on the absence of evidence in the Veteran's service treatment records to provide a negative opinion). The examiner also did not consider her April 1990 Report of Medical History on separation, which documents a history of a “trick” or locked knee during service. Further medical opinion is also needed for the right shoulder disability. The Veteran has residuals of a right rotator cuff tear, documented on VA examination in January 2016. The January 2016 examiner provided a negative nexus opinion, based on a lack of documentation of a right shoulder disability “in the reviewed STR medical records or any other available records.” In making this finding however, the examiner did not address medical records from 1990 and 1991, dated shortly after discharge, showing right shoulder problems, or the Veteran’s lay statements regarding chronic symptoms in and since service. See Dalton, 21 Vet. App. at 23. In fact, the examiner specifically stated that records from 1990 did not show a shoulder condition. The matters are REMANDED for the following action: 1. Undertake the required development procedures as set forth in 38 C.F.R. § 3.311, with respect to the Veteran’s assertion that she was exposed to ionizing radiation resulting from the Chernobyl, Ukraine nuclear accident in April 1986. If evidence of possible exposure to radiation or ionizing radiation is found, obtain a dose assessment and an opinion. If more details are needed, contact the Veteran to request the information. 2. Request from the National Personnel Records Center (NPRC) or other appropriate entity, any outstanding service treatment records. The RO must specifically seek the any records pertaining to a 1986 motor vehicle accident (as noted on the Report of Medical History on separation), including any inpatient hospitalization records. 3. Schedule the Veteran for an examination to address the nature and etiology of her right shoulder and right knee disabilities. The examiner must opine on whether it is at least as likely as not that the current right shoulder and right knee disabilities are related to an in-service injury, event, or disease. In rendering his/her opinion, the examiner must consider the following: • September 1985 service treatment records showing right knee traumatic patellofemoral syndrome • April 1990 Report of Medical History on separation from service showing a history of “trick” or locked knee • Records from shortly after discharge in 1990 and 1991 showing treatment for a right shoulder disability • Veteran’s reports of chronic right shoulder and right knee symptoms in and since service M. Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Smith, Counsel