Citation Nr: 21072634 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 09-42 362A DATE: December 3, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II (DMII) is remanded. Entitlement to special monthly compensation based on loss of use of a creative organ is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1953 to July 1955. The Veteran died in February 2019, and his surviving spouse has been substituted as the appellant. In May 2016, the Veteran was afforded a hearing before a Veterans Law Judge. Due to technical difficulties, a copy of the hearing transcript is unavailable, and it has not been associated with the claims file. In July 2016, the Veteran was advised that the transcript of the hearing could not be obtained, and in August 2016, he indicated that he did not wish to have another Board hearing. In February 2021, the current claim was remanded by the Board for additional development. Entitlement to service connection for DMII and special monthly compensation based on loss of use of a creative organ are remanded. In the February 2021 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain a VA medical opinion that addresses whether the Veteran's DMII and loss of use of a creative organ (i.e., erectile dysfunction) were otherwise related to his service. The Board specifically requested that the VA examiner discuss whether these disorders were caused by contaminated water at Camp Lejeune and/or frequent contact with dichlorodiphenyltrichloroethane (DDT) in Korea in the 1950s. The Board also requested that the VA examiner provide an opinion as to whether the Veteran's erectile dysfunction was caused or aggravated by bladder cancer. In an attempt to comply with the February 2021 remand directives, the AOJ procured June 2021 VA medical opinions. The same VA examiner provided all medical opinions. With regard to DMII, the examiner provided a negative nexus opinion and generally stated that there was too much time from exposure to Camp Lejeune contamination or DDT and his diagnosis for DMII. With regard to the loss of use of a creative organ, the examiner rendered a negative nexus opinion and indicated that the Veteran's erectile dysfunction was due to senescence and complications of stroke. The examiner also provided a negative secondary service connection opinion and did not provide a rationale. In spite of the AOJ's attempts at obtaining adequate VA medical opinions, the Board finds that the current evidence of record is insufficient for adjudication purposes. In that regard, the Board finds that the June 2021 VA medical opinions are conclusory and are not supported by adequate rationales. Notably, it is not otherwise clear how temporal proximity is a factor in the development of DMII as it relates to exposure to water contaminants and/or DDT. Moreover, the examiner concluded that erectile dysfunction was due to other causes and was not caused or aggravated by bladder cancer without any explanation or rationale, whatsoever. Accordingly, remand is warranted for new VA medical opinions consistent with the directives herein. The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion from an appropriate VA examiner to address the etiology of the Veteran's diabetes mellitus, type II. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner. The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that diabetes mellitus, type II was caused by or related to active military service, to include as due to the Veteran's conceded exposure to water-based contaminants at Camp Lejeune and/or exposure to DDT in Korea. A complete rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Obtain a VA medical opinion from an appropriate VA examiner to address the etiology of the Veteran's claimed loss of use of a creative organ. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner. The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's erectile dysfunction was caused by or related to active military service, to include as due to the Veteran's conceded exposure to water-based contaminants at Camp Lejeune and/or exposure to DDT in Korea. The examiner should also opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's erectile dysfunction was caused or aggravated by bladder cancer. Aggravation in this context is defined as any increase in disability. A complete rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. PAUL E. METZNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael J. O'Connor, 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.