Citation Nr: 21007388 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 11-18 840 DATE: February 9, 2021 REMANDED Service connection for prostate cancer, to include as due to ionizing radiation exposure. Service connection for bilateral cataracts, to include as due to ionizing radiation exposure. Service connection for hypothyroidism, to include as due to ionizing radiation exposure.   REASONS FOR REMAND The Veteran served on active duty from November 1951 to November 1954. The case is on appeal from January 2010 and May 2012 rating decisions. In February 2014, the Veteran testified at a Board hearing. In a November 2018 decision, the Board denied the claims of service connection for prostate cancer, bilateral cataracts, hypothyroidism, as well as urinary incontinence. The Veteran appealed the decision with regard to the denied claims of service connection for prostate cancer, bilateral cataracts and hypothyroidism to the United States Court of Appeals for Veterans Claims (Court). The Board notes the Veteran did not appeal the denial of service connection for urinary incontinence. In a June 2020 Memorandum Decision, the Court vacated the decision with regard to the three challenged claims. 1. Service connection for prostate cancer. 2. Service connection for bilateral cataracts. 3. Service connection for hypothyroidism. The Veteran contends that his exposure to ionizing radiation during service led to his current prostate cancer, bilateral cataracts and hypothyroidism. The Veteran’s military records confirm his participation in Operation “Tumbler-Snapper” conducted at the Nevada Test Site in 1952, which exposed him to ionizing radiation. In December 2006, the Chief of Public Health and Environmental Hazards outlined dose tables for the review of skin and prostate cancer compensation claims. The December 2006 dose tables indicate that for Nevada Test Site cases, such as the Veteran’s, the total reported dose exposure is 17.5 rem. The “adjusted” total prostate dose for the Nevada Test Site is listed at 19 rem. The largest dose the Veteran was estimated to be exposed to according to the Defense Threat Reduction Agency (DTRA), is 16 rem. Additionally, in accordance with 38 C.F.R. § 3.311, a dose assessment was obtained from the Department of Defense, specifically the DTRA, in December 2011. According to this dose assessment, the Veteran was estimated to be exposed to 16 rem external gamma dose; .5 rem external neutron does; zero rem internal committed dose to the prostate (alpha); 1 rem internal committed dose to the prostate (beta plus gamma); and 28 rem total dose to lens of eye (beta plus gamma). As noted, the claims were denied by the Board in November 2018. The Board relied on a July 2018 medical opinion from a health physicist who determined the Veteran’s prostate cancer, bilateral cataracts and hypothyroidism are not related to service, to include his exposure to ionizing radiation. In the June 2020 Memorandum Decision, the Court indicated the July 2018 medical opinion contained “multiple inaccurate statements.” With regard to the claim for prostate cancer, the Court found the opinion did not address the December 2006 memorandum instructions noted above, which reported for Nevada Test Site participants, the prostate doses have to be adjusted for neutron and alpha radiation. The Court noted the medical opinion also did not discuss the statement that the “adjusted” total prostate dose for Nevada Test Site cases is 19 rem. With regard to the claim for bilateral cataracts, the July 2018 medical opinion found the Veteran’s dose exposure was 17.5 rem, which is about 1/10th of the lower exposure threshold required to result in cataracts for an exposed person. The Court indicated in contrast to this, the dose estimate the Board relied upon was 28 rem total dose exposure to the lens of the eyes. Lastly, with regard to hypothyroidism, the 2018 medical opinion reported the Veteran was diagnosed with the disability in 2009. However, the Court noted this is not entirely accurate, as the VA treatment records show a hypothyroidism diagnosis as early as August 1998. Therefore, an additional VA opinion is warranted to determine if the Veteran’s prostate cancer, bilateral cataracts and hypothyroidism are etiologically related to his in-service exposure to ionizing radiation. Based on the June 2020 Court Memorandum Decision, the Board finds an additional VA opinion is warranted to determine the etiology of the disabilities. The matters are REMANDED for the following action: Obtain a VA medical opinion from a qualified Physician to determine the etiology of the Veteran’s prostate cancer, bilateral cataracts and hypothyroidism. The examiner is to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s prostate cancer, bilateral cataracts and hypothyroidism had their onset during, or are otherwise related to, service. The examiner should review and discuss the relevant evidence of record, including the dose estimates referenced above from the December 2006 Chief of Public Health and Environmental Hazards and the December 2011 assessment from the DTRA. The examiner must also address the June 2020 Court Memorandum Decision in regard to the three claims, as well as the medical evidence of record. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.