Citation Nr: 18146043 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-35 501 DATE: October 30, 2018 REMANDED Entitlement to service connection for breast cancer (claimed as breast cancer surgery). REASONS FOR REMAND The appellant served in the United States Army Reserve. She had initial active duty for training (ACDUTRA) from July 1976 to October 1976, as well as ACDUTRA from June 10, 2000, to June 23, 2000. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA). The appellant has contended that her breast cancer first manifested during her period of ACDUTRA in June 2000 based on a surgical procedure performed at that time that provided the basis for the diagnosis. She has indicated that, since that procedure, she has been unable to sleep comfortably. See March 2013 written statement; September 2014 notice of disagreement; July 2016 substantive appeal. The record shows that the appellant had some irregularities in the right breast on a February 2000 annual VA evaluation. She had a mammogram in early April 2000 with an impression of a benign finding (category 2), and a second mammogram that same month revealing new findings in the right breast, with a notation of a suspicious finding (category 4). She was scheduled for a needle location biopsy on June 14, 2000 (during the ACDUTRA period), after a stereotactic biopsy was attempted in May 2000. See VA treatment records from February 2000 to June 7, 2000. The needle location biopsy was performed as scheduled, and the pathology report diagnosis was right breast atypical ductal hyperplasia with focal questionable ductal carcinoma in situ, fibrocystic disease, atypical lobular hyperplasia, calcification. See VA treatment records from June 14 and June 20, 2000. Thereafter, the appellant had an additional procedure at Duke University Medical Hospital in August 2000, and she also underwent radiotherapy at VA from October 2000 to November 2000. Based on the foregoing, a VA examination and medical opinion are needed. The appellant will also have the opportunity while the case is on remand to submit or request that VA attempt to obtain more recent treatment records. The case is REMANDED for the following actions: 1. The Agency of Original Jurisdiction (AOJ) should request that the appellant provide the names and addresses of any and all health care providers who have provided treatment for her claimed breast cancer or residuals thereof. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. It is noted that the record does contain treatment records from Duke University Medical Hospital dated in 2000. The AOJ should also secure any outstanding VA treatment records. 2. After completing the foregoing development, the appellant should be afforded a VA examination to determine the nature and etiology of any current breast cancer or residuals thereof that may be present. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The appellant has contended that her breast cancer first manifested during her June 2000 period of ACDUTRA based on a surgical procedure performed at that time that provided the basis for the diagnosis. She has indicated that she has been unable to sleep comfortably since that procedure. See March 2013 written statement; September 2014 notice of disagreement; July 2016 substantive appeal. It should be noted that the appellant is competent to attest to factual matters of which she has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner should state whether the appellant has had breast cancer or residuals thereof during the appeal period (beginning around October 2012). (1) If the appellant currently has breast cancer or residuals thereof, the examiner should state whether the breast cancer preexisted the appellant’s period of ACDUTRA from June 10, 2000, to June 23, 2000. If so, the examiner should state whether there was an increase in the severity during the ACDUTRA period. If the evidence reflects such an increase, the examiner should indicate whether any increase was due to the natural progression of the disorder or whether it represented a chronic worsening of the underlying pathology. In providing this opinion, the examiner is asked to discuss the findings in the pre-June 14, 2000, VA treatment records detailed below in determining whether the breast cancer had manifested prior to the procedure on that date. The record shows that the appellant had some irregularities in the right breast on a February 2000 annual VA evaluation. She had a mammogram in early April 2000 with an impression of a benign finding (category 2) and a second mammogram that same month revealing new findings in the right breast with a notation of a suspicious finding (category 4). She was scheduled for a needle location biopsy on June 14, 2000 (during the ACDUTRA period), after a stereotactic biopsy was attempted in May 2000. See VA treatment records from February 2000 to June 7, 2000. The needle location biopsy was performed as scheduled, and the pathology report diagnosis was right breast atypical ductal hyperplasia with focal questionable ductal carcinoma in situ, fibrocystic disease, atypical lobular hyperplasia, calcification. See VA treatment records from June 14 and June 20, 2000. Thereafter, the appellant had an additional procedure at Duke University Medical Hospital in August 2000, and she also underwent radiotherapy at VA from October 2000 to November 2000. See VA and private treatment records in December 2012 VBMS entry and April 2015 VBMS entry. (2) If the appellant currently has breast cancer or residuals thereof that did not preexist the June 2000 ACDUTRA period, the examiner should state whether it is at least as likely as not (a 50 percent or greater probability) that the disorder manifested in or is otherwise related to that period of service. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the claims file, or in the alternative, the claims file, must be made available to the examiner for review. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Postek, Counsel