Citation Nr: 21073230 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-32 758 DATE: December 7, 2021 REMANDED Entitlement to service connection for a heart disability, to include as due to radiation exposure, is remanded. REASONS FOR REMAND The Veteran had active military service from May 1960 to May 1963. This current matter came before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran and his spouse testified at a hearing. The transcript of the hearing is of record. In June 2019, August 2019, and September 2021, the Board remanded the issue on appeal for further evidentiary development and adjudication. However, the Board finds that further development is required. As such, a remand is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a heart disability, to include as due to radiation exposure, is remanded. The Veteran alleged that his heart disability manifested as a result of radiation exposure while stationed in Treasure Island, California. Specifically, he stated that he was stationed in Treasure Island, California from August 1960 to October 1961. See April 2014 Correspondence. As a radarman he operated, tested, and maintained surface and air search radars, sound-powered radio frequency circuits, electronic counter measures equipment, CIC radar repeaters, and radar antennas. Radiation was present in CIC radar, microwave, and radio FM. All radarmen were in close quarters with this equipment. Additionally, he reported that during the nights and weekends he stood watch around buildings, storage tanks, and around a land locked training ship called the USS Pandemonium in Treasure Island. The military personnel records show that he was stationed in the Naval Schools Command in Treasure Island from August 1960 to February 1961 and was subsequently stationed on the USS Lowe from March 1961 to October 1961; USS Hamner from October 1961 to March 1962; and USS King from March 1962 to May 1963. See April 2014 Military Personnel Record. In a July 2014 letter, the Department of the Navy indicated that they had no reports of occupational exposure to ionizing radiation pertaining to the Veteran. The Veteran submitted multiple articles showing that Treasure Island has high levels of radiation. See September 2016 Correspondence; August 2016 Correspondence; July 2015 Correspondence; and June 2014 Web/HTML Documents. The Veteran submitted additional articles of Treasure Island and Cesium-137. The articles stated that during the USS Pandemonium's early years, until 1963, highly radioactive cesium-137 was routinely placed aboard the vessel in sealed containers in at least 11 locations. See April 2014 Correspondence; June 2014 Web/HTML Documents records; July 2015 Correspondence; August 2016 Correspondence; and September 2016 Correspondence. In support of his claim, he submitted three medical opinions. In a December 2015 private medical opinion, Dr. John Ellis opined that it is more likely than not that the Veteran was exposed to herbicide agents, both on Treasure Island and Okinawa. See August 2016 VA 21-0960A-1 Ischemic Heart Disease Disability Benefits Questionnaire. Further, he opined that it is more likely than not that his exposures are similar to those exposures of a serviceman in Vietnam wherein it is presumptive that herbicide exposures contribute to coronary artery disease. His exposure to herbicide agents has contributed to and aggravated his coronary artery disease. However, as for his claim for radiation induced heart disability, Dr. Ellis noted that the Veteran has had numerous and repeated exposure to radiation in service, but that none of his diseases are related to radiation. In the September 2016 Heart Condition Disability Benefits Questionnaire, Dr. Hennebry diagnosed the Veteran with atherosclerotic cardiovascular disease, coronary artery disease, and hypertensive heart disease. Although Dr. Hennebry did not opine as to the etiology of the Veteran's heart disability he did note that the Veteran has an unusual diffuse distal coronary artery disease suggestive of radiation induced heart disability. In the June 2018 and April 2019 medical opinion, Dr. Hennebry stated that even a low-level radiation contributes to the development of coronary artery disease. See April 2019 Medical Treatment Record Non-Government Facility. The physician explained that medical literature is filled with references demonstrating an increased rate of coronary artery disease in those with radiation exposure. As such, the physician opined that it is highly probable that the radiation exposure is a significant contributor to the Veteran's heart disability. Based on the foregoing, in August 2019, the Board found that the VA's duty to assist was triggered and as such a VA examination should be afforded to the Veteran. Additionally, the Board instructed the RO to contact the appropriate entity to determine whether the Veteran was exposed to ionizing radiation during any training in the Naval Schools Command in Treasure Island, California. Pursuant to the August 2019 Board remand order, the Department of the Navy Naval Dosimetry Center stated that a review of the exposure registry by name, service number, command, and social security number revealed no reports of occupational exposure to ionizing radiation pertaining to this Veteran. However, it was noted that The Exposure Registry does not maintain records for non-ionizing forms of radiation, such as radar or microwave. See October 2020 Third Party Correspondence. In September 2021, the Board again remanded the issue to obtain a medical opinion as to whether his heart disability is at least as likely as not related to service, to include radiation exposure as a radarman. In a September 2021 addendum opinion, the examiner opined that the claimed condition is at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that the VA recognizes ischemic heart disease as being associated with exposure to Agent Orange or other herbicides during military service. The examiner also opined that it is less likely as not that the Veteran's heart disability is due to his exposure to Cesium 137, diesel fuel, chemicals, and biological chemicals while in service. The examiner explained that Cesium-137 has a half-life of 30 years, meaning that it takes 30 years to see a 50 percent reduction in the levels of Cesium-137 in the blood system. Although cesium-137 affects the heart, it does so in the form of cardiac arrhythmias, which the Veteran does not have. He has a strong family history of cardiac issues similar to his heart issues and also is hypertensive. The examiner cited to a website that stated that cesium interferes with potassium channels and this is the likely major mechanism of rhythm issues. The Board notes that in a November 2019 myocardial perfusion SPECT summary, the Veteran exhibited arrhythmia with rare PACs and PVCs. See December 2019 Medical Treatment Record Non-Government Facility. The Board finds that a remand is warranted as the September 2021 examiner did not substantially comply with the Board remand directives. Specifically, the examiner's positive nexus medical opinion was based on a claim that the Veteran was exposed to herbicide agents which is not conceded by the Board as there is no records to indicate that the Veteran was exposed to herbicide agents. Additionally, the Board has not conceded to the presence of Cesium-137 in Treasure Island. The examiner was requested to opine whether the Veteran's heart disability is at least as likely as not had its onset in service or is otherwise etiologically related to service, to include radiation exposure as a radarman, to include non-ionizing radiation. As the examiner did not address his exposure to non-ionizing radiation, the Board finds that a remand is warranted. The matter is REMANDED for the following action: Obtain an addendum medical opinion from an appropriately qualified examiner to determine the nature and etiology of the Veteran's heart disability. The Veteran should be scheduled for an examination if determined necessary. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. For each diagnosed heart disability, provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in service or is otherwise etiologically related to service, to include non-ionizing radiation exposure as a radarman while stationed at Treasure Island from August 1960 to February 1961. The examiner is asked to consider the September 2021 VA examiner's opinion that it is less likely as not that the Veteran's heart disability is due to his exposure to Cesium 137, diesel fuel, chemicals, and biological chemicals while in service. The examiner explained that Cesium-137 has a half-life of 30 years, meaning that it takes 30 years to see a 50 percent reduction in the levels of Cesium-137 in the blood system. Although cesium-137 affects the heart, it does so in the form of cardiac arrhythmias, which the Veteran does not have. He has a strong family history of cardiac issues similar to his heart issues and also is hypertensive. The examiner cited to a website that stated that cesium interferes with potassium channels and this is the likely major mechanism of rhythm issues. However, the Board notes that in a November 2019 myocardial perfusion SPECT summary, the Veteran exhibited arrhythmia with rare PACs and PVCs. See December 2019 Medical Treatment Record Non-Government Facility. The examiner is asked to consider whether this affects the September 2021 VA opinion provided about the presence of arrythmia. The examiner is also asked to consider the September 2016 and June 2018 medical opinions wherein the physician opined that the Veteran's heart disability is etiologically related to his exposure to radiation as a radarman. The examiner is asked to consider the Veteran's assertions that as a radarman he operated, tested, and maintained surface and air search radars, sound-powered radio frequency circuits, electronic counter measures equipment, CIC radar repeaters, and radar antennas. Radiation was present in CIC radar, microwave, and radio FM. All radarmen were in close quarters with this equipment. The examiner should note that the Veteran's exposure to herbicide agents and ionizing radiation are not conceded by the Board. A detailed rationale for all opinions must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort 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. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Noh, 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.