Citation Nr: 21071356 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 20-15 490 DATE: November 30, 2021 REMANDED Entitlement to service connection for hernia of the abdomen and groin is remanded. Entitlement to service connection for diabetes mellitus, type II, to include as due to in-service exposure to herbicide agents or as secondary to in-service exposure to microwave radiation/toxic chemicals, is remanded. Entitlement to service connection for bilateral arthritis of the knees and arms is remanded. REASONS FOR REMAND This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7101(a)(2). The Veteran served on active duty in the Air Force from February 1962 to February 1966. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Board remanded the Veteran's claim for additional development. Regrettably, the Board finds that another remand is necessary, prior to readjudication of the claims. 1. Entitlement to service connection for hernia of the abdomen and groin is remanded. The Veteran contends that his current hernia condition of the abdomen and groin is directly related to his active duty service, specifically, from lifting heavy food containers, garbage cans, and other heavy equipment during mandatory in-service KP duty. In July 2021, the Veteran was afforded a VA examination and medical opinion to assess the current nature and etiology of his claimed condition. Upon examination, the examiner diagnosed the Veteran with an inguinal hernia and ventral hernia. The examiner provided an unfavorable opinion as to these conditions being etiologically related to his active duty service. Nevertheless, the Board finds this opinion to be inadequate, as the examiner improperly relied solely on the lack of objective medical evidence in-service corroborating a diagnosis of a hernia or abdominal pain due to the allege in-service occurrence of lifting heavy equipment. Additionally, the examiner failed to adequately consider the Veteran's in-service complaints and treatment for pain in the scrotum and bilateral inguinal pain as it relates to the Veteran's currently diagnosed conditions, as the examiner merely noted the in-service complaints and diagnoses, without any further discussion of the in-service injuries being the possible cause of the Veteran's currently diagnosed conditions. Lastly, the examiner failed to discuss and/or consider the Veteran's in-service lifting of heavy containers and garbage cans while conducting KP duty as it relates to his current hernia conditions. Therefore, the Board finds that the Veteran should be provided an addendum VA medical opinion that adequately addresses the claim. Accordingly, a remand is necessary to address the matter discussed above. 2. Entitlement to service connection for diabetes mellitus, type II, to include as due to in-service exposure to herbicide agents or as secondary to in-service exposure to microwave radiation/toxic chemicals is remanded. The Veteran contends that his current diabetes mellitus is related to his exposures to herbicide agents and/or exposures to microwave radiation and other toxic chemicals/contaminants. As an initial matter, the Board notes that the Veteran does not have verified service in Vietnam to warrant presumptive service connection for his diabetes mellitus, pursuant to 38 C.F.R. §§ 3.307 and 3.309(e). Additionally, with regard to the claimed in-service radiation exposure, a review of the file does not reflect that the Veteran is considered a radiation-exposed veteran, nor that he participated in a radiation-risk activity. Moreover, the Veteran's diabetes mellitus is not a listed disease to warrant presumptive service connection pursuant to 38 C.F.R. § 3.309(d). Furthermore, diabetes mellitus is not considered a radiogenic disease, nor has the Veteran provided any competent scientific or medical evidence to state otherwise; and the record fails to reveal that the Veteran was exposed to any ionizing radiation. Therefore, while already provided, a dose estimate pursuant to 38 C.F.R. § 3.311 is not required. In July 2021, the Veteran was afforded a VA examination and medical opinion to assess the current nature and etiology of his claimed condition. Upon examination, the examiner diagnosed the Veteran with diabetes mellitus, type II. The examiner provided an unfavorable opinion as to these conditions being etiologically related to his active duty service. Nevertheless, the Board finds this opinion to be inadequate, as the examiner noted that he/she could not opine beyond speculation the etiology of the Veteran's diabetes mellitus without providing an explanation for why this is the case. Therefore, the Board finds that the Veteran should be provided an addendum VA medical opinion that adequately addresses the claim. Accordingly, a remand is necessary to address the matter discussed above. 3. Entitlement to service connection for bilateral arthritis of the knees and arms is remanded. The Veteran contends that his bilateral arthritis in the knees and arms are directly related to his active duty service; specifically, from his rigorous in-service physical training and work. In July 2021, the Veteran was afforded a VA examination and medical opinion to assess the current nature and etiology of his claimed condition. Upon examination, the examiner diagnosed the Veteran with bilateral knee joint osteoarthritis, bilateral elbow osteoarthritis, and bilateral acromioclavicular joint osteoarthritis; however, provided an unfavorable opinion as to these conditions being etiologically related to his active duty service. Nevertheless, the Board finds this opinion to be inadequate, as the examiner noted that he/she could not opine beyond speculation the etiology of the Veteran's conditions without providing an explanation for why this is the case. Additionally, the examiner improperly relied on the lack of evidence in-service corroborating an incident that could have caused pain/injury to the affected joints, without further discussion and/or consideration of the Veteran's competent and credible statements of his rigorous physical training and work causing his condition. Lastly, the examiner failed to adequately discuss and/or consider the Veteran's in-service complaints and diagnosis related to his legs and arms as it relates to the etiology of his currently diagnosed conditions. Therefore, the Board finds that the Veteran should be provided an addendum VA medical opinion that adequately addresses the claim. Accordingly, a remand is necessary to address the matter discussed above. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his hernias, diabetes mellitus, and bilateral arthritis in the knees and arm, and obtain any outstanding records and associate them with the Veteran's claims file. 2. After associating all newly acquired records with the claims file, send the claims file back to the July 2021 VA examiner, to provide addendum VA medical opinions to determine the nature and etiology of the Veteran's conditions. If the July 2021 VA examiner is not available, please forward the claims file to another appropriate clinician. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. If the examiner finds that a new VA examination must be scheduled prior to providing the opinion, schedule such an examination. Following complete review of the record, the examiner must address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hernias had its onset during any period of active duty service, or otherwise is etiologically related to his active duty service, to include from lifting heavy food containers, garbage cans, and other heavy equipment during mandatory in-service KP duty. Please note: the examiner must discuss the in-service complaints and treatment for pain in the scrotum and bilateral inguinal pain as it relates to possible causes of the Veteran's currently diagnosed conditions. Additionally, if the examiner concludes that an opinion cannot be provided without resorting to mere speculation, the examiner must provide an adequate explanation as to why this is so. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diabetes mellitus had its onset during any period of active duty service, or otherwise is etiologically related to his active duty service, to include exposures to non-ionizing microwave radiation or other toxic chemicals. Please note: if the examiner concludes that an opinion cannot be provided without resorting to mere speculation, the examiner must provide an adequate explanation as to why this is so. (c) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral arthritis of the knees and arms had its onset during any period of active duty service, or otherwise is etiologically related to his active duty service, to include from rigorous in-service physical training and work. Please note: the examiner must discuss the in-service complaints of leg cramps and arm pain as it relates to possible causes of the Veteran's currently diagnosed conditions. Additionally, if the examiner concludes that an opinion cannot be provided without resorting to mere speculation, the examiner must provide an adequate explanation as to why this is so. (d) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (e) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.