Citation Nr: 21061274 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 12-18 642 DATE: October 1, 2021 REMANDED Entitlement to service connection for a blood disorder to include as due to ionizing radiation exposure, also claimed as a blood condition to include leukemia, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1979 to November 1983 with additional service in the Virginia Army National Guard from October 1984 to October 1986. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a September 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for radiation poisoning. In March 2017, the Veteran testified at a Board Central Office hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. In June 2017, the Board remanded the claim, recharacterizing it more broadly, as service connection for a blood disorder, to include as due to ionizing radiation exposure, also claimed as radiation poisoning. In June 2019, the Board denied service connection for a blood disorder, to include as due to ionizing radiation exposure, also claimed as a blood condition to include leukemia. The Veteran appealed the Board's denial to the United States Court of Appeals for Veterans Claims (Court). Before the Court issued a decision, the parties filed a joint motion for partial remand (joint motion). The Court granted the joint motion in August 2020, which vacated the portion of the June 2019 Board decision that denied service connection for a blood disorder and remanded it to the Board for review consistent with the joint motion instructions. In January 2021, the Board remanded this claim for additional development consistent with the joint motion, which indicated that the Board consider the Veteran's reports of fatigue as a symptom possibly associated with a blood disorder. As explained below, the instructed development has not been completed, and the claim is again remanded. The Board apologizes for the additional delay. Entitlement to service connection for a blood disorder to include as due to ionizing radiation exposure, also claimed as a blood condition to include leukemia, is remanded. Although the Board regrets the delay, an ionizing radiation dose estimate and updated VA medical examination are needed for this claim. The January 2021 Board remand requested an ionizing radiation dose estimate from the Under Secretary for Health based upon the Veteran's nearly four year service as a Pershing Missile Crewmember between November 1979 and November 1983 in accordance with 38 C.F.R. § 3.311(a)(2)(iii) and then an appropriate VA medical examination and opinion. The agency of original jurisdiction (AOJ) obtained a May 2021 report from the Army Dosimetry Center stating that there were no records for ionizing radiation exposure for the Veteran. The record does not include an ionizing radiation dose estimate from the Under Secretary of Health based on the Veteran's service as a Pershing Missile Crewmember. 38 C.F.R. § 3.311(a)(2)(iii). Again, there is medical evidence suggesting the diagnosed leukopenia is a radiogenic disease to trigger the development procedures under 38 C.F.R. § 3.311 for claims based upon ionizing radiation exposure. 38 C.F.R. § 3.311(b)(4). The Board has considered the favorable July 2021 VA-contract medical opinion. However, it is from a nurse practitioner and not based upon an ionizing radiation dose estimate in compliance with the special development procedures for claims based upon ionizing radiation exposure. Id. To comply with applicable regulations and the January 2021 remand, the following development is needed. First, forward the Veteran's personnel records, service and post-service medical records and any other pertinent documents to the VA Under Secretary of Health for an ionizing radiation dose estimate based on his service as a Pershing Missile Crewmember in accordance with 38 C.F.R. § 3.311(a)(2)(iii). Then, schedule a VA hematology examination and medical opinion from a physician as detailed below. The matter is REMANDED for the following action: 1. Forward the Veteran's personnel records, service and post-service medical records, and other pertinent documents to the VA Under Secretary for Health for a dose estimate based on his service as a Pershing Missile Crewmember in accordance with 38 C.F.R. § 3.311(a)(2)(iii). 2. Then, schedule a VA hematology examination and obtain a medical opinion from an appropriately qualified physician to the determine the nature and etiology of the claimed blood disorder. If tele-health examination will provide the physician with sufficient information to render an opinion, such an examination is acceptable. The claims file and a copy of this remand must be made available to the physician for review, and the physician must specifically acknowledge receipt and review of these materials in any reports generated. The physician must provide opinions as to the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that any blood disorder was caused by in-service radiation exposure. (b) If the physician concludes that the blood disorder is not the result of radiation exposure, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that it began during active service or is related to any incident of service. A complete rationale should accompany any opinion provided. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. D. Simpson, 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.