Citation Nr: 21067148 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-30 811 DATE: November 3, 2021 REMANDED The issue of entitlement to service connection for a nutritional deficiency disability, to include rickets and vitamin D deficiency, is remanded. The issue of entitlement to service connection for a testicular disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1979 to August 1982, and from June 1986 to July 1993. In February 2019, the appeal was remanded by the Board. For the reasons outlined below, the Board finds that remand is again needed in this matter. 1. Entitlement to service connection for a nutritional deficiency disability, to include rickets and vitamin D deficiency. 2. Entitlement to service connection for a testicular disability. At the outset, the Board acknowledges that additional treatment records and VA examinations were added to the claim file following the May 2020 Supplemental Statement of the Case (SSOC). In October 2021 correspondence, the Veteran requested that his case be remanded back to the AOJ for review of the additional evidence submitted. The Board complies with the Veteran's request. Further, the Board has reviewed the below October 2019 VA examinations and opinions obtained following the February 2019 Board remand, and prior to the May 2020 SSOC. The Board finds that new VA examinations and opinions are needed for the following reasons. First, the Board seeks clarification of the status of the Veteran's claimed nutritional deficiency. The October 2019 VA examination report appears to be internally inconsistent. For example, it indicates that the Veteran does not currently have a diagnosed nutritional deficiency. It also states: "Current documented lab result reports indicate no evidence of low levels of Vitamin D, during service or after." However, it also notes that the Veteran's nutritional deficiency condition requires continuous medications for control and identifies the medication. The Board acknowledges the VA opinion, which states: "There is no current objective lab data to indicate the Veteran's Vit D levels were low currently or during service, it is not at all clear why Vit D supplementation is use/prescribed." Nevertheless, it is unclear to the Board to which lab data these statements refer, and the opinion does not address the Veteran's statements regarding his claim. The Board notes that this is particularly relevant as the Veteran is himself a physician. Similarly, the Board seeks clarification regarding the claimed testicular disability. The Veteran has been diagnosed with hypogonadism. See CAPRI, January 2017. Further, VA treatment records note that the Veteran has been treated with Androgel. See CAPRI, June 2017. However, neither are identified in the October 2019 VA examination report. Similarly, the October 2019 VA opinion indicates there is no current diagnosis and "current medication lists do not include active testosterone replacement type medications (since c. 3/2018)." However, in March 2019 correspondence, the Veteran indicates that he uses "Androgen gel at six pumps per day, twice the normal range in order to achieve the minimal circulating testosterone levels considered normal for a male my age." See Correspondence, March 2019. Accordingly, the Board finds that new VA examinations and opinions are needed. The appeal is REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issues on appeal. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for a VA examination to clarify the diagnosis of his claimed nutritional deficiency disability, to include rickets and vitamin D deficiency, as well as his claimed testicular disability, and to address the etiology of any diagnosed disabilities. For each disability diagnosed, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it is related to the Veteran's active duty service. The examiner is asked to specifically address the Veteran's contentions regarding his exposure to environmental toxins, heavy metals, and arsenic. See, e.g., Congressionals, September 2018. In addition, the examiner should address whether it is at least as likely as not that either of the Veteran's claimed disabilities is an undiagnosed illness or a medically unexplained chronic multisymptom illness. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 3. If upon completion of the above action the issues are denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Foster, 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.