Citation Nr: 20005945 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 16-33 972 DATE: January 23, 2020 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depressive disorder, is granted. REMANDED Entitlement to service connection for prostate cancer, to include as due to exposure to ionizing radiation and/or asbestos, is remanded. Entitlement to service connection for hypothyroidism (claimed as Ambien abuse, benzodiaz, hyperlipidemia, and constipation) to include as due to exposure to ionizing radiation and/or asbestos, is remanded. Entitlement to service connection for diabetes mellitus, type II, to include as due to exposure to ionizing radiation and/or asbestos, is remanded. Entitlement to service connection for chronic kidney disease, to include as due to exposure to ionizing radiation and/or asbestos, is remanded. Entitlement to service connection for hypertension, to include as due to exposure to ionizing radiation and/or asbestos, is remanded. Entitlement to service connection for right eye residuals of pterygium (also claimed as surfer’s eye) is remanded. Entitlement to service connection for left eye residuals pterygium (also claimed as surfer’s eye) is remanded. Entitlement to service connection for a bilateral hip disorder is remanded. Entitlement to service connection for a bilateral ankle disorder is remanded. Entitlement to service connection for abdominal pain (also claimed as axis 1-60 moderate symptoms) is remanded. Entitlement to service connection for a total disability based on individual unemployability (TDIU) is remanded. FINDING OF FACT Probative evidence supports a finding that the Veteran currently has an acquired psychiatric disorder, to include PTSD and depressive disorder, that is related to his active duty service. CONCLUSION OF LAW Resolving all doubt in the Veteran’s favor, the criteria for entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depressive disorder, have been met. 38 U.S.C. §§ 1110, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Navy from April 1968 to January 1972. These matters come before the Board of Veteran Appeals’ (Board) on appeal from August 2014 and August 2017 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran was scheduled for a July 2019 Board hearing in conjunction with his appeal for service connection for prostate cancer and pterygium residuals of the right and left eye, but later withdrew his hearing request. See June 2019 Correspondence. As an initial matter, in Clemons v. Shinseki, 23 Vet. App. 1 (2009), the United States Court of Appeals for Veterans Claims held that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant’s reported symptoms and other information of record, i.e., that matters of service connection for diagnosed psychiatric disabilities other than PTSD are part and parcel of a service connection for PTSD claim. Accordingly, the Board has expanded the Veteran’s service connection claim for that issue as indicated on the title page. Additionally, the Board finds it more appropriate to recharacterize the Veteran’s claim for service connection for ostearthritis as service connection for a bilateral hip disorder and service connection for a bilateral ankle disorder as these are separate and distinct disabilities. Therefore, to most accurately reflect the evidence of record, the Veteran’s claim has been bifurcated into two separate issues of entitlement to service connection. See Locklear v. Shinseki, 24 Vet. App. 311, 315 (2011) (bifurcation of a claim generally is within VA’s discretion). The Board also notes that in a September 2016 correspondence, VA requested that the Veteran clarify has claim for service connection for osteoarthritis. In November 2016, the Veteran described experiencing hip and ankle pain, which he believed was related to service. See Statement in Support of Claim. In January 2017, VA received a notification from the Veteran’s representative in response to the September 2016 VA correspondence indicating that the Veteran’s claim for osteoarthritis was related to arthritis and degenerative disc disease in his low back. However, the August 2017 rating decision only addressed entitlement to service connection for osteoarthritis of the hips and ankles. Thus, the issue of service connection for arthritis/degenerative disc disease of the low back has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD and depressive disorder Generally, service connection may be established if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active duty service. 38 C.F.R. § 3.303. To that end, service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to the period of service, establishes the disease was incurred during active duty service. 38 C.F.R. § 3.303(d). In addition to the general requirements for service connection, establishing service connection for PTSD requires medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a); credible supporting evidence that the claimed in-service stressor occurred; and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. See 38 C.F.R. §§ 3.304(f); 4.125. The evidence needed to establish the occurrence of a claimed in-service stressor is typically dependent upon whether the Veteran engaged in combat with the enemy, as well as whether the claimed in-service stressor is related to such combat; or, if not, whether there is objective evidence to verify the occurrence of the claimed stressor. See 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. at 147; Moreau v. Brown, 9 Vet. App. 389, 395 (1996); see also 38 U.S.C. § 1154(b). 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. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In the present case, the Veteran claims that he has a psychiatric disorder, to include PTSD, related to a crash-landing of an airplane while in service in Antarctica. See May 2016 Statement in Support of Claim for PTSD. The Board finds, after careful review of the relevant evidence and resolving all reasonable doubt in the Veteran’s favor, that service connection is warranted for an acquired psychiatric disorder, to include PTSD and depressive disorder. First, VA psychiatric treatment records indicate current psychiatric diagnoses including PTSD, depressive disorder, and alcohol abuse from multiple VA treatment providers. See October 2015, December 2015, and January 2017 VA treatment records. In particular, the Veteran’s primary psychiatrist diagnosed the Veteran with PTSD and depressive disorder in January 2015. This VA psychiatrist discussed details of the Veteran’s reported plane crash and discussed the Veteran’s PTSD symptoms including nightmares from this incident, intrusive memories, hypervigilance, and flashbacks. See January 2015 VA treatment note. In addition, a different VA psychiatrist came to the same favorable conclusion as to PTSD in October 2015. Moreover, another VA psychiatrist also diagnosed the Veteran with PTSD after noting that the Veteran had severe alcoholism following a plane crash during the Navy in the Arctic and noting his psychiatric treatment thereafter. See January 2017 VA mental health admission note. The Board notes that mental health professionals are experts and are presumed to know the Diagnostic and Statistical Manual of Mental Disorders (DSM) requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis. As such, the United States Court of Veterans Appeals (Court) has held that a PTSD diagnosis provided by a mental-health professional must be presumed to have been made in accordance with the applicable DSM-IV or DSM-5 criteria as to both the adequacy of the symptomatology and the sufficiency of the stressor, unless there is evidence to the contrary. Cohen v. Brown, 10 Vet. App. 128, 140 (1997). The DSM-5 cannot be used “as a basis for rejecting the Veteran’s favorable medical evidence as to the sufficiency of a stressor or the adequacy of the Veteran’s symptomatology.” Id. Thus, if the Board cannot support a conclusion that the diagnosis was not made in accordance with DSM-IV or DSM-5 requirements, it must accept the diagnosis as valid. As such, the Board will accept the above PTSD diagnoses rendered by VA medical professionals as valid and in accordance with the DSM-5. Overall, the above VA psychiatry notes and opinions were thorough and considered the Veteran’s history and relevant longitudinal complaints. In short, there is probative evidence in support of the PTSD claim. The Board also finds there is objective evidence to verify the occurrence of the Veteran’s claimed stressor. Review of the Veteran’s service personnel records and service treatment records (STRs) confirm that he served in Antarctic Development Squadron Six and was in Antarctica in October 1970. Additionally, a March 1971 STR reflects that on October 8, 1970, the Veteran was involved in a crash landing of a C-123 in Antarctica and for one day thereafter he was hospitalized with a diagnosis of acute anxiety reaction, placed on minor tranquilizers, and returned to full duty. After that, he required supportive treatment from the flight surgeon of his squadron because of fears of going outdoors and fears of flying. In support of his claim, the Veteran submitted a November 1970 Navy Times article detailing a crash landing in Antarctica involving the Antarctic Development Squadron Six, which took off for Operation Deep Freeze. The article indicated that after the crash landing all the passengers were soon released from the dispensary, except five individuals with minor injuries and shock who were held 48 hours for observation. VA also received a statement in May 2017 from a fellow serviceman indicating that the Veteran and himself were both passengers on an airplane heading to McMurdo Station, Antarctica and were involved in a crash landing. Accordingly, the competent and credible evidence of record indicates that the in-service stressor the Veteran described did occur. Finally, the evidence also establishes a link between the Veteran’s current symptoms and the in-service stressor. As noted above, the Veteran’s VA treatment records provide competent and probative evidence that his PTSD and depressive disorder are related to his military service and crash-landing in Antarctica. Specifically, the VA treatment records refect that the Veteran has nightmares about the plane crash. In this regard, in an August 1996 VA treatment note, the Veteran was diagnosed with insomnia secondary to nightmares and PTSD. The Veteran’s history included a plane crash in Antarctica and the treatment note reflected the Veteran had difficulty dealing with flashbacks, nightmares, and the memory associated with the crash. Significantly, in a January 2015 VA treatment note, the Veteran’s primary psychiatrist diagnosed the Veteran with PTSD and depressive disorder after indicating that the Veteran was in a plane crash in the Navy and noted current symptoms of intrusive memories, nightmares, hypervigilance, anxiety episodes, and flashbacks related to the incident. Additionally, in a January 2017 VA psychiatry note, a different VA psychiatrist diagnosed the Veteran with PTSD, depressive disorder, and alcohol abuse after noting the Veteran had occasional nightmares and dreams about a plane crash landing in Antarctica on ice and that transmission fluids still triggers memories. The VA psychiatrists’ diagnoses and notations on related symptoms serve to link the Veteran’s current PTSD to his in-service stressor as the VA psychologists, who are competent to provide an opinion as to the nature and origin of psychiatric disorders, concluded that the Veteran had diagnoses related to the fact that he was involved in a plane crash landing in service. The Board notes that the Veteran was scheduled for a PTSD examination on June 15, 2017 but failed to appear. After review of the record, it appears the Veteran may not have gone to his examination due to hospital admittance for his mental health condition. In this regard, a VA treatment note dated June 19, 2017, reflects that the Veteran was admitted to the hospital for two weeks and was discharged three days prior. Nevertheless, the Board finds there is sufficient evidence of record to grant the Veteran’s claim without scheduling him for a VA examination. The Board emphasizes that VA may not order additional development for the sole purpose of obtaining evidence unfavorable to a claimant. Mariano v. Principi, 17 Vet. App. 305, 312 (2003). Therefore, after resolving all reasonable doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise with respect to his psychiatric disorder claim. As such, service connection for an acquired psychiatric disorder, to include PTSD and depressive disorder, is granted. In reaching this conclusion, the benefit of doubt doctrine has been applied where appropriate. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; 3.304(f); see also Gilbert, 1 Vet. App. at 53 The present decision is considered a full grant of the benefits sought by the Veteran for his acquired psychiatric disorder claim. REASONS FOR REMAND Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claims so that he is afforded every possible consideration. 1. Entitlement to service connection for prostate cancer, to include as due to exposure to ionizing radiation and/or asbestos The Veteran contends that his prostate cancer is the result of military service, to include as due to radiation exposure and/or asbestos exposure. See June 2013 VA 21-526EZ Form. Specifically, he argues that he was exposed to radiation while he was stationed at McMurdo Station, Antarctica during the time a leak occurred at the Nuclear Plant. See June 2013 Statement in Support of Claim. He also argues that his prostate cancer may be the result of exposure to asbestos while aboard the U.S.S. Intrepid and/or while he was part of a clean-up crew in Pensacola Florida, that involved firefighting. See id.; see also June 2013 Statement in Support of Claim. As to the Veteran’s claim of exposure to ionizing radiation, the Veteran’s service personnel files confirm that he was part of an Antarctica Development Squadron and that his diagnosed prostate cancer became manifest five years or more after any such radiation exposure. Because the Veteran’s prostate cancer qualifies as a “radiogenic disease” under 38 C.F.R. § 3.311, VA sought evidence regarding whether the Veteran had been exposed to radiation during his active duty service. In this regard, in June 2014 the Navy Dosimetry Center (NDC) issued a finding that the Veteran had, at most, the following exposure to radiation during service at McMurdo Station, Antarctica, between October 1970 and March 1971: DDE (deep dose equivalent) -photon 01.665 rem, CEDE (committed effective dose equivalent) 00.020 rem, and CDE (committed dose equivalent)-prostate 00.010 rem. The dose estimate obtained from NDC was then sent to the Director of Compensation Service (Director) for an advisory opinion. See 38 C.F.R. § 3.311. The Director then forwarded the dose estimate and other records and information regarding the Veteran’s medical history to the Under Secretary for Health (Under Secretary) for a medical opinion as to the likelihood that the Veteran’s prostate cancer was the result of ionizing radiation exposure during active service. In a December 2014 memorandum, the Director of the Post-9/11 Era Environmental Health Program (DEHP), writing for the Under Secretary, found that it was unlikely the Veteran’s prostate cancer was the result of exposure to ionizing radiation during military service. The DEHP explained that the Health Physics Society, in its position statement PS010-2, “Radiation Risk in Perspective,” which was revised in July 2010, recommended against quantitative estimation of health risks below an individual dose of 5 rem in one year or a lifetime dose of 10 rem above that received from natural sources. According to the DEHP, the position statement further observed that there was substantial and convincing scientific evidence for health risks following high-dose exposures. However, below 5-10 rem, which included occupational and environmental exposures, risks of health effects were either too small to be observed or nonexistent. As such, in an Advisory Opinion based upon the DEHP’s December 2014 memorandum and the Veteran’s medical history, the Director of the Compensation and Pension Service concluded that there is no reasonable possibility that the Veteran’s prostate cancer can be attributed to ionizing radiation exposure while in military service. Despite VA’s development of the Veteran’s claim regarding exposure to ionizing radiation, the Board cannot make a fully-informed decision on the issue of service connection for prostate cancer because the Veteran has not been afforded a VA opinion on the issue of whether his prostate cancer is related to asbestos exposure. The Board notes that with respect to claims involving asbestos exposure, there is no specific statutory or regulatory guidance. However, the VA Adjudication Procedures Manual (M21-1), although not binding on the Board, contains relevant provisions, which includes a table that characterizes the probability of exposure to asbestos for various Navy military occupational specialties, ranging from minimal to highly probable. See M21-1, Part IV, Subpart ii, 1.I.3.d. Here, the Veteran’s service personnel records show that he served as an Aviation Boatswain’s Mate, Aircraft Handler (code ABH) and that section of the Manual lists a military occupational specialty (MOS) code of “ABH” as an MOS that is “probable” for asbestos exposure. See IV.ii.1.I.3.c. The Manuel further provides that if an MOS is listed as minimal, probable, or highly probable in the table in M21-1, Part IV, Subpart ii, 1.I.3.d, asbestos exposure is conceded for the purposes of scheduling an examination. See IV.ii.1.I.3.f. Accordingly, the Board finds that a remand for a VA examination and opinion is warranted as to whether the Veterans diagnosed prostate cancer and treatment is related to service, to include asbestos exposure. 2. Entitlement to service connection for hypothyroidism, diabetes mellitus, type II, chronic kidney disease, and hypertension, to include as due to exposure to ionizing radiation and/or asbestos The Veteran contends that service connection is warranted for hypothyroidism, diabetes mellitus, type II, chronic kidney disease, and hypertension. Specifically, he contends that the claimed conditions are related to ionizing exposure to service at McMurdo Station in Antarctica and/or asbestos exposure during service. The Board notes that claims based upon exposure to ionizing radiation are governed by separate regulations and each provides a separate, distinct basis for establishing service connection. See 38 C.F.R. §§ 3.309, 3.311. In this case, the Veteran is not considered a “radiation-exposed Veteran” as he does not assert nor does the evidence show that he participated in a “radiation-risk activity” as defined in 38 C.F.R. § 3.309(d). Since the Veteran does not qualify as a radiation-exposed veteran involved in radiation-risk activity, that is, either as a participant in a test of a nuclear device or in the occupation of Hiroshima or Nagasaki, Japan by U.S. forces during the period beginning on August 6, 1945 and ending on July 1, 1946, see 38 C.F.R. § 3.309 (d)(3), the presumption of service connection for specific diseases for radiation-exposed veterans under 38 U.S.C. § 1112(c) and 38 C.F.R. § 3.309(d) do not apply. He also is not asserting entitlement to service connection for a “radiogenic disease” as defined in 38 C.F.R. § 3.311. Indeed, the Veteran is currently diagnosed with hypothyroidism, diabetes mellitus, type II, a kidney condition, to include acute kidney injury on chronic kidney disease, and hypertension. See July 2011, December 2013, November 2015 VA treatment notes. These disabilities are not listed among the diseases specific to radiation-exposure. See 38 C.F.R. §§ 3.309, 3.311. The Board notes that because the claims do not relate to a disease specific to radiation exposed veterans, or radiogenic diseases, presumptive service is not for application in this case and the alleged exposure does not trigger any particular development under 38 C.F.R. §§ 3.309, 3.311. However, despite the fact that the Veteran does not qualify for entitlement to service connection based on the presumptions under 38 C.F.R. §§ 3.309, 3.311, direct service connection can be established under 38 C.F.R. § 3.303(d) by showing that the disabilities were incurred during or aggravated by service. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation. Id. Here, service at McMurdo Station has been recognized as a circumstance during which serviceman may have been exposed to radiation and the Veteran’s possibility of exposure to at least some radiation has been confirmed. See June 2014 NDC finding. Additionally, the Veteran’s assertion of current disabilities is supported by the available treatment records. As such, a remand is warranted so that the Veteran is afforded VA examinations and opinions to determine whether his disabilities are related to service, to include exposure to radiation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Additionally, the Board finds that medical opinions concerning the Veteran’s claims for service connection for hypothyroidism, diabetes mellitus, type II, chronic kidney disease, and hypertension based on exposure to asbestos is warranted. As discussed above, the Veteran’s MOS code is ABH, which has a probable risk of exposure to asbestos. See VA Manual M21-1, Part IV, Subpart ii, 1.I.3.c. Therefore, on remand, a VA examiner will be requested to also opine as to whether any of the claimed disabilities are related to asbestos exposure. 3. Entitlement to service connection for residuals of pterygium in the right and left eye The Veteran asserts that his pterygium condition in this right and left eye is due to his military service including sunlight exposure in Antarctica. See June 2013 Statement in Support of Claim. Specifically, he argues that the sun did not set while he was stationed at McMurdo Station in Antarctica and he did not routinely wear eye protection. Id. The Veteran has a diagnosis of corneal pterygium. See April 2013 private treatment record. A June 2016 VA optometry consult also reflects that the Veteran has pterygium symptoms for both eyes. Additionally, VA treatment records reflect the Veteran underwent bilateral pterygium excisions and had four eye surgeries in 1974, 1982, 1999, and 2013. See March and May 2013 VA treatment records. The record does not include a VA examination or medical opinion addressing whether the Veteran’s left and right eye pterygium conditions are related to his active military service. Given that the Veteran has current diagnoses and eye surgery approximate to his separation from active service in January 1972, a VA examination is warranted to fulfill the duty to assist. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 4. Entitlement to service connection for bilateral hip and ankle disorders The Veteran contends that his current bilateral hip and ankle pain is related to service. See November 2016 Statement in Support of Claim. Specifically, the Veteran asserts that he hurt his hip and ankle after jumping out of an airplane during a snow storm after a crash landing in Antarctica. Id. He reported that his ankle hurt for a week thereafter and that he has continued to experience hip and ankle pain since that incident. Id. Although the Veteran’s STRs are silent for hip and ankle injuries/treatment related to a crash landing, a March 1971 STR indicates that in October 1970, the Veteran was involved in a crash landing in Antarctica and was hospitalized for one day where he was also diagnosed with acute anxiety reaction. Additionally, a January 1972 STR indicates the Veteran sprained his left ankle. Post-service treatment records demonstrate long-term opioid therapy to control hip pain and the Board finds that the Veteran is competent to assert experiencing current ankle pain and pain related to such since service. Thus, there are symptoms of current disabilities, indications of symptoms during service, and an indication that an association exists. See McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). Accordingly, the Board finds that the low threshold requirement for a VA examination has been met and that a remand is warranted so that the Veteran may be afforded a VA examination in connection with his claims. 5. Entitlement to service connection for abdominal pain The Veteran’s claim for service connection for abdominal pain is intertwined with his claim for prostate cancer, as the evidence reflects that the Veteran’s abdominal pain may be secondary to his prostate cancer. See 38 C.F.R. § 3.310; see also March 2015 VA treatment record (reflecting that the Veteran’s lower abdominal pain is related to prolonged radiation treatment) and November 2015 VA treatment record (reflecting that the Veteran reported cancer since 2011 and abdominal pain from cancer radiation). Because a decision on the remanded issue of service connection for prostate cancer could significantly impact a decision on the issue of service connection for abdominal pain, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Consequently, the Board will defer a decision on this issue pending resolution of the claim for prostate cancer. 6. Entitlement to service connection for a TDIU The Veteran’s claim asserting entitlement to a TDIU must also be remanded, as it is inextricably intertwined with the service connection claims on appeal. In other words, the remanded claims may significantly impact the claim of TDIU if they are granted. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding VA treatment records. The last VA treatment of record is dated August 2017. 2. Provide the Veteran with an opportunity to identify and/or submit any outstanding private treatment records related to his claims. Review of the record indicates that for VA to obtain treatment records from Princeton Baptist Medical Center, the Veteran must provide a date of service on the authorization forms. See July 2017 VA notification letter. After obtaining any necessary authorization from the Veteran, all outstanding records, should be obtained and associated with the claims file. 3. Then, schedule a VA examination to determine the origin and nature of the Veteran’s prostate cancer and residuals thereof. The entire claims file, including a copy of this Remand, should be available to, and be reviewed by, the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s prostate cancer had an onset in service or is otherwise related to service, to include by way of exposure to asbestos during service. In providing this opinion, the examiner must discuss the Veteran’s MOS as an ABH and lay statements indicating in-service asbestos exposure. The examiner should provide a complete rationale for any opinion rendered. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 4. Schedule the appropriate hypothyroidism, diabetes mellitus, chronic kidney disease, and hypertension VA examinations with appropriate examiners to assess the relationship, if any, between the Veteran’s current disabilities and his active service. The entire claims file, including a copy of this Remand, should be available to, and be reviewed by, the examiner(s). The examiner(s) should respond to the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypothyroidism (1) had an onset in service; (2) is otherwise related to service, to include exposure to ionizing radiation and/or asbestos; OR (3) manifested within one year after discharge from service? (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s diabetes mellitus, type II (1) had an onset in service; (2) is otherwise related to service, to include exposure to ionizing radiation and/or asbestos; OR (3) manifested within one year after discharge from service? (c) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s kidney disorder, to include acute kidney injury on chronic kidney disease (1) had an onset in service; (2) is otherwise related to service, to include exposure to ionizing radiation and/or asbestos; OR (3) manifested within one year after discharge from service? (d) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension (1) had an onset in service; (2) is otherwise related to service, to include exposure to ionizing radiation and/or asbestos; OR (3) manifested within one year after discharge from service? As to the Veteran’s claim for hypertension, the examiner must consider and discuss the Veteran’s STRs indicating elevated blood pressure and the September 1971 Report of Medical Examination listing blood pressure as a defect. The VA examiner is advised of the following: the Board is cognizant that there is no VA presumption of service connection for the claimed disabilities as due to radiation exposure. Thus, the question is what is the likelihood that these disabilities are related to his period of service, to include any radiation and/or asbestos exposure, given his medical history, family history, risk factors, etc. In providing these opinions, the examiner must consider the Veteran’s MOS as an ABH and lay statements indicating in-service asbestos exposure as well as the June 2014 NDC dose assessment findings relating to the Veteran’s service in Antarctica. Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. A thorough explanation must be provided for the opinions rendered. 5. Schedule a VA examination to address the Veteran’s claim for residuals of pterygium in the right and left eye. The entire claims file, including a copy of this Remand, should be available to, and be reviewed by, the examiner. An opinion as follows is requested: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s right and left eye pterygium condition had its onset during service or is otherwise related to service, to include the Veteran’s reports of sunlight exposure in Antarctica? Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. 6. Schedule the Veteran for a VA examination to determine the nature and origin of his bilateral hip and ankle pain. The claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner. The examiner should respond to the following: (a) Identify any hip and ankle disorder that has been present during the appeal period or within close proximity thereto that is associated with the Veteran’s hip and ankle pain. If the Veteran does not have current diagnoses associated with his symptoms, the examiner should state this with a fully reasoned explanation. (b) The examiner should also state whether there is any functional impairment caused by any bilateral hip and ankle pain. Evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. (c) If the examiner determines the Veteran has a current hip and/or ankle disability, or that the Veteran’s hip and/or ankle pain results in functional loss or impairment, the examiner should opine whether it is at least as likely as not (50 percent probability or greater) that any such disability/pain is incurred in service, caused by service, or is otherwise related to service. The examiner must consider the Veteran’s contentions that his hip and ankle pain was caused by jumping out of an airplane in Antarctica that had crash-landed. See November 2016 Statement in Support of Claim. The examiner is advised that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should provide a complete rationale for all opinions. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Purcell, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.