Citation Nr: 21030774 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-11 757 DATE: May 19, 2021 REMANDED Service connection for osteoporosis is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1982 to September 1996. These claims are on appeal from an August 2012 rating decision. The Veteran testified at a January 2021 hearing before the undersigned Veterans Law Judge. A copy of that transcript is associated with the evidence of record. At this hearing, the Veteran's representative requested an additional 90 days from the date of the hearing to submit evidence. On March 31, 2021, VA received a letter from the Veteran's representative requesting an additional 30 days to submit evidence. As of the date of this remand, no additional evidence has been received. While this case is in remand status, the Veteran and his representative are informed they have the right to submit additional evidence and argument on this matter. See Kutscherousky v. West, 12 Vet. App. 369 (1999). Service connection for osteoporosis is remanded The Veteran is claiming service connection for osteoporosis, to include as due to exposure to ionizing radiation and/or receiving steroid injections. He also contends his dental disease during service represented early signs of osteoporosis. After the Veteran injured his back in a work accident in 2011, magnetic resonance imaging (MRI) and a bone density scan revealed the first diagnosis of osteoporosis. At his hearing before the Board, the Veteran testified that during his active service aboard a Navy ship, he was exposed to ionizing radiation. See January 2021 Hearing Testimony, p. 11. VA has verified his exposure to ionizing radiation. See July 2018 Radiation Exposure Compensation Act Memorandum. The Veteran also testified at his hearing that he received steroid injection shots during service for his service-connected headaches. See January 2021 Hearing Testimony, p. 11. While only four steroid shots were documented in his service treatment records, the Veteran stated he received approximately 25 to 29 shots. Id. at 20-22. The Board finds the Veteran credible and also finds that it is plausible the medical corpsman providing the shots did not always record such. The Veteran further testified that he believed his in-service dental disease demonstrated early signs of osteoporosis. See January 2021 Hearing Testimony, p. 11. He indicated he felt he was losing bone mass in his teeth which began in at least 1995 (following treatment for a root canal and infection) and possibly as early as 1992 (when a tooth broke off). In support of his claim, he submitted medical literature discussing: (1) radiation-induced osteoporosis; (2) corticosteroid-induced osteoporosis; (3) periodontal disease/oral disease and osteoporosis; and (4) ionizing radiation and bone loss. See Documents Received in December 2015, November 2014, and June 2013. The record contains a May 2019 Veterans Health Administration (VHA) opinion which concludes it is less likely than not that the Veteran's osteoporosis began during or is etiologically related to his active duty service. However, based on the evidence of record, the Board finds a new opinion is required. First, the May 2019 VHA opinion only considered that the Veteran received four steroid injections shots during service; as the Board has found that the Veteran actually received 25 to 29 shots during service, this opinion is based on an inaccurate factual premise, and is not adequate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Additionally, part of the basis for the opinion was that osteoporosis was not related to ionizing radiation is that it was not diagnosed until approximately 26 years following the Veteran's separation from active duty service, which is also inaccurate. See id. Significantly, osteoporosis was diagnosed in 2011, and the Veteran separated from service in 1996, representing a 15-year span. Thus, the Board finds a remand is required to obtain an adequate opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that when VA provides obtains a medical opinion in a service connection claim, the opinion must be adequate). In providing a new opinion, the medical professional is required to consider and discuss, explaining the significance (or lack thereof) of the following: (a) the Veteran's verified exposure to ionizing radiation; (b) the Veteran's credible testimony that he received approximately 25 to 29 steroid injections during service; (c) his contentions that his 1992 and 1995 dental disease represented early signs and symptoms of osteoporosis; and (d) medical literature submitted by the Veteran and received by VA in December 2015, November 2014, and June 2013. Additionally, at his hearing before the Board, the Veteran testified that he receives Social Security Administration (SSA) disability benefits. See January 2021 Hearing Testimony, p. 15. No requests to obtain these identified SSA disability records have been made by the Agency of Original Jurisdiction (AOJ). Given that these records may be relevant to the Veteran's claim, a remand is required to attempt to obtain them. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992). The Veteran also indicated at his hearing that he mostly saw private medical providers, he did seek treatment at the VA Medical Center in Danville, Illinois for his headaches. See January 2021 Hearing Testimony, p. 16. Accordingly, the AOJ must obtain all outstanding VA treatment records and associate them with the evidence of record. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records, to include, but not necessarily limited to, those from the Danville, Illinois VA Medical Center and associate them with the electronic claims file. 2. Attempt to obtain the Veteran's outstanding Social Security Administration disability benefit records in accordance with VA regulation. If it is determined these records do not exist or that further attempts to obtain them would be futile, the AOJ must associate documentation of such with the evidence of record. 3. Afford the Veteran an examination to determine the etiology of his osteoporosis. The examiner must obtain from the Veteran and record in the examination report a complete history regarding the onset and continuity of symptoms. Determine whether it is at least as likely as not (50 percent probability or higher) that the Veteran's osteoporosis began during or is etiologically related to his active duty service, to include as due to verified exposure to ionizing radiation and/or receiving steroid injection shots. Why or why not? If providing a negative opinion, the examiner must consider and discuss, considering the significance (or lack thereof) of the following: The Veteran's verified exposure to ionizing radiation. See July 2018 Radiation Exposure Compensation Act Memorandum. Medical literature discussing (1) corticosteroid-induced osteoporosis; (2) radiation-induced osteoporosis; (3) periodontal disease/oral disease and osteoporosis; (4) ionizing radiation and bone loss. See Documents Submitted by Veteran dated December 2015, November 2014, and June 2013. The Veteran's testimony at his hearing that he received approximately 25 to 29 steroid injections during service. The examiner must accept this statement as credible even though service treatment records document less injections. The Veteran's contentions that he felt his in-service dental disease represented early signs of osteoporosis, beginning in at least 1995 (following a root canal and infection) and possibly as early as 1992 (when a tooth broke off). A complete rationale for this opinion must be provided. If the medical professional is unable to provide this opinion without resorting to speculation, he or she must explain why this is so. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O'Connell, Jessica L. 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.