Citation Nr: 21062065 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 14-19 820A DATE: October 6, 2021 REMANDED Entitlement to service connection for residuals of testicular cancer, to include as due to ionizing radiation exposure is remanded. Entitlement to service connection for tumors, to include as due to ionizing radiation exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1979 to August 1979, from March 1980 to May 1980, and from March 1981 to August 1983. A Travel Board of Veterans' Appeals (Board) hearing was held in September 2015. A transcript of the hearing is associated with the Veteran's claim file. The Board remanded this matter for further evidentiary development in February 2016, March 2018, and May 2021. The case has returned to the Board for appellate review. 1. Entitlement to service connection for residuals of testicular cancer, to include as due to ionizing radiation exposure is remanded. 2. Entitlement to service connection for tumors, to include as due to ionizing radiation exposure is remanded. The Veteran seeks entitlement to service connection for residuals of testicular cancer and tumors. The Veteran contends that these disorders are related to in-service radiation exposure. Specifically, the Veteran contends that he was exposed to radiation while assisting X-ray technicians during his military service and he was not always provided an apron. See May 2010 Correspondence and September 2015 Hearing Testimony. His DD 214s reflect his military occupational specialty (MOS) was a Medical Specialist and Patient Case Specialist. There is an indication of in-service exposure, although an October 2011 letter from the Army notes that there are no dosimetry center records. The Board finds the agency of original jurisdiction (AOJ) failed to substantially comply with the Board's May 2021 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Specifically, while the AOJ attempted to contact the Veteran to request further information regarding his radiation exposure, the AOJ failed to forward the Veteran's statements and testimony regarding radiation exposure to VA's Under Secretary for Health for preparation of a dose estimate based on the Veteran's statements that he was exposed to ionizing radiation while assisting with X-ray machines during his service. Further, the AOJ did not schedule the Veteran for VA examinations as specifically requested in the May 2021 Board remand. Another remand is necessary to ensure compliance with the May 2021 Board remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Forward all records concerning the Veteran's claimed radiation exposure, including any relevant service records, statements or testimony regarding exposure, and any other information obtained, to the Under Secretary for Health for preparation of a radiation dose estimate, to the extent feasible based on the Veteran's active-duty service. If a specific estimate cannot be made, a range of possible doses should be provided. If more information from the Veteran is required regarding specifics of the Veteran's alleged exposure, he should be contacted and asked to provide the information. 2. The issue should then be further developed under 38 C.F.R. § 3.311(c) as provided under § 3.311(b)(1). In any review of the claim under 38 C.F.R. § 3.311(c), any opinion from the VA Under Secretary for Benefits, or designee of the VA Under Secretary for Benefits, of no reasonable possibility that the cancer was caused by exposure to radiation in service must be accompanied by a thorough explanation of rationale for such conclusion. In accordance with the guidance in Stone v. Gober, 14 Vet. App. 116 (2000), such opinion need not explicitly discuss each 38 C.F.R. § 3.311(e) factor but it must be more than a cursory explanation and a mere restatement of any opinion from the office of the VA Under Secretary for Health. 3. Then, obtain VA opinions from a VA examiner of appropriate expertise to determine the nature and etiology of any residuals of cancer and tumor disability. The claims file, including a copy of this Remand and all findings by the VA Under Secretary for Benefits, must be made available to the examiner, and the examination report should include discussion of the Veteran's documented medical history and assertions. The examiner is requested to provide the following opinion: (a.) Is it at least as likely as not (a 50% or greater probability) that the Veteran's cancer or tumors are caused by or related to the Veteran's service and/or events in service, to specifically include exposure to ionizing radiation in service? (b.) In considering any lay statements of record, the examiner should note that the Veteran is competent to attest to 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. (c.) The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. (d.) The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Frazier, Associate Attorney 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.