Citation Nr: 21040320 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 18-09 856 DATE: July 3, 2021 REMANDED Entitlement to service connection for a left ear disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for diabetes mellitus (DM), to include as due to ionizing radiation, is remanded. Entitlement to service connection for a kidney disability, to include as due to ionizing radiation, is remanded. Entitlement to a compensable rating for internal hemorrhoids is remanded. REASONS FOR REMAND The Veteran had active naval service from May 1976 to July 1980 and active air service from February 1981 to October 1983. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Service Connection 1. Left Ear Disability The Veteran has contended that his left ear disability is related to his active service. Specifically, he reported that he was assigned a bed next to a high-speed turbine fan which produced hazardous noise. He recalled that he was attacked by a fellow recruit who "boxed his ears." Additionally, he testified that his hearing was affected by improperly pressurized doors between the ribs of the ship. Service treatment records (STRs) documented that the Veteran complained of earaches in his left ear. In this regard, the Veteran was diagnosed with otitis media in September 1976 and a blockage or foreign body debris was discovered in his left ear in May 1978. A review of post-service VA medical records revealed that the Veteran had otitis media in March 2007. In August 2017, the Veteran was afforded a VA examination. He was not diagnosed with a left ear disability. The examiner opined that the Veteran's left ear disability was less likely than not incurred in or caused by the Veteran's active service. She explained that the diagnosis of left ear infection (acute otitis media) as evidenced in 2013 was an acute process and would not be related to the Veteran's complaint of ear pain with popping in 1978. In light of the August 2013 VA examiner's observation that the Veteran had a left ear infection (acute otitis media) in 2013, the Board finds that she failed to address similar diagnoses for otitis media in September 1976 and March 2007. Therefore, an addendum medical opinion is warranted to determine the nature and etiology of any currently present left ear disability. 2. Right Knee Disability The Veteran has asserted that his right knee disability is related to his active service. Specifically, he reported that his service duties required routine crouching, kneeling, and stairs and he has had knee pain since service. Alternatively, he asserted that his right knee disability is secondary to his nonservice-connected left knee disability. STRs revealed that the Veteran had mild chondromalacia of the right knee in August 1975. Post-service VA medical records showed that he complained of bilateral knee pain. In light of the August 1975 STR notation and the Veteran's post-service complaints of right knee pain; the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present right knee disability. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 3. DM and Kidney Disability The Veteran has claimed that his DM and kidney disability are related to his active service, to include as due to exposure to ionizing radiation and other contaminants. Specifically, he reported that there was a release of contaminated water after a nuclear reactor overheated aboard the U.S.S. Long Beach (CGN-9). He recalled that the incident occurred two weeks after the three-mile island accident in March 1979. He was reportedly sprayed with contaminated water while transferring it to the U.S.S. Gompers and was subjected to inhaling radioactive air. The Board notes that the RO has not yet verified the Veteran's exposure to ionizing radiation while serving aboard the U.S.S. Long Beach. As such, the appropriate development should be completed upon remand. Furthermore, no VA medical opinion has been obtained to address the Veteran's exposure to ionizing radiation. Accordingly, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present DM and kidney disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Increased Rating The Veteran was last afforded a VA examination for his service-connected internal hemorrhoids in August 2017. In July 2020, he testified that the severity of his symptoms had increased since that time. Therefore, the Board finds that the Veteran should be provided a new VA examination to determine the current level of severity of all impairment resulting from his internal hemorrhoids. Duty to Assist The Veteran has reported that he receives additional private medical treatment. Any outstanding private medical records, to specifically include the Veteran's medical records from Dr. M, nurse practitioner M. L., and as listed on an October 2019 correspondence, should be identified and obtained before a decision is made with regard to the appeal. The matters are REMANDED for the following action: 1. Conduct the appropriate development to verify the Veteran's reported exposure to nuclear radiation during his active service, to include obtaining any necessary deck logs and unit history from 1979. If radiation exposure is identified, the necessary development should be conducted pursuant to 38 C.F.R. § 3.311. 2. Identify and obtain any pertinent, outstanding VA and private treatment records, to include private medical records from Dr. M., nurse practitioner M. L., and as listed on an October 2019 correspondence, and associate them with the claims file. 3. Identify and obtain any pertinent, outstanding Social Security Administration records and associate them with the claims file. 4. Then, return the claims file to the same VA examiner who conducted the August 2017 VA examination or a VA examiner with sufficient expertise for an addendum opinion to determine the nature and etiology of any currently present left ear disability. The claims file must be made available to and reviewed by the examiner. If a new VA examination is required, then one should be scheduled. Based on the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that a left ear disability had its onset during the Veteran's active service, or is otherwise etiologically related to such service. In forming the opinion, the examiner must address the August 2017 VA examination report finding of left ear infection (acute otitis media) in 2013, a September 1976 STR diagnosis for otitis media, and a March 2007 post-service diagnosis for otitis media. The rationale for all opinions expressed must be provided. 5. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present right knee disability. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should determine whether it is at least as likely as not (50 percent or better probability) that a right knee disability had its onset during the Veteran's active service, or is otherwise etiologically related to such service. The rationale for all opinions expressed must be provided. 6. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present diabetes mellitus and kidney disability. The claims file must be made available to and reviewed by the examiner. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present diabetes mellitus and/or kidney disability are etiologically related to the Veteran's active service, to include as due to exposure to nuclear radiation. The rationale for all opinions expressed must be provided. 7. Then, schedule the Veteran for a VA examination to determine the current level of severity of all impairment resulting from his service-connected internal hemorrhoids. The claims file must be made available to and reviewed by the examiner. Any indicated studies must be performed. The examiner should provide all information required for rating purposes. 8. Confirm that the VA medical opinions provided comport with this remand and undertake any other development determined to be warranted. (Continued on the next page) 9. Then, readjudicate the appeal. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ware, 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.