Citation Nr: 22016485 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 13-29 835 DATE: March 22, 2022 REMANDED Entitlement to service connection for rheumatoid arthritis, to include as a result of exposure to ionizing radiation is remanded. Entitlement to service connection for a non-arthritis disorder characterized by muscle and joint pain, to include as a result of exposure to ionizing radiation, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include memory loss, and to include as a result of exposure to ionizing radiation, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1977 to July 1980. In August 2017, a travel board hearing was held before the undersigned. A transcript of that hearing is of record. In June 2018, the case came before the Board. The Board remanded the Veteran's claims in order for the RO to obtain a radiation dose estimate for when the Veteran was stationed on Eniwetok Atoll. The Board also remanded the Veteran's claims in order for him to attend VA examinations. In August 2021, the case returned to the Board. The Board granted entitlement to service connection for basal cell carcinoma and actinic keratoses. In addition, the Board found the Veteran's VA examinations for his claims remaining on appeal were inadequate and remanded the Veteran's case in order for additional VA medical opinions to be obtained. 1. Entitlement to service connection for rheumatoid arthritis, to include as a result of exposure to ionizing radiation is remanded. 2. Entitlement to service connection for a non-arthritis disorder characterized by muscle and joint pain, to include as a result of exposure to ionizing radiation, is remanded. In October 2021, an addendum opinion was obtained. The Board finds this examination report inadequate for two reasons. First of all, in August 2021, the Board requested the VA examiner to specifically address the medical articles that the Veteran submitted. However, the Board notes that the October 2021 VA examiner's opinion spoke in general terms and did not specifically address the information that was submitted by the Veteran. In addition, the Board notes that the October 2021 VA examiner stated that the dose estimate was not included in the Veteran's claims file. The Board notes that the radiation does estimate (0.22 REM) is included in the Veteran's claims and was available for the examiner to review. Thus, for the above stated reasons, a remand is required to obtain a more complete medical opinion as to the nature and etiology of the Veteran's disabilities. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). 3. Entitlement to service connection for an acquired psychiatric disorder, to include memory loss, and to include as a result of exposure to ionizing radiation is remanded. In October 2021, the Veteran attended a VA examination for this issue. Following the examination, the examiner found that there is no overwhelming evidence that the veteran's reactions to his service-connected conditions amount to a permanent aggravation. The Board finds this opinion to be inadequate because the examiner used an inaccurate legal standard to address the issue of aggravation. In that regard, the medical opinion addressed whether there was a permanent aggravation of the Veteran's claimed psychiatric disorder rather than merely an aggravation beyond the disorder's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019) (any incremental increase in disability and additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence). Accordingly, the Board finds that a remand is necessary to obtain an addendum opinion which is based on an accurate legal standard. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from January 11, 2022, to the present. 2. Obtain an addendum opinion for the Veteran's claims for service connection for his arthritis and non-arthritis disorders. If the examiner determines that an additional examination is necessary, then the RO should schedule an additional VA examination. After a review of the Veteran's claims file, the examiner should address the articles the Veteran submitted in March 2021, October 2018, and August 2018, and opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's arthritis disorder and/or non-arthritis disorder characterized by muscle and joint pain are related to service, to include his in-service exposure to radiation. The examiner's addendum opinion must specifically address the medical articles that discussed evidence that radiation can affect a person's bones and joints. The examiner must also specifically address the medical article that discussed evidence that radiation can affect inflammation. The examiner must also address the radiation dose estimate that was obtained in January 2021 (0.22 REM). 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any diagnosed psychiatric disabilities. After a review of the claims file and an examination of the Veteran, the examiner should provide answers to the following questions: What are the diagnoses for all of the Veteran's current acquired psychiatric disorders? (A). As to each current psychiatric disorder, is it at least as likely as not that (50 percent or greater probability) that the psychiatric disability manifested in or is otherwise related to the Veteran's military service, to include the Veteran's exposure to radiation? (B). Is it as least as likely as not (50 percent or greater probability) that any of the Veteran's diagnosed acquired psychiatric disabilities are caused or aggravated by any of his service-connected disabilities? In providing the requested opinions, the examiner should consider the Veteran's competent lay claims regarding the observable symptoms he has experienced. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Rescan, 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.