Citation Nr: 18149813 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-16 378 DATE: November 13, 2018 REMANDED Entitlement to service connection for a back disability, claimed as secondary to a service-connected left knee disability, is remanded. Entitlement to service connection for a neck disability, claimed as secondary to a service-connected left knee disability, is remanded. Entitlement to service connection for a left hip disability, claimed as secondary to a service-connected left knee disability, is remanded. Entitlement to service connection for an endocrine disability, claimed as related to either exposure to chemicals at Camp Lejeune or radiation, is remanded. Entitlement to service connection for a skin disability, claimed as related to either exposure to chemicals at Camp Lejeune or radiation, is remanded. REASONS FOR REMAND The Veteran had active service in the Marine Corps from October 1969 to April 1972. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). An opinion that relies on an inaccurate factual premise can be of little probative weight. See Reonal v. Brown, 5 Vet. App. 458 (1993). 1. Entitlement to service connection for a back disability, claimed as secondary to a service-connected left knee disability, is remanded. A September 2013 VA examiner opined that the Veteran’s back disorder was not related to his left knee disability. However, the main rationale provided was that medical notes indicated it was caused in a fishing accident. This did not take into consideration the Veteran’s statement that his fishing accident occurred when he was standing in a river and his left knee buckled, causing him to crash into a rock. Because this opinion is based on an inaccurate or incomplete understanding of the evidence, it is inadequate to support a decision of the Board. A new examination and opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claims. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 2. Entitlement to service connection for a neck disability, claimed as secondary to a service-connected left knee disability, is remanded. The Board notes that a September 2013 VA examiner opined that the Veteran’s neck disorder was not related to his left knee disability. However, the main rationale provided was that the Veteran claimed this began in 2013 but it clearly predated this and had been followed by a workman’s compensation doctor. This mischaracterized a May 2013 statement that a recent fall had aggravated conditions that existed for years. The opinion also failed to address the Veteran’s claim that he injured his neck in the early 1990s when he was running bases and his left knee buckled, causing him to fall and injure his neck. Because this opinion is based on an inaccurate or incomplete understanding of the evidence, it is inadequate to support a decision of the Board. A new examination and opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claims. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 3. Entitlement to service connection for a left hip disability, claimed as secondary to a service-connected left knee disability, is remanded. The Board notes that a September 2013 VA examiner opined that the Veteran’s left hip condition was not related to his left knee disability. However, the main rationale provided was that medical notes indicated it was caused in a fishing accident. This did not take into consideration the Veteran’s statement that his fishing accident occurred when he was standing in a river and his left knee buckled, causing him to crash into a rock. Because this opinion is based on an inaccurate or incomplete understanding of the evidence, it is inadequate to support a decision of the Board. A new examination and opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claims. See 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2017); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 4. Entitlement to service connection for an endocrine disability, claimed as related to either exposure to chemicals at Camp Lejeune or radiation, is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for an endocrine condition because no VA examiner has opined whether the Veteran has an endocrine condition that began in service or was caused by an injury, disease, or event in service. There has also been no attempt to develop evidence related to the Veteran’s claim that in-service exposure to chemicals or radiation caused his endocrine condition. 5. Entitlement to service connection for a skin disability, claimed as related to either exposure to chemicals at Camp Lejeune or radiation, is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a skin condition because no VA examiner has opined whether the Veteran’s skin condition began in service or was caused by an injury, disease, or event in service. There has also been no attempt to develop evidence related to the Veteran’s claim that in-service exposure to chemicals or radiation caused his skin condition. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the doctor who diagnosed his human growth hormone deficiency, the doctor who originally diagnosed and treated his hypogonadism/low testosterone levels, and the “workman’s compensation doctor” referred to in the September 2013 VA examination, as well as any other private treatment providers who may have information relevant to his claims. Make two requests for the authorized records from each identified doctor or facility, unless it is clear after the first request that a second request would be futile. 2. Develop the Veteran’s assertion that he was exposed to radiation while guarding nuclear warheads on the USS Simon Lake, including during alleged mishandling incidents. The Veteran states that he wore a dosimeter to measure his exposure. Attempt to obtain the records of the Veteran’s dosimeter readings, as well as any other records relevant to the Veteran’s claim of exposure to radiation. If evidence of possible exposure to radiation or ionizing radiation is found, obtain a dose assessment and an opinion as to whether the Veteran has a skin condition or endocrine condition that is at least as likely as not caused or aggravated beyond its natural progression by this exposure. If more details are needed, contact the Veteran to request the information. 3. Obtain an opinion regarding whether the Veteran’s back condition is at least as likely as not related to or aggravated beyond its natural progression by his service-connected left knee disability. The clinician should also opine as to whether the Veteran’s back condition at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The clinician must discuss the Veteran’s statement that he injured his back in a fishing accident when his left knee buckled and he was thrown against a large rock in a river. The clinician must discuss the two June 2014 letters from treatment providers, one stating that the Veteran’s back condition was “due in part from his knee injury and the subsequent injuries by his knee giving out” and the other stating that it was “partially due to the described knee instability.” At the discretion of the clinician, if an opinion cannot be rendered without a new examination, schedule the Veteran for an appropriate examination. 4. Obtain an opinion regarding whether the Veteran’s neck condition is at least as likely as not related to or aggravated beyond its natural progression by his service-connected left knee disability. The clinician should also opine as to whether the Veteran’s neck condition at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The clinician must discuss the Veteran’s statement that he injured his neck in the early 1990s when he was running and his left knee buckled, causing him to fall and injure his head and neck. The clinician must discuss the two June 2014 letters from treatment providers, one stating that the Veteran’s neck condition was “due in part from his knee injury and the subsequent injuries by his knee giving out” and the other stating that it was “partially due to the described knee instability.” At the discretion of the clinician, if an opinion cannot be rendered without a new examination, schedule the Veteran for an appropriate examination. 5. Obtain an opinion regarding whether the Veteran’s left hip condition is at least as likely as not related to or aggravated beyond its natural progression by his service-connected left knee disability. The clinician must discuss the Veteran’s statement that he injured his left hip and hamstring in a fishing accident when his left knee buckled and he was thrown against a large rock in a river. The clinician must discuss the two June 2014 letters from treatment providers, one stating that the Veteran’s left hip condition was “due in part from his knee injury and the subsequent injuries by his knee giving out” and the other stating that it was “partially due to the described knee instability.” At the discretion of the clinician, if an opinion cannot be rendered without a new examination, schedule the Veteran for an appropriate examination. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any endocrine condition, including but not limited to low testosterone, low human growth hormone, and diabetes. For each diagnosed endocrine condition, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. For any diagnosed chronic condition listed in 38 C.F.R. 3.309(a), including diabetes, the examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The Veteran is presumed to have been exposed to contaminants in the water at Camp Lejeune. For each diagnosed condition the examiner should opine whether it is at least as likely as not related to contaminants in the water during service at Camp Lejeune. If the Veteran is found to have been exposed to radiation during his active service then for each diagnosed condition the examiner should opine whether it is at least as likely as not related to ionizing radiation during active service. 7. Schedule the Veteran for an examination to determine the nature and etiology of any skin condition. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The Veteran is presumed to have been exposed to contaminants in the water at Camp Lejeune. The examiner should opine whether the Veteran’s skin condition it is at least as likely as not related to contaminants in the water during service at Camp Lejeune. If the Veteran is found to have been exposed to radiation during his active service, then the examiner should opine whether the Veteran’s skin condition is at least as likely as not related to ionizing radiation during active service. 8. Readjudicate the Veteran’s claims. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Zimmerman, Associate Counsel