Citation Nr: 18143988
Decision Date: 10/23/18	Archive Date: 10/22/18

DOCKET NO. 14-35 356
DATE:	October 23, 2018
REMANDED
Entitlement to service connection for breast cancer, to include as due to herbicide exposure, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from November 1962 to July 1969.
The Board of Veterans’ Appeals (Board) remanded the matter for further development in December 2017.
Entitlement to service connection for breast cancer, to include as due to herbicide exposure is remanded.
The Board finds that VA has not met its duty to assist the Veteran in obtaining an adequate examination for the purposes of rendering a decision in the instant appeal.  The Veteran contends her breast cancer is due to herbicide exposure.  The Veteran was afforded a VA examination in March 2018.  The examiner provided a negative nexus opinion, basing the opinion solely on silent service treatment records.  See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007).  The examiner merely listed risk factors of breast cancer without explaining how the risk factors applied to Veteran’s medical history.  The examiner also used the list of disabilities afforded presumptive service connection due to herbicide exposure as part of the rationale.  However, the Board is well aware of disabilities for which the presumption applies, and therefore under Combee, requested a professional medical opinion to determine if the Veteran’s specific disability was due to herbicide exposure.  See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).  An addendum opinion is required as to the nature and etiology of the Veteran’s breast cancer.
The matter is REMANDED for the following action:
1. Make efforts to obtain all outstanding medical records regarding the Veteran’s breast cancer in accordance with the duties set forth in 38 C.F.R. § 3.159(c).
2. After all outstanding records have been associated with the claims file, forward the Veteran’s claim file to the March 2018 VA examiner, or, if unavailable, forward the Veteran’s claim file to another qualified medical professional to obtain an addendum opinion as to the nature and etiology of the Veteran’s breast cancer. (A new VA examination, may be conducted if deemed necessary.) The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. 
The examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s breast cancer was incurred during or was caused by active military service, to include herbicide exposure. 
A complete rationale for all opinions expressed should be provided.  The examiner must explain the relevance or significance, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically.  Recitation of VA regulations is not an adequate rationale for Board purposes. 
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. N. Quarles, Associate Counsel