Citation Nr: 21011083 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 11-15 245 DATE: February 26, 2021 ORDER Service connection for bilateral otitis externa is granted. Service connection for prostate cancer is granted. REMANDED Service connection for a respiratory disorder, claimed as difficulty breathing, is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his bilateral otitis externa began during his active service. 2. Resolving reasonable doubt in the Veteran’s favor, his prostate cancer is at least as likely as not related to his in-service exposure to dioxin-like polychlorinated biphenyls (PCBs). CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral otitis externa have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for prostate cancer have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1971 to January 1975. In December 2020, the Veteran testified before the undersigned Veterans Law Judge. At that time, the Veteran’s representative requested that the record be held open for 30 days to submit additional evidence. However, no additional evidence has been received. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Otitis Externa The Veteran asserts that his bilateral otitis externa is due to his in-service duties as a scuba diver, specifically, exposure to contaminated water. Specifically, at a February 2013 hearing before a decision review officer, he testified that he had recurrent ear infections during service from scuba diving for which he was treated. At the December 2020 Board hearing, he testified that he had recurrent ear infections during service from scuba diving for which he was treated. A July 2007 VA memorandum on the medical consequences of scuba diving notes chronic otitis externa as a long-term effect of diving. Service treatment records do not show any complaints, findings, or diagnoses of otitis externa. However, they do not appear to be complete. VA medical records dated since June 2009 show a diagnosis of bilateral otitis externa. Private medical records dated since April 2011 show a diagnosis of chronic otitis externa. In an April 2014 examination report, a VA examiner stated that chronic otitis externa is not a well-recognized complication of scuba diving, but it is possible that there is a relationship to the ear infections the Veteran had while in service. The examiner stated that the more likely cause of the Veteran’s chronic otitis externa is his eczema. [Service connection is not in effect for eczema.] Given the above, while there is no objective evidence of ear infections in service, the Board finds credible the Veteran’s testimony of having had recurrent bilateral ear infections during service. The Board also observes that chronic otitis externa is a known long-term effect of scuba diving. The VA examiner also indicated that the Veteran’s current chronic otitis externa may be related to the ear infections he had in service. Resolving all reasonable doubt in the Veteran’s favor, the Board finds that his bilateral otitis externa at least as likely as not began during active service. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, the Board concludes that service connection for bilateral otitis externa is warranted. Prostate Cancer The Veteran asserts that his prostate cancer is due to his in-service exposure to chemicals and ionizing radiation while serving aboard submarines. He testified at a February 2013 hearing before a decision review officer that his prostate cancer is due to exposure to chemicals and radiation while scuba diving. Prostate cancer is associated with exposure to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(ii). As the Veteran does not assert that he was exposed to an herbicide agent (like the dioxin in Agent Orange) from service in the Republic of Vietnam, he does not qualify for the presumptive provisions. However, service connection may still be established by showing that his prostate cancer is, in fact, causally linked to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In a June 2016 memo, the VA director of the Post 9/11-Era Environmental Health Program opined that the Veteran’s prostate cancer is not due to in-service exposure to ionizing radiation. Also in a June 2016 memo, based in part on the above opinion, the VA Acting Director of Compensation Service opined that the Veteran’s prostate cancer is not due to in-service exposure to ionizing radiation. In a March 2018 report, a private physician opined that the Veteran’s prostate cancer is due to his in-service exposure to PCBs. The physician stated that the Veteran served as an electrician aboard submarines that used PCBs as insulation in electrical systems. The physician observed that the Veteran did not develop acne conglobata in service as indicated in the service treatment records, but rather chloracne, which is associated with exposure to certain dioxins. The physician explained that the two types of acne are similar and that the Veteran’s development of chloracne in service while aboard the submarines indicates significant exposure to halogenated hydrocarbons. The physician noted that PCBs have similar effects as dioxins and have been linked to an increased risk of prostate cancer. The physician concluded that the Veteran was exposed to PCBs in service which led to his prostate cancer. Given the above, while the record shows that the Veteran’s prostate cancer is not due to his in-service exposure to ionizing radiation, the record suggests that it may be due to his in-service exposure to PCBs. Resolving all reasonable doubt in the Veteran’s favor, the Board observes that he was exposed to dioxin-like PCBs in service while performing his duties as an electrician aboard submarines. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. Again resolving all reasonable doubt in the Veteran’s favor, the Board finds that his prostate cancer is at least as likely as not related to in-service exposure to PCBs. Accordingly, the Board concludes that service connection for prostate cancer is warranted. REASONS FOR REMAND Service connection for a respiratory disorder The Veteran asserts that he has a respiratory disorder due to his in-service duties as a scuba diver. In this regard, the Board notes that a July 2007 VA memo on the medical consequences of scuba diving reflects that airflow obstruction due to airway narrowing has been reported but to date has not been found to affect the diver’s health. Private medical records dated since September 2011 show that the Veteran has had bouts of acute bronchitis. Chest X-rays have been normal, but a February 2017 CT showed mild bilateral lower lobe bronchial wall thickening. At an April 2014 VA examination, the Veteran reported occasional shortness of breath while scuba diving in service, treatment for pneumonia after discharge in 1975, and a sense of being unable to breathe in fully since that time. He reported that last pulmonary function tests (PFTs) were performed about eight years ago and that, while results were normal, they are not available. The examiner stated that there is no evidence of a lung disorder at the present time or in service and that a relationship between the Veteran’s subjective symptom of restricted respiration and active service cannot be determined. At the December 2020 hearing, the Veteran testified that he had respiratory problems in service from using older diving gear. He stated that he had infections with bronchitis, which led to restrictive breathing, and that he essentially became more susceptible to further respiratory problems. Given the above, the Veteran has reported symptoms of restricted breathing and a February 2017 CT has shown mild bilateral lower lobe bronchial wall thickening. While the Board appreciates the VA examiner’s findings and conclusions, the examiner was unable to provide an opinion on whether the Veteran’s symptoms are related to service. Also, no diagnostic tests were performed at that time. Thus, the Veteran should be provided another examination to determine whether he has a current respiratory disorder due to service, particularly from scuba diving. Accordingly, this matter is REMANDED for the following action: Schedule the Veteran for an appropriate examination to determine the nature and etiology of any current respiratory disorder he may have. The examiner should review the claims file and note that review in the report. The examiner should ensure that all indicated tests and studies are conducted, including PFTs. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a respiratory disorder, to include chronic bronchitis, that had its onset during active service or is otherwise causally related to such service, to include scuba diving. In answering this question, the examiner should discuss the Veteran’s service treatment records, VA medical records showing diagnoses of bronchitis, private medical records noting diagnoses of bronchitis and a February 2017 CT showing mild bilateral lower lobe bronchial wall thickening, and April 2014 VA examination report. The examiner should also discuss the Veteran’s lay statements regarding the history and chronicity of symptomatology. The examiner should provide a complete rationale for all conclusions. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. W. Kim, 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.