Citation Nr: 21041774 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 17-64 538 DATE: July 10, 2021 REMANDED Entitlement to service connection for testicular cancer is remanded. Entitlement to service connection for an abdominal mass associated with the testicular cancer also is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1990 to August 2014. This appeal to the Board of Veterans' Appeals (Board) is from a March 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a February 2020 decision, the Board denied these claims, and in response the Veteran appealed to the higher U. S. Court of Appeals for Veterans Claims (Court/CAVC). In a March 2021 Order, the CAVC vacated the Board's decision denying these claims and remanded them back to the Board for further development and readjudication pursuant to agreement in the March 2021 Joint Motion for Remand (JMR). To comply with the Court's Order granting the JMR, the Board, in turn, is remanding these claims back to the RO. 1. Entitlement to service connection for testicular cancer is remanded. 2. Entitlement to service connection for an abdominal mass associated with the testicular cancer also is remanded. The March 2021 JMR cites the Board's failure to provide adequate reasons and bases for limiting the Veteran's claim to dust exposure. In a September 2005 Post Deployment Health Assessment, he also contended that he was exposed to DEET Insect repellent applied to skin, pesticide-treated uniforms, vehicle or truck exhaust fumes, jet propellent 8 or other fuels, radar and microwaves, and sand/dust. However, these additional exposures were not addressed in the Board's prior denial of these claims. Additionally, the Board did not address possible asbestos exposure. The Veteran's service treatment records (STRs) from September 2003 indicate he had exposure to asbestos, albeit minimal. The Veteran has not been afforded a VA examination for a medical opinion concerning the etiology of these claimed conditions, especially in terms of whether they are related or attributable to the several exposures alleged. Thus, to address the concerns outlined in the JMR, the Board is obtaining this needed medical comment. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. §5103A(d); 38 C.F.R. §3.159(c)(4). Accordingly, these claims are REMANDED for the following action: Have the Veteran examined or, at the very least, send his claims file, including a copy of the JMR and this remand, to an appropriate examiner to determine the nature and etiology of the testicular cancer and abdominal mass being claimed especially in terms of whether related or attributable to his military service. To this end, the examiner is specifically asked to address the following: Whether it is at least as likely as not (50 percent or greater probability) the Veteran's testicular cancer and associated abdominal mass are: a) due to exposure to DEET insect repellent applied to the skin, pesticide-treated uniforms, vehicle or truck exhaust fumes, jet propellent 8 or other fuels, radar and microwaves, sand/dust, and/or asbestos during his military service from August 1990 to August 2014; or b) that is testicular cancer initially manifested within a year of his discharge from service so by August 2015, to in turn warrant presuming that it was incurred during his service; or c) that his testicular cancer and associated abdominal mass are otherwise related or attributable to his service. In making these determinations, the examiner should consider and discuss the Veteran's lay statement that "when I was [d]iagnosed the mass was very large, and the doctor said it had been growing for quite a while". Also, the examiner should consider and discuss the July 2018 private examiner's opinion that "there may be occupational causes of testicular cancer in adults. There are ongoing studies regarding endocrine disrupting chemicals (EDCs) and a higher prevalence of testicular cancer. These studies have thus far shown that exposure to EDCs through various occupations may increase the risk of malignant transformation. Additionally, exposure to electromagnetic radiation, chrono disruption (shiftwork), and solvent exposure can also disrupt hormonal release, which again increases the risk of malignant transformation." The examiner is reminded that the term "at least as likely as not" does not mean merely "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. The examiner should note that a lack of documented treatment or diagnosis in service, while a consideration, cannot be the sole or exclusive reason for disassociating these claimed conditions from the Veteran's service, especially if there is an accepted latency period between an inciting or precipitating event and eventual diagnosis of the disease. Thus, to reiterate, the Veteran's lay contentions must be considered in determining whether there is the required correlation ("nexus") between these claimed conditions and his service either directly, presumptively, or secondarily. Rationale for the opinion is essential, regardless of whether favorable or unfavorable to the claims, preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. If an opinion cannot be provided without resorting to mere speculation, the examiner must expressly indicate this but, as importantly, provide explanation for why a response is not possible or feasible. In other words, merely saying that he/she cannot response will not suffice. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Hamm, 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.