Citation Nr: 19103478 Decision Date: 01/15/19 Archive Date: 01/14/19 DOCKET NO. 17-34 474 DATE: January 15, 2019 ORDER Entitlement to service connection for left eye pseudophakia from cataract with central serous retinopathy and epiretinal membrane (claimed as macular degeneration) is denied. Entitlement to service connection for loss of vision, left eye, is denied. Entitlement to service connection for gynecomastia, secondary to androgen deficiency, is denied. The severance of service connection for testicular hypogonadism with erectile dysfunction (claimed as infertility) is proper; the Veteran’s appeal of this severance is denied. The severance of entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is proper; the Veteran’s appeal of this severance is denied. FINDINGS OF FACT 1. The Veteran’s left eye pseudophakia from cataract, with central serous retinopathy and epiretinal membrane (claimed as macular degeneration), is not shown to be casually or etiologically related to an in-service event, injury, or disease, or to be related to radiation exposure. 2. The Veteran’s loss of vision, left eye, is not shown to be casually or etiologically related to an in-service event, injury, or disease, or to be related to radiation exposure. 3. The Veteran’s gynecomastia, secondary to androgen deficiency, is not shown to be casually or etiologically related to an in-service event, injury, or disease; to be aggravated by pre-existing left varicocele during service; or to be related to radiation exposure. 4. The grant of service connection for testicular hypogonadism with erectile dysfunction (claimed as infertility), pursuant to a January 2013 rating decision, was clearly and unmistakably erroneous. 5. The grant of entitlement to SMC based on loss of use of a creative organ, pursuant to a January 2013 rating decision, was clearly and unmistakably erroneous. CONCLUSIONS OF LAW 1. The criteria for service connection for left eye pseudophakia from cataract, with central serous retinopathy and epiretinal membrane (claimed as macular degeneration), have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.311. 2. The criteria for service connection for loss of vision, left eye, have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.311. 3. The criteria for service connection for gynecomastia, secondary to androgen deficiency, have not been met. 38 U.S.C. §§ 1110, 1154; 38 C.F.R. §§ 3.102, 3.303, 3.311. 4. Severance of service connection for testicular hypogonadism with erectile dysfunction (claimed as infertility) is proper. 38 U.S.C. §§ 1110, 5109A; 38 C.F.R. §§ 3.103, 3.105, 3.303, 3.311. 5. Severance of entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is proper. 38 U.S.C. § 1114; 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Navy from April 1961 through January 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2012, May 2014, and April 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Veteran was afforded a video conference hearing before the undersigned Veterans Law Judge (VLJ). During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claims. Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A hearing transcript is in the record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called nexus requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). For veterans who were exposed to ionizing radiation during service, service connection for a condition that is claimed to be attributable to such exposure may be established in one of three different ways. First, there are 15 types of cancer that are presumptively service-connected if they become manifest in a radiation-exposed veteran. 38 U.S.C. § 1112(c); 38 C.F.R. § 3.309(d). Second, 38 C.F.R. § 3.311(b)(2) lists other radiogenic diseases that may also be service connected if the VA Undersecretary for Benefits determines that they are related to ionizing radiation exposure during service. Third, direct service connection can be established by showing that the disease was incurred during or aggravated by service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s 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 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr, 21 Vet. App. 303. Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for left eye pseudophakia from cataract, with central serous retinopathy and epiretinal membrane (claimed as macular degeneration). 2. Entitlement to service connection for loss of vision, left eye. The Veteran contends that service connection is warranted for his left eye pseudophakia condition and for loss of vision in his left eye because the conditions are linked to his complaint of blurry vision in service. Alternatively, he contends that these conditions may be due to radiation exposure in service as the result of atmospheric nuclear testing and occupational radiation exposure. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. An April 2012 VA examiner opined that the Veteran’s left eye conditions are not at least as likely as not related to an in-service injury, event, or disease, including an April 1963 head injury which caused blurry vision. The examiner explained that eye examinations conducted a month following the claimed in-service event and at the time of separation showed normal vision. Furthermore, there is no diagnosis associated with the April 1963 incident. The incident is based on the Veteran’s subjective report. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA and Private treatment records do not document any left eye condition until 2008, over 40 years after his separation from service. However, the Veteran reports a left eye laser surgery in 1973, which is still approximately eight years after service. The Veteran indicated in his report of medical examination at separation that his eyes were normal and he had 20/20 vision in both eyes. See January 1965 Report of Medical Examination. These medical records are highly probative both as to the Veteran’s subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. While the Veteran believes his left eye conditions are related to an in-service injury, event, or disease, including a head injury which caused blurry vision during service, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner. There is no objective medical evidence establishing a nexus between the Veteran’s left eye conditions and the April 1963 injury. Furthermore, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his military occupational specialty (MOS) as a mine assembler. The law provides that due consideration shall be given to the places, types and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). However, there is no objective evidence to establish that as a mine assembler, the Veteran would have been exposed to radiation. The Veteran contends his left eye conditions are due to exposure to ionizing radiation associated with atmospheric atomic testing from Bluegill and Starfish at Johnson Island in July 1962, and has submitted literature consistent with such explosion. He reported he was told during the atomic test to cover one eye with the palm of his hand, and he covered his right eye. The Veteran reported remembering the light from the blast and that shortly thereafter, he began to see several black spots disturbing the vision in his left eye. The Veteran submitted deck logs showing the ship was part of a flotilla in the Pacific in July 1962. However, these logs do not reference any participation in any atmospheric nuclear testing during that time frame. He reported only a few ships were directly involved in the atmospheric testing, but his ship was present to clear debris from the explosion. The Veteran further explained that his ship was 100 miles away from the detonation, the light from the detonation was 100 times brighter than the sun, and it disrupted numerous satellites and electricity as far as 900 miles away. The Veteran further reported his left eye conditions are due to nonionizing radiation from working next to the main battery radar antenna for four years aboard his ship. He stated the radar antenna was located next to the torpedo mounts where he worked. The Veteran provided pictures of the ship showing a short tower near the rear gun mounts and provided literature excerpts regarding radiation exposure. He indicated this tower was a radar antenna. He reported that vision in his left eye has deteriorated over the years since and that he has been receiving treatment for the last 40 or 50 years. The April 2012 VA examiner noted there is no evidence of radiation effect from atomic explosion. The Board has considered September 2011 and October 2018 letters from private physicians stating the Veteran’s left eye conditions are the result of exposure to a nuclear blast and exposure to hazardous radiation of both ionizing and nonionizing radar during service. However, both physicians provide summary conclusions, and do not state which records were reviewed, and do not give an account of the Veteran’s medical history nor of any amount of radiation exposure. Furthermore, both of these opinions are based solely on the Veteran’s subjective report of having participated in atmospheric nuclear testing in service. Therefore, the Board affords these letters no probative value. Letters received from the Defense Threat Reduction Agency dated May 8, 2014 and December 8, 2016 stated historical records do not document the Veteran’s participation in U.S. atmospheric nuclear testing. The Veteran’s service records confirm that he was stationed aboard the USS Cogswell from April 1961 through January 1965. However, these records do not document any participation in any nuclear atmospheric testing at Johnson Island in 1962 or anywhere else at any other time while he was in service. Furthermore, the Veteran’s service records do not provide any radiation dosimetry readings or any other evidence of occupational radiation exposure. A May 2017 letter from the Department of the Navy, Naval Dosimetry Center revealed no reports of occupational exposure to ionizing radiation pertaining to the Veteran. Internet extracts from the Naval History and Heritage Command show that the USS Cogswell participated in nuclear weapons testing at Johnson Island in 1958, which was three years before the Veteran began service. The ship’s history does not show that it participated in any other atmospheric radiation testing at any time while the Veteran was stationed aboard the USS Cogswell. As a result, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS. Although the Veteran has a current diagnosis of left eye pseudophakia and loss of vision in the left eye, and evidence shows that an April 1963 injury causing blurry vision occurred, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of left eye pseudophakia and loss of vision in the left eye began during service or is otherwise related to an in-service injury, event, or disease. Furthermore, the preponderance of the evidence is against a finding that the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS. Since the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). For these reasons, the claim is denied. 3. Entitlement to service connection for gynecomastia, secondary to androgen deficiency. The Veteran contends that service connection is warranted for his gynecomastia due to androgen deficiency because the condition is linked to a left varicocele in service. Alternatively, he contends that this condition may be due to radiation exposure as the result of atmospheric nuclear testing and occupational radiation exposure. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. An October 2013 VA examiner opined that the Veteran’s gynecomastia is not at least as likely as not due to active service via the mechanism of varicocele and/or left testicular atrophy. The examiner explained the Veteran had a normal right testicle, which should be adequate for normal production at the time of separation. The examiner added that the Veteran’s gynecomastia was not diagnosed until three decades after his separation from service. In an October 2015 VA addendum opinion, the examiner opined that there is no evidence in the Veteran’s service records of any aggravation of pre-existing left varicocele due to service. She explained the service records are silent for any genitourinary related complaints or treatments that would have impacted the Veteran’s gonadal function. The examiner previously explained it is likely that the Veteran’s left testicular atrophy also pre-existed service, although it was not noted on his enlistment examination. She explained there is no evidence of any traumatic event in service that would have resulted in unilateral testicular changes. However, the examiner added that even if the Veteran’s atrophy did not exist prior to service, the atrophy did not result in the Veteran’s low hormone levels. She explained the Veteran still had a normal right testicle at separation and his left varicocele was not significant enough to warrant surgical intervention at that time. Furthermore, the examiner explained the evidence shows the Veteran still had erectile function, which is dependent upon testosterone production, for at least one to two decades following service. The examiner’s combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA and Private treatment records show the Veteran was diagnosed with gynecomastia in 1998, over 30 years after his separation from service. The Veteran indicated in his report of medical examination at enlistment a varicocele left testicle, and at separation a varicocele left testicle with some atrophy. See February 1961 Report of Medical Examination and January 1965 Report of Medical Examination. However, the Veteran’s service treatment records do not show any treatment for his varicocele or any gynecomastia during service. These medical records are highly probative both as to the Veteran’s subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. While the Veteran believes his gynecomastia is related to his left varicocele and/or left testicular atrophy, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner. There is no objective medical evidence establishing a nexus between the Veteran’s gynecomastia and his left varicocele and/or left testicular atrophy. Furthermore, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS as a mine assembler. The law provides that due consideration shall be given to the places, types and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). However, there is no objective evidence to establish that as a mine assembler, the Veteran would have been exposed to radiation. The Veteran contends his gynecomastia is due to exposure to ionizing radiation associated with atmospheric atomic testing from Bluegill and Starfish at Johnson Island in July 1962, and has submitted literature consistent with such explosion. He submitted deck logs showing the ship was part of a flotilla in the Pacific in July 1962. However, these logs do not reference any participation in any atmospheric nuclear testing during that time frame. He reported only a few ships were directly involved in the atmospheric testing, but his ship was present to clear debris from the explosion. The Veteran further explained that his ship was 100 miles away from the detonation, the light from the detonation was 100 times brighter than the sun, and it disrupted numerous satellites and electricity as far as 900 miles away. The Veteran further reported his gynecomastia is due to nonionizing radiation from working next to the main battery radar antenna for four years aboard his ship. He stated the radar antenna was located next to the torpedo mounts where he worked. The Veteran provided pictures of the ship showing a short tower near the rear gun mounts and provided literature excerpts regarding radiation exposure. He indicated this tower was a radar antenna. The April 2012 VA examiner noted there is no evidence of radiation effect from atomic explosion. The October 2013 VA examiner opined that the Veteran’s gynecomastia is not at least as likely as not due to active service via the mechanism of radiation exposure. The examiner explained radiation is not known to affect hormonal production in the testes. The examiner added that the Veteran’s gynecomastia was not diagnosed until three decades after his separation from service. The October 2015 VA examiner further opined that the Veteran’s gynecomastia is neither due to nor aggravated by in-service nonionizing radiation. The examiner explained that there is no epidemiologic (or other medical research consensus) support for a contention of gynecomastia due to nonionizing radiation exposure. The examiner’s combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board has considered an October 2018 letter from a private physician stating the Veteran’s gynecomastia is the result of exposure to hazardous radiation of both ionizing and nonionizing radar during service. However, the physician provided a summary conclusion, and did not state which records were reviewed, and did not give an account of the Veteran’s medical history nor of any amount of radiation exposure. Furthermore, this opinion is based solely on the Veteran’s subjective report of having participated in atmospheric nuclear testing in service. Therefore, the Board affords this letter no probative value. Letters received from the Defense Threat Reduction Agency dated May 8, 2014 and December 8, 2016 stated historical records do not document the Veteran’s participation in U.S. atmospheric nuclear testing. The Veteran’s service records confirm that he was stationed aboard the USS Cogswell from April 1961 through January 1965. However, these records do not document any participation in any nuclear atmospheric testing at Johnson Island in 1962 or anywhere else at any other time while he was in service. Furthermore, the Veteran’s service records do not provide any radiation dosimetry readings or any other evidence of occupational radiation exposure. A May 2017 letter from the Department of the Navy, Naval Dosimetry Center revealed no reports of occupational exposure to ionizing radiation pertaining to the Veteran. Internet extracts from the Naval History and Heritage Command show that the USS Cogswell participated in nuclear weapons testing at Johnson Island in 1958, which was three years before the Veteran began service. The ship’s history does not show that it participated in any other atmospheric radiation testing at any time while the Veteran was stationed aboard the USS Cogswell. As a result, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS. Although the Veteran has a current diagnosis of gynecomastia, and evidence shows that the Veteran had a pre-existing left varicocele, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of gynecomastia began during service or was aggravated by his service, to include his pre-existing left varicocele. Furthermore, the preponderance of the evidence is against a finding that the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS. Since the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). For these reasons, the claim is denied. Severance of Service Connection VA regulations provide, generally, that service connection can be severed only upon VA’s showing that the final rating decision granting service connection was clearly and unmistakably erroneous (CUE), and only after certain procedural safeguards have been met. 38 U.S.C.A. § 5109A; 38 C.F.R. § 3.105(d); Daniels v. Gober, 10 Vet. App. 474, 478 (1997). Specifically, when severance of service connection is warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The Veteran will be notified at his latest address of record of the contemplated action and furnished detailed reasons therefore and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. 38 C.F.R. § 3.103(b)(2), 3.105(d); Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). Generally, determinations of CUE are based upon the record only as it existed at the time of the decision in question. However, when determining whether a severance of service connection was proper, post-decisional evidence is relevant in determining whether the granting of service connection was clearly and unmistakably erroneous. See Allen v. Nicholson, 21 Vet. App. 54, 59 (2007) (citing Daniels v. Gober, 10 Vet. App. 474, 480 (1997)). 38 C.F.R. § 3.105(d) does not limit the reviewable evidence to that which was before the RO in making its initial service connection award and specifically states that “[a] change in diagnosis may be accepted as a basis for severance,” which clearly contemplates the consideration of evidence acquired after the original granting of service connection. Therefore, VA is not limited to the law and the record that existed at the time of the original decision. The burden is on VA to demonstrate CUE in the prior rating decision. To establish CUE, VA must show that either the correct facts, as they were known at the time, were not before the adjudicator, or that the statutory or regulatory provisions extant at the time were incorrectly applied. See Russell v. Principi, 3 Vet. App. 310 (1992). The proponent of CUE must assert more than a disagreement as to how the facts were weighed or evaluated. Crippen v. Brown, 9 Vet. App. 412, 418 (1996). CUE is a very specific and rare kind of error. It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). To warrant revision of a decision on the ground of CUE in a severance of service connection case, there must have been an error in the adjudication of the appeal that, had it not been made, would have manifestly changed the outcome, i.e., whether, based on the current evidence of record, a grant of service connection would be CUE. Stallworth v. Nicholson, 20 Vet. App. 482, 487 (2006). 4. Whether the severance of service connection for testicular hypogonadism with erectile dysfunction (claimed as infertility) is proper. The Veteran appeals the severance of his service connection for testicular hypogonadism with erectile dysfunction, originally granted effective June 2011 and severed effective July 2015. In considering whether the RO’s initial grant of service connection was clearly erroneous, the Board has considered the requirements for the establishment of service connection as described above. The Veteran was afforded a VA examination in September 2012. The examiner opined that it is as likely as not that the Veteran’s infertility is a result of the varicocele diagnosed while on active duty. However, the examiner formed this opinion without any predetermination investigation or documentation regarding in-service radiation exposure and thus without formal VA concession of significant radiation exposure. In a January 2013 rating decision, the RO granted service connection for testicular hypogonadism with erectile dysfunction effective June 29, 2011 because it was found as a secondary complication. In a May 2014 notification letter, the RO informed the Veteran that it proposed to sever service connection for testicular hypogonadism with erectile dysfunction and provided 60 days for the Veteran to submit evidence to show the RO should not make this change. In an April 2015 rating decision, the RO severed service connection for testicular hypogonadism with erectile dysfunction determining that the evidence does not show that this condition was caused or aggravated by service or that it is secondary to a service-connected disability. Furthermore, the evidence does not show that the Veteran was exposed to radiation in service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The October 2013 VA examiner opined that the Veteran’s testicular hypogonadism is not at least as likely as not due to active service via the mechanism of the left varicocele and/or left testicular atrophy. She further opined that the left testicular atrophy is not at least as likely as not the most likely cause of low sperm count. The examiner explained the Veteran had a normal right testicle, which should be adequate for normal production at the time of separation. The examiner explained the Veteran’s left varicocele was documented as a pre-existing condition upon entry into service. She explained the Veteran’s left testicular atrophy may have pre-existed service, although it was not noted on his enlistment examination. However, the examiner added that even if the Veteran’s atrophy did not exist prior to service, the atrophy did not result in the Veteran’s low hormone levels. She explained the Veteran still had a normal right testicle at separation and his left varicocele was not significant enough to warrant surgical intervention at that time. Thus, it was not large and thus was unlikely to cause significant scrotal temperature elevation (the mechanism by which varicoceles are felt to potentially impact spermatogenesis). Similarly, though an atrophic left testicle might be expected to produce fewer functional sperm, the Veteran still had a normal right testicle and infertility with a functional unilateral testicle is unlikely. The examiner referred to many studies, which document normal spermatogenesis in the majority of patients who have undergone unilateral orchiectomies for cancer treatments. In an October 2015 VA addendum opinion, the examiner opined that there is no evidence in the Veteran’s service records of any aggravation of pre-existing left varicocele due to service. She explained the service records are silent for any genitourinary related complaints or treatments that would have impacted the Veteran’s gonadal function. The examiner’s combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). VA and Private treatment records show the Veteran do not document any testicular hypogonadism did not begin to manifest until the 1980s and was not formally diagnosed until the 1990s, decades after his separation from service. However, the Veteran reports infertility in 1978, which is still approximately 13 years after service. The Veteran indicated in his report of medical examination at enlistment a varicocele left testicle, and at separation a varicocele left testicle with some atrophy. See February 1961 Report of Medical Examination and January 1965 Report of Medical Examination. However, the Veteran’s service treatment records do not show any treatment for his varicocele or any testicular hypogonadism during service. These medical records are highly probative both as to the Veteran’s subjective reports and their resulting objective findings. They were generated with a view towards ascertaining the Veteran’s then-state of physical fitness and are akin to statements of diagnosis or treatment. While the Veteran believes his testicular hypogonadism is related to his left varicocele and/or left testicular atrophy, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiner. There is no objective medical evidence establishing a nexus between the Veteran’s testicular hypogonadism and his left varicocele and/or left testicular atrophy due to service or aggravation of pre-existing left varicocele due to service. Furthermore, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS as a mine assembler. The law provides that due consideration shall be given to the places, types and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). However, there is no objective evidence to establish that as a mine assembler, the Veteran would have been exposed to radiation. The Veteran contends his testicular hypogonadism is due to exposure to ionizing radiation associated with atmospheric atomic testing from Bluegill and Starfish at Johnson Island in July 1962, and has submitted literature consistent with such explosion. He submitted deck logs showing the ship was part of a flotilla in the Pacific in July 1962. However, these logs do not reference any participation in any atmospheric nuclear testing during that time frame. He reported only a few ships were directly involved in the atmospheric testing, but his ship was present to clear debris from the explosion. The Veteran further explained that his ship was 100 miles away from the detonation, the light from the detonation was 100 times brighter than the sun, and it disrupted numerous satellites and electricity as far as 900 miles away. The Veteran further reported that his testicular hypogonadism is due to nonionizing radiation exposure from working next to the main battery radar antenna for four years aboard his ship. He stated the radar antenna was located next to the torpedo mounts where he worked. The Veteran provided pictures of the ship showing a short tower near the rear gun mounts and provided literature excerpts regarding radiation exposure. He indicated this tower was a radar antenna. The April 2012 VA examiner noted there is no evidence of radiation effect from atomic explosion. In the October 2015 VA addendum examination, the examiner opined that the Veteran’s testicular hypogonadism is neither due to nor aggravated by in-service nonionizing radiation. The examiner explained that there is no epidemiologic (or other medical research consensus) support for a contention of hypogonadism due to nonionizing radiation exposure. The examiner’s combined opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The October 2013 VA examiner stated if radiation exposure during service is verified, it is at least as likely at not that the Veteran’s testicular hypogonadism is related to ionizing radiation exposure since sperm producing cells are well known to be amongst the most radiation sensitive cells in the body. However, there is no such objective evidence establishing radiation exposure. The Board has considered an October 2018 letter from a private physician stating the Veteran’s infertility is the result of exposure to hazardous radiation of both ionizing and nonionizing radar during service. However, the physician provided a summary conclusion, and did not state which records were reviewed, and did not give an account of the Veteran’s medical history nor of any amount of radiation exposure. Furthermore, this opinion is based solely on the Veteran’s subjective report of having participated in atmospheric nuclear testing in service. Therefore, the Board affords this letter no probative value. Letters received from the Defense Threat Reduction Agency dated May 8, 2014 and December 8, 2016 stated historical records do not document the Veteran’s participation in U.S. atmospheric nuclear testing. The Veteran’s service records confirm that he was stationed aboard the USS Cogswell from April 1961 through January 1965. However, these records do not document any participation in any nuclear atmospheric testing at Johnson Island in 1962 or anywhere else at any other time while he was in service. Furthermore, the Veteran’s service records do not provide any radiation dosimetry readings or any other evidence of occupational radiation exposure. A May 2017 letter from the Department of the Navy, Naval Dosimetry Center revealed no reports of occupational exposure to ionizing radiation pertaining to the Veteran. Internet extracts from the Naval History and Heritage Command show that the USS Cogswell participated in nuclear weapons testing at Johnson Island in 1958, which was three years before the Veteran began service. The ship’s history does not show that it participated in any other atmospheric radiation testing at any time while the Veteran was stationed aboard the USS Cogswell. As a result, there is no objective evidence to establish the Veteran was exposed to any radiation as the result of atmospheric nuclear testing or his MOS. The Board finds that there was clear and unmistakable error in the award of service connection for testicular hypogonadism with erectile dysfunction because there was no factual basis. Specifically, the Board finds it was error to award service connection because there is no objective evidence to establish the testicular hypogonadism is due to radiation exposure as the result of atmospheric nuclear testing or occupational radiation exposure. Thus, the RO’s original grant of service connection for testicular hypogonadism with erectile dysfunction was due to clear and unmistakable error. The Board therefore concludes that the severance of service connection for testicular hypogonadism with erectile dysfunction is proper. 5. Whether the severance of entitlement to SMC based on loss of use of a creative organ is proper. The Veteran appeals the severance of his entitlement to SMC based on loss of use of a creative organ, originally granted effective June 2011 and severed effective July 2015. In considering whether the RO’s initial grant of service connection was clearly erroneous, the Board has considered the requirements for the establishment of SMC. Under 38 C.F.R. § 3.350(a)(1), SMC under 38 U.S.C. § 1114(k) is payable if the veteran, as the result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs. The Board has determined the severance of service connection for testicular hypogonadism with erectile dysfunction (claimed as infertility) is proper. The medical evidence shows the Veteran’s loss of the use a creative organ is the result of his testicular hypogonadism with secondary erectile dysfunction. Since this disability is no longer service connected, the Veteran is no longer entitled to SMC as the result of service-connected disability. As such, severance of entitlement of SMC based on the loss of use of a creative organ is proper. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. McLendon, Associate Counsel