Citation Nr: 21027072 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 14-19 820A DATE: May 4, 2021 REMANDED Entitlement to service connection for residuals of testicular cancer, to include as due to ionizing radiation exposure, is remanded. Entitlement to service connection for tumors, to include as due to ionizing radiation exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from March 1981 to August 1983. This matter was previously before the Board of Veterans' Appeals (Board) in February 2016 and March 2018. In March 2018, the Board remanded the issues of entitlement to service connection for residuals of testicular cancer and for tumors for further development. Specifically, the Board instructed the regional office (RO) to verify Veteran's reported exposure to ionizing radiation during his service. Upon review of the record, the Board finds that the claims must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claims. 1. Entitlement to service connection for residuals of testicular cancer, to include as due to ionizing radiation exposure, is remanded. 2. Entitlement to service connection for tumors, to include as due to ionizing radiation exposure, is remanded. First, the Board finds that the RO failed to substantially comply with the Board's March 2018 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In particular, although the RO requested more information about the Veteran's radiation exposure, the letter was marked as "return to sender," indicating that the Veteran likely did not receive it. See January 2020 Subsequent Development Letter; February 2020 Returned Mail. There is no evidence that the RO attempted to contact the Veteran to obtain this information or to resend the radiation-exposure form. Moreover, the RO did not follow any procedures outlined in 38 C.F.R. § 3.311, to include obtaining a dosage estimate from the Under Secretary for health and referral to the Under Secretary for Benefits, as instructed by the Board in March 2018. Upon remand, the RO must take all appropriate action to verify the Veteran's reported exposure to ionizing radiation. Second, the Board finds that new examinations and etiological opinions are warranted for the Veteran's claims. Though the Veteran underwent VA examinations in June 2020 pertaining to his claims, the RO failed to attempt to develop the Veteran's radiation exposure, and with possible new evidence that was unavailable to the June 2020 examiner, a remand for a new examinations is warranted. The matters are REMANDED for the following action: 1. Attempt to contact the Veteran request further information, if needed, regarding his radiation exposure. Document all attempts to contact the Veteran. 2. Forward the Veteran's statements and testimony regarding radiation exposure, and any other information obtained while the case is Remand status, to VA's Under Secretary for Health, or its designee, as is appropriate, for preparation of a dose estimate, to the extent feasible, based on the Veteran's statements that he was exposed to ionizing radiation while assisting with X-ray machines during his service. 3. Then, refer the claim to the Under Secretary for Benefits for further consideration in accordance with paragraph 38 C.F.R. § 3.311(c). 4. Thereafter, schedule the Veteran for a VA examinations with an appropriate examiner to determine the nature and etiology of his testicular cancer residuals and tumors. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and examination of the Veteran, the examiner should respond to the following: (a.) Whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's testicular cancer residuals had its onset in or is related to service, to include radiation exposure from X-ray machines and environmental hazards from working in missile unit? (b.) Whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's tumors had their onset in or are related to service, to include radiation exposure from X-ray machines and environmental hazards from working in missile unit? The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, Associate 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.