Citation Nr: 21012000 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 17-09 334 DATE: March 3, 2021 ORDER Entitlement to service connection for residuals from adrenal gland tumor removal to include as due to environmental agent exposure from Project Shipboard Hazard and Defense (SHAD) is denied. Entitlement to service connection for a left-hand disability to include as due to environmental agent exposure from Project SHAD is denied. Entitlement to service connection for residuals from a right-hand disability to include as due to environmental agent exposure from Project SHAD is denied. Entitlement to service connection for sleep apnea to include as due to environmental agent exposure from Project SHAD is denied. REMANDED Entitlement to service connection for right knee disability to include as due to environmental agent exposure from Project SHAD and/or due to a left knee disability, is remanded. Entitlement to service connection for a left hip disability to include as due to environmental agent exposure from Project SHAD is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran’s residuals from adrenal gland tumor removal is related to active duty service to include as due to environmental agent exposure from Project SHAD. 2. The preponderance of the evidence is against a finding that the Veteran’s right-hand disability is related to active duty service to include as due to environmental agent exposure from Project SHAD. 3. The preponderance of the evidence is against a finding that the Veteran’s left-hand disability is related to active duty service to include as due to environmental agent exposure from Project SHAD. 4. The preponderance of the evidence is against a finding that the Veteran’s sleep apnea is related to active duty service to include as due to environmental agent exposure from Project SHAD. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of adrenal gland removal to include as due to environmental agent exposure from Project SHAD, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 1137; 38 C.F.R. § 3.303. 2. The criteria for service connection for a right-hand disability to include as due to environmental agent exposure from Project SHAD, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 1137; 38 C.F.R. § 3.303. 3. The criteria for service connection for a left-hand disability to include as due to environmental agent exposure from Project SHAD, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 1137; 38 C.F.R. § 3.303. 4. The criteria for service connection for sleep apnea to include as due to environmental agent exposure from Project SHAD, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 1137; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in active duty service with the Navy from May 1961 t to April 1965. This matter is on appeal from a May 2016 rating decision. The Veteran was afforded an October 2018 hearing before the undersigned Judge. A transcript of the hearing has been associated with the claims record. The Board remanded this appeal in March 2019 for additional development. The Board notes that in the March 2019 Board decision, the Board remanded issues for further development to include entitlement to service connection for chronic obstructive pulmonary disease (COPD); skin cancer; left and right-hip disability; prostate cancer; right shoulder disability; left knee disability; right knee disability; hypertension; renal cancer; left and right-hand disabilities; sleep apnea; and residuals from adrenal gland tumor removal as all include as due to environmental agent exposure from Project SHAD. During the pendency of the appeal, a March 2020 rating decision granted service connection for chronic renal disease of the left kidney and residuals of right kidney removal; residuals of skin cancer; right shoulder disability; right hip disability; prostate cancer; and COPD. In an October 2020 rating decision, service connection was granted for the left knee and for hypertension. As such, the issues remaining on appeal with the Board are entitlement to service connection for a right knee disability to include as due to environmental agent exposure from Project SHAD and/or due to a left knee disability; a left hip disability to include as due to environmental agent exposure from Project SHAD; a right-hand disability to include as due to environmental agent exposure from Project SHAD; a left-hand disability to include as due to environmental agent exposure from Project SHAD; sleep apnea to include as due to environmental agent exposure from Project SHAD; and residuals from adrenal gland tumor removal to include as due to environmental agent exposure from Project SHAD. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In relevant part, 38 U.S.C. § 1154 (a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. 38 U.S.C. § 5107 (b); see Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). As an initial matter, the Board notes the Veteran’s assertions of participation in Project SHAD and therefore exposed to environmental agents from testing. In this regard, the record contains a Department of Defense (DOD) fact sheet, which indicates that Project SHAD was part of the joint service chemical and biological warfare test program conducted during the 1960s. Project SHAD was a series of tests conducted by the Department of Defense (DoD) from 1962 to 1973 to determine the potential risks to U.S. warships and American forces from chemical and biological warfare agents. https://www.publichealth.va.gov/exposures/shad/index.asp There is no specific statute or regulation pertaining to the development of claims alleging participation in Project SHAD. The Veterans Health Care, Capital Asset, and Business Improvement Act of 2003, Public Law 108-170, provides participating Veterans with a thorough clinical evaluation and enhanced access to enrollment in the VA Health Care System, to include VA health care at no cost for any illness possibly related to their participation in that project. Veterans Health Administration (VHA) Directive 2004-016 (April 15, 2004) states that DoD has provided VA with declassified information concerning the test name, date, location, ship involved, names and service numbers of participating veterans, and identification of the exposure types. Information concerning the ships involved is published at http://www.va.gov/shad/. DoD estimates 6,000 veterans were involved and has provided VA with the names of approximately 5,000 veterans who participated in the tests. The Veterans Benefits Administration (VBA) has contacted those individuals. Review of the record shows a July 2002 verification of the Veteran’s participation in Project SHAD as abord the USS Granville for testing from January to April 1965. Accordingly, the Board finds that the evidence of record shows that the Veteran was exposed to environmental agents from Project SHAD during active service. The Board also notes that the Veteran has made statements and testimony that he was exposed to radiation during his time in active duty service. Such assertions include a June 2008 testimony to the US House of Representatives Armed Services Committee and Subcommittee on Military Personnel, the Veteran testified that the ship he was assigned to was docked at a pier where a nuclear warhead was dumped; in an April 2011 statement the Veteran noted exposure to Project SHAD “in addition of radioactive plutonium close below our pier”; a May 2016 notice of disagreement (NOD) statement where the Veteran states they “forgot” that the “slip space [at Johnston Island] was just above the pump area of 2 warheads”; a September 2016 statement where the Veteran stated that the pier his ship was docked at was built over the top of an area where “two warheads had been splashed during testing from Johnston Island … they ‘forgot’ to let us know that was there”; and an October 2018 testimony where the Veteran testified that his ship was tied up “right above where they had dumped two warheads or RCMs and they were not done properly” but stated that there were no dosimeters. With respect to the theory of in-service radiation exposure, the Board must focus, as an initial matter, on whether the evidence suggests that the Veteran had actual in service exposure to ionizing radiation. 38 U.S.C. § 1112 (c); 38 C.F.R. §§ 3.309 (d), 3.311(b); Ramey v. Brown, 9 Vet. App. 40 (1996). The Board finds that the VA regulations governing ionizing radiation exposure are not applicable in this case. 38 C.F.R. §§ 3.309 (d), 3.311(b). The evidence of record regarding Project SHAD does not demonstrate that the Veteran was exposed to radiation of any kind during that testing. The Veteran’s service and post-service medical records are negative for complaints or clinical findings of ionizing radiation exposure, nor do those records contain any evidence of diseases presumptively linked to ionizing radiation exposure. 38 C.F.R. § 3.309 (d). Moreover, the Veteran does not allege that he participated in any radiation-risk activities, as set forth in VA’s governing regulatory provisions. 38 C.F.R. § 3.309 (d)(3)(iv). Furthermore, there is no evidence that he had onsite participation in any testing involving the atmospheric detonation of a nuclear device, occupation of Hiroshima or Nagasaki during World War II, or presence at certain sites specified by regulation. 38 C.F.R. § 3.309 (d)(3). Additionally, the Board considers it significant that the Veteran has neither alleged nor been shown to have contracted one of the legally classified radiogenic diseases within five years or more of his active service. 38 C.F.R. § 3.311 (b)(2). He also has neither cited nor submitted competent evidence that supports an alternate finding of a radiogenic disease attributable to ionizing radiation exposure. 38 C.F.R. § 3.311 (b)(4). Therefore, the Board finds that he does not qualify as an ionizing radiation-exposed Veteran under VA’s regulatory provision. It follows that the Board need not further consider the specific guidelines governing ionizing radiation claims, which require VA to obtain a dose estimate from the Defense Threat Reduction Agency and to refer the Veteran’s case to the Under Secretary for Benefits for an opinion as to whether his claimed disease resulted from in-service ionizing radiation exposure. 38 C.F.R. § 3.311. As it appears that the Veteran’s service connection claims are predicated on his exposure to environmental agents from Project SHAD and not from alleged non-ionizing radiation exposure, the Board’s inquiry with respect to such exposure is limited to a theory of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Residuals from adrenal gland tumor removal The Veteran asserts that his residuals from an adrenal gland tumor removal are related to his active duty service to include exposure to environmental agents from Project SHAD. Review of the medical treatment shows in August 1985 the Veteran underwent a surgical procedure to remove a adrenal adenoma mass on the Veteran’s right adrenal gland. In an October 2019 VA examination the examiner diagnosed the Veteran with an adrenal tumor. Accordingly, the Board finds the Veteran with a current disability. As addressed above, the Board finds the Veteran was part of Project SHAD testing and therefore exposed to environmental agents. Review of the Veteran’s service treatment records (STRs) do not show any complaints, treatments or diagnoses relating to the Veteran’s adrenal glands. In August 1985 the Veteran was seen with a history of difficulty controlling his hypertension. The treating provider noted that the Veteran was previously seen in 1978 with a finding that he was hypertensive, but “could not afford treatment … until [the Veteran] found a job and insurance later that year.” The provider noted the Veteran was referred here for further workup of a “presumed aldosterone secreting mass.” Upon diagnostic testing, a right adrenal adenoma was diagnosed, and the Veteran underwent a procedure to remove the tumor. No complications were reported during the surgical procedure. In April 1999 the Veteran stated he had an adrenal gland tumor removed in 1982. In September 1999 diagnostic testing found no recurrence of the adrenal gland tumor. In March 2002 the Veteran stated that he was part of Project SHAD and exposed to chemical and biological warfare but was unsure what he was exposed to, listing agents such as “BCG, tularemia, and anthrax.” In the July 2002 claim for compensation the Veteran noted that his claimed issues were not treated in service and asserted they were the result of Project SHAD under project Shady Grove. The Veteran provided a fact sheet from the Office of the Special Assistant to the Under Secretary of Defense (Personnel and Readiness) on Project SHAD. The Fact sheet noted that crews who participated in Project SHAD were “not test subjects but test conductors…under actual test conditions, test conductors should have worn appropriate nuclear, biological and chemical (NBC) protect equipment and should have taken extensive safety precautions to prevent any adverse health effects from the testing.” The Veteran also included a list of agents used in the Project SHAD testing for project Shady Grove to include Bacillus globigii (BG), Coxiella burnetii (OU), and Pasteurella tularensis (UL). In a January 2003 VA examination, the Veteran stated his residuals of his removal of an adrenal gland tumor was the result of possible exposure to chemical or biological agents during participation in Project SHAD. The Veteran reported exposure to various biological agents while cleaning area of the ship as well as exposure to various cleaning agents to include high concentrations of chlorine and trichothecene. The Veteran stated that the cleaning mop was stored in a garbage can “embalmed in ethylene bromide” and was “out in the biological storms.” The Veteran reported testing biological weapons, his primary job was with electronic repair, and other duties included ship piloting, assistant navigating, and cleaning. The Veteran stated suffering from uncontrolled hypertension in the 1980s leading to a diagnosed adrenal gland tumor in 1982 that required surgery to remove. The Veteran further stated that during the surgery a nerve was severed resulting in a loss of feeling in the right flank. The examiner did not render an opinion regarding the etiology of the Veteran’s claimed issue. In an April 2004 SHAD registry examination, the Veteran reported that during his time with the project the air filters became wet and allowed contaminants to come in. The Veteran referenced a deposition from a Dr. Spendlove who testified that that all Project SHAD participants were to have gas masks and full body exposure suits; the Veteran stated that “these items were neither discussed nor available during testing.” The Veteran stated that he had a hypertensive episode during service where he felt dizzy and stopped at a dispensary after drinking in a club; the Veteran was told that he had elevated blood pressure and advised to quit drinking, there was no followup from this visit. The Board notes that review of the Veteran’s STRs do not have records of this reported event. The treating provider noted the Veteran’s family history was significant for cerebral vascular accidents (CVA) and lung cancer. The Veteran was assessed as a Project SHAD participant with adrenal adenoma post-participation but with no recurrence after resection and no opinion on the etiology of his adrenal adenoma in relation to his claimed exposure. In June 2006 the Veteran submitted an article on Project SHAD. In January 2011 the Veteran submitted several articles on decontamination procedures for boats in Project SHAD, a supplement on the health effects of exposure to biological agents from Project SHAD, a May 2007 article on the long term effects on SHAD, and June 2008 testimony from the Veteran and another fellow service member to the Use House of Representatives Armed Services Committee. In the Veteran’s June 2008 testimony to the House Committee, the Veteran testified that he was “brought as a crew into a classroom setting and [trained] on exposure suits and gas masks.” The Veteran stated that a deposition from Dr. Spendlove testified that “gas masks and bio gear were not need as we were test conductors and were not subjects because we were behind the filters.” The Veteran noted that the filters were leaking and therefore rendered the filters ineffective. The Veteran submitted statements in April 2011 that he participated in a biological weapons research test program for 2 years and was exposed to chemical decontaminants. The Veteran was afforded a March 2012 VA examination. The examiner noted the Veteran’s participation in Project SHAD and received treatment in 1985 to remove an adrenal adenoma. The examiner found it was less likely than not that the Veteran’s claimed condition was incurred in or caused by the claimed in-service event, illness or injury. The examiner noted that Project SHAD involved biological experiments carried out with airborne material with ships taking readings and measurements. The examiner noted that agents used included “Coxiella burnetii, Francisella tularensis, and Staphylococcal Enterotoxin B…organophosphorus chemical warfare nerve agents including Sarin, VX, Tabun, and Soman.” The examiner found that stimulants were mostly used in testing to include methylacetoacetate or sulfur dioxide. The examiner also noted that sterilizing agents used include B-propiolactone, ethyl alcohol, Lysol, peracetic acid, potassium and sodium hydroxide, and bleach. The examiner stated the Veteran had an adrenal adenoma removed in 1985 that was an “aldosterone-secreting type.” The examiner found that it was “unknown as to what causes adrenal tumors” and stated while systemic exposure to carcinogens had a “potential to cause cancers in organs and affect duplicate organs simultaneously, “the pocket guide on Project 112 and Project SHAD says that ‘no diagnosis stands out among Project 112/SHAD Veterans.’” The examiner found review of medical literature was silent and concluded the Veteran’s adrenal adenoma was not a result of his exposure to Project SHAD. In May 2015 the Veteran was noted to be upset over copays and wanted the treating provider to “retroactively forgive copays for most of his problems which [the Veteran] believes are a result of Project SHAD.” In a separate May 2015 VA provider letter, the treating physician noted that “until there is a directive naming various medical conditions attributable to Project SHAD, I cannot declare them service-connected treatment.” In a September 2015 notice of disagreement (NOD) the Veteran stated that VA did not obtain all the records for Project SHAD and believed the records would show that his exposure to carcinogens let to the development of his health conditions. In a February 2016 provider phone call, the Veteran wished to discuss Project SHAD and that he “should not pay co-pays”; the answering provider noted that the latest study in January 2016 found no noted adverse effects from Project SHAD. In March 2016 the Veteran submitted a Project SHAD fact sheet that showed the types of agents used to include Bacillus globuli, fluorescent particles, Coxiella burnetii (OU), and Pasteurella tularensis (UL) and their associated health effects. In an April 2016 VA medical opinion, the VA examiner reviewed the SHAD fact sheet and online medical literature. The examiner noted that “Bacillus globigii, now called B. subtilis, is non-pathogenic in humans…does not cause any known disease.” The examiner next found cadium in low level acute exposure was not known to cause disease and at higher dose exposures were associated with kidney toxicity and lung cancer; the examiner also noted that “chronic ingestion in animals led to increases in systolic blood pressure.” The examiner found Pasteurella tularensis causes tularemia which manifests with high fever, lesions and lymphadenopathy; more severe infections resulted in pneumonia, meningitis and peritonitis. However, the examiner noted while acute disease may be fatal, there were no known long-term sequalae. The examiner then noted that Xociella burnetti caused Q fever which was noted to be an “acute disease and most people recover” with symptoms of fever, headache, myalgias, and arthralgia, and cough. The examiner stated that complications were rare but severe, and chronic disease was most often seen in pregnant women, immunocompromised people and epeople with pre-existing aortic heart valve defects with the most common outcome in endocarditis and less common conditions in infections of the bone, liver or reproductive organs. The examiner found it was less likely than not that the Veteran’s claimed conditions were due to or caused by his claimed inservice injury, event or illness. The examiner opined that review of the SHAD fact sheet and online medical literature regarding exposure was relative to the Veteran’s claimed conditions. In a May 2016 NOD, the Veteran stated that records relating to biological exposure and medical records during Project SHAD remained classified. In a September 2016 statement the Veteran stated that the medical records were held separate from “normal” records and the first notice of the existence of biological and chemical warfare testing was in 2001 shortly after the 9/11 attacks. In November 2018 the Veteran submitted the deposition made by Dr. Spendlove and review of literature on Project SHAD. The Veteran was afforded an October 2019 VA examination. The Veteran stated that in 1984 or 1985 he had a “benign adrenal tumor on my right adrenal gland” that caused “massive high blood pressure” and was removed. The Veteran stated that the only symptom he had now was pain in the area where the surgery was. The Veteran did not mention or discuss Project SHAD. The examiner found it was less likely than not that the Veteran’s claimed condition was related to his inservice event, illness and injury. The examiner discussed several chemicals to include beta-Propiolactone and cadmium and its associated health effects. The examiner noted that the Veteran stated that in 1978 his high blood pressure was high and was diagnosed with a benign adrenal tumor in 1984 or 1985 that was removed. The examiner found that review of medical literature did not show the Veteran’s exposure in Project SHAD caused adrenal tumors and therefore concluded that the Veteran’s claimed condition was less likely that not incurred in or caused by his exposure to bacillus globigii, cadmium, Pasteurella tularensis, Coxiella burnetii, beta-propriolactone, formalin and calcium hypocholorite during Project SHAD. The Board finds the April 2016 and October 2019 medical opinions highly probative of a negative nexus between the Veteran’s current condition and service because they not only contain clear conclusions with supporting data, but also reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Moreover, neither the Veteran nor his representative has produced a medical opinion to contradict the conclusions of the April 2016 and October 2019 VA examiners. The Board notes the Veteran has been afforded many opportunities to present competent medical evidence in support of his claim. He has not done so. See 38 U.S.C. § 5107 (a) (it is the claimant’s responsibility to support a claim for VA benefits). As such, there is no competent medical evidence to establish a nexus between the current residuals of adrenal gland tumor removal and any documented event or incident of service. The Board acknowledges the Veteran’s assertions that his residuals of adrenal gland tumor removal was related to his military service to include exposure to environmental agents from Project SHAD. Certainly, he is competent to describe experiencing symptoms in service and recurring thereafter. Indeed, treatment records corroborate at least to some extent the Veteran’s history of symptoms. Nevertheless, a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). As such, the Board attaches greater probative weight to the VA examination opinions than to the Veteran’s lay statements. Furthermore, the Board notes that review of the claims record show inconsistencies in the Veteran’s reported history and symptoms of his residuals of adrenal gland tumor removal. Such inconsistencies include the Veteran’s April 2004 report that protective items such as gas masks and full body suits were never discussed or available during his time with Project SHAD conflicting with his June 2008 testimony to the House committee where he testified that he and his crew were brought into a classroom and educated on the use of exposure suits and gas masks; and the Veteran’s April 2004 statement that the deposition of Dr. Spendlove stated that gas masks and exposure suits were required for test conductors like the Veteran conflicting with his June 2008 testimony to the House committee stating that Dr. Spendlove testified in his deposition that gas masks and exposures suits were not required for test conductors. Given the inconsistencies of the statements made by the Veteran compared to the findings in the claims record, the Board affords the Veteran’s statements less probative weight and outweighed by VA examinations of record performed by professionals. Based on the above, the Board finds that the competent evidence on record is against a finding of service connection for the Veteran’s residuals of adrenal gland tumor removal to include as due to exposure to environmental agents from Project SHAD. The Veteran’s STRs do not contain any complaints, treatments or diagnoses relating to an adrenal gland tumor or issue. The earliest medical treatment record relating to the Veteran’s adrenal gland is in 1978 with complaints of hypertension that were found to be caused by an adrenal adenoma in 1985 requiring surgery to remove, many years after the Veteran’s separation from service. Although the Veteran is found to be exposed to environmental agents from Project SHAD, the April 2016 and October 2019 VA examiners provided reasoned analysis of the case to support their opinion that the Veteran’s current residuals of adrenal gland removal was not related to the Veteran’s service to include exposure to environmental agents from Project SHAD. The Board thus finds that the weight of the competent and probative evidence is against a finding of service connection for the Veteran’s residuals of adrenal gland tumor removal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Left and right-hand disability and obstructive sleep apnea (OSA) The Veteran asserts his left and right-hand disability and obstructive sleep apnea (OSA) are related to his active duty service to include exposure to environmental agents from Project SHAD. Review of the medical treatment record shows complaints and treatments relating to left- and right-hand disabilities and OSA. In an October 2019 VA examination, the examiner diagnosed the Veteran with degenerative arthritis in both hands. A November 2009 and December 2009 sleep study diagnosed sleep apnea and an October 2019 VA examiner diagnosed the Veteran with OSA. As such, the Board finds the Veteran with a current disability. As noted above, the Board finds the Veteran participated in Project SHAD and was exposed to environmental agents. Review of the Veteran’s service treatment records (STRs) do not show any complaints, treatments or diagnoses relating to a left or right-hand disability or OSA. In the August 1965 separation examination, the Veteran did not report any musculoskeletal issues or sleeping issues and no such related diagnoses were made. Review of the medical treatment record shows in May 2003 the Veteran complained of bilateral pain in his hands in the past 2 to 3 months. The treating provider stated that an April 2003 x-ray showed degenerative changes. In June 2004 the Veteran reported pain in his right thumb for several years and noted suffering a fall 5 years ago onto his right hand. The treating provider found that an x-ray showed degenerative changes in the right thumb. The Veteran from February 2005 through October 2007 complained of pain in his thumbs and received treatment for arthritis in his thumbs. In February 2006 the Veteran reported having sleep apnea but the treating provider noted the Veteran had not been afforded a formal sleep study to confirm this diagnosis. In February 2008 the Veteran complained of osteoarthritis in his thumbs and trouble with his knees; the provider noted the Veteran “claims that this all started with a playground accident as a young child.” In September 2009 the treating provider noted that during recovery from knee surgery the staff reported concerns of sleep apnea based on observation of the Veteran. November and December 2009 sleep studies diagnosed OSA. In February 2010 the Veteran was noted to undergo a surgical procedure for both the left and right thumbs. In July 2010 the Veteran reported stiffness and pain in his left finger for the past 2 to 3 months and an x-ray found degenerative changes in multiple fingers. In June 2015 the Veteran filed a claim for arthritis and in July 2015 clarified his claimed issues to involve his hands, hips and knees. Following a September 2015 rating decision that denied his claimed issues, the Veteran’s notice of disagreement (NOD) stated the Veteran’s belief that VA did not obtain all records related to Project SHAD and that those records would show exposure to “carcinogens that led to the development of health conditions to include arthritis of the hands, hips and knees, OSA…” The Veteran was afforded an October 2019 VA examination. In the examination for the Veteran’s hands, the examiner diagnosed the Veteran with bilateral degenerative arthritis. The Veteran reported having surgery in 2012 mainly to treat pain in his thumbs. The Veteran stated his right thumb started bothering him in 2016. In the examination for sleep apnea, the Veteran reported that in 2009 he began having trouble sleeping and woke up with shortness of breath and tired. The Veteran stated that a sleep study diagnosed with him with OSA and he had been receiving treatment since. The examiner found it was less likely than not that the Veteran’s left- and right-hand disabilities were incurred in on the result of the Veteran’s active duty service to include environmental agent exposure from Project SHAD. The examiner discussed several chemicals and their health impacts from Project SHAD. In particular, the examiner noted there was evidence regarding chronic cadmium exposure. The examiner noted upon review of medical literature shows that cadmium toxicity is associated with bone disease characterized by multiple fractures, a mixed pattern of osteoporosis, osteomalacia, and kidney damage. Other clinical manifestations include multiple fractures, vertebral compression, and shortening of stature. The examiner noted the Veteran’s complaints centered around pain in the base of his thumb to include findings of degenerative arthritis in both thumbs. The examiner stated while the Veteran was involved in Project SHAD and evidence of cadmium exposure causing toxicity of the kidney and bones, review of medical literature showed no direct evidence of such exposure causing degenerative arthritis. The examiner concluded that the Veteran’s claimed condition was less likely than not incurred in or caused by his exposure to bacillus globigii, cadmium, Pasteurella tularensis, Coxiella burnetii, beta-propriolactone, formalin and calcium hypocholorite during Project SHAD. Regarding the Veteran’s OSA, the examiner found it was less likely than not that the Veteran’s OSA was incurred in or related to an inservice event, injury or illness. The examiner noted that the Veteran was involved in Project SHAD, however review of medical literature does not show any evidence that such exposure can cause OSA. The examiner concluded that the Veteran’s claimed condition was less likely than not incurred in or caused by his exposure to bacillus globigii, cadmium, Pasteurella tularensis, Coxiella burnetii, beta-propriolactone, formalin and calcium hypocholorite during Project SHAD. The Board finds the October 2019 medical opinion probative of a negative nexus between the Veteran’s current condition and service because they not only contain clear conclusions with supporting data, but also reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Moreover, neither the Veteran nor his representative has produced a medical opinion to contradict the conclusions of the October 2019 VA examiners. The Board notes the Veteran has been afforded many opportunities to present competent medical evidence in support of his claim. He has not done so. See 38 U.S.C. § 5107 (a) (it is the claimant’s responsibility to support a claim for VA benefits). As such, there is no competent medical evidence to establish a nexus between the current left and right-hand disability, OSA, and any documented event or incident of service. The Board acknowledges the Veteran’s assertions that his left and right-hand disability and OSA was related to his military service to include exposure to environmental agents from Project SHAD. Certainly, he is competent to describe experiencing symptoms in service and recurring thereafter. Indeed, treatment records corroborate at least to some extent the Veteran’s history of symptoms. Nevertheless, a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). As such, the Board attaches greater probative weight to the VA examination opinions than to the Veteran’s lay statements. Based on the above, the Board finds that the competent evidence on record is against a finding of service connection for the Veteran’s left- and right-hand disabilities and OSA to include as due to exposure to environmental agents from Project SHAD. The Veteran’s STRs do not contain any complaints, treatments or diagnoses relating to a left- or right-hand disability or OSA. The earliest medical treatment record relating to the Veteran’s claimed conditions was in 2003 for his hands and 2006 for OSA, many years after the Veteran’s separation from service. The Veteran has submitted testimony and articles regarding Project SHAD and health effects but has not submitted statements or opinions on what chemicals or exposure resulted in his claimed disabilities. Although the Veteran is found to be exposed to environmental agents from Project SHAD, the October 2019 VA examiners provided reasoned analysis of the case to support their opinion that the Veteran’s current residuals of adrenal gland removal was not related to the Veteran’s service to include exposure to environmental agents from Project SHAD. The Board thus finds that the weight of the competent and probative evidence is against a finding of service connection for the Veteran’s left- and right-hand disability and OSA. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND The Board finds remand is warranted for additional development. Right knee disability The Veteran was afforded an October 2019 VA examination where he reported left knee pain in 1961 to 1962 after marching on curved road with pain “worsening over the years and then happening in the right knee.” The examiner noted the Veteran no longer has degenerative arthritis as both knees have been replaced and found it less likely than not that the Veteran’s claimed knee disabilities were incurred in or due to exposure to environmental agents during Project SHAD. No opinion was made regarding the theory of secondary service connection. In an August 2019 VA examination the examiner noted the Veteran asserted that his right knee went bad because of the left knee injury but “could not support a service-related condition in respect to [the Veteran’s] knees.” The opinion did not discuss aggravation or identify a baseline. The Board notes that an October 2020 rating decision granted service connection for a left knee disability. As the October 2019 VA examination did not address secondary service connection, the August 2019 VA opinion did not address aggravation or a baseline, and the October 2020 rating decision granted service connection for a left knee disability, the Board finds the opinions inadequate and remand warranted to obtain an addendum opinion. Left hip disability The Veteran was afforded an October 2019 VA examination. The examiner diagnosed the Veteran with osteopenia in both hips but found it less likely than not that the Veteran’s left hip disability was related to his active duty service to include exposure to environmental agents from Project SHAD as examination findings to include x-ray testing did not find arthritis in the hip. Review of the medical treatment record shows in May 2020 diagnostic testing found mild degenerative changes in the left hip. In a June 2020 addendum opinion, the examiner noted that it was “very reasonable …over a 6 month period the Veteran could have developed mild degenerative changes” or otherwise missed on the October 2019 examination; as such, the examiner opined the Veteran had developed arthritis in the left hip in May 2020. However, the examiner did not provide an etiology opinion regarding the new diagnosis of degenerative arthritis in the left hip and whether it was related to the Veteran’s active duty service to include exposure to environmental agents from Project SHAD and the new diagnosis for October 2019 opinion is factually incorrect as the Veteran now has arthritis in the left hip. As such, the Board finds the opinions inadequate and remand warranted for addendum opinion. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. After all outstanding records have been associated with the claims file, obtain an addendum medical opinion. The record and a copy of this remand must be made available to the examiner. If the examiner determines that an examination of the Veteran is necessary to provide the requested opinion with rationale, then such examination should be scheduled. The VA examiner should opine as to the following: (a.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right knee disability is due to his service-connected left knee disability. (b.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right knee disability is aggravated by his service-connected left knee disability. “Aggravation” is defined as any worsening beyond the natural progression of the disability. The examiner should establish a baseline level of disability prior to aggravation. If a baseline cannot be established, the examiner should explain why. (c.) If the Veteran’s right knee disability is NOT aggravated by his service-connected left knee disability, is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s right knee disability had its onset during, or is otherwise related to, the Veteran’s active duty service to include exposure to environmental agent exposure from Project SHAD. (d.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left hip disability had its onset during, or is otherwise related to, the Veteran’s active duty service to include exposure to environmental agent exposure from Project SHAD. 3. In addressing any of the above opinions, the VA examiner should discuss the Veteran’s assertions and statements to include statements made in the April 2018 Notice of Disagreement and the January 2021 testimony. (a.) The examiner is to presume the Veteran has been exposed to environmental agents as part of Project SHAD. (b.) The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (c.) The examiner should provide a complete and clearly stated rationale for any opinion provided. (d.) If the VA examiner is unable to provide an opinion without resorting to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. 4. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.