Citation Nr: 18154436 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-20 195 DATE: November 29, 2018 REMANDED Entitlement to service connection for a heart disorder including atrial fibrillation is remanded. Entitlement to service connection for prostate cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1953 to January 1955. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. In January 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The Board previously remanded these matters for VA examinations and opinions in March 2018. They now return for appellate review.   1. Entitlement to service connection for a heart disorder including atrial fibrillation is remanded. The Veteran received a VA examination in August 2018. The examiner found the Veteran’s atrial fibrillation was less likely than not incurred in or caused by the Veteran’s active service or exposure to burn pits. The examiner noted he was unaware of any scientific literature that dealt specifically with burn pit exposure in France during the 1950s and noted the most relevant literature dealt with Gulf War events, including burn pit exposure. The examiner also noted the study found no increased incidence of any heart condition in deployed Gulf War veterans and that atrial fibrillation occurred slightly less often in deployed Veterans compared to Veterans of the same era who had not been deployed. The examiner went on to note that the report concluded there was inadequate or insufficient evidence to determine whether an association exists between deployment to the Gulf War and cardiovascular conditions or conditions of the blood organs. The examiner concluded that there are no comparable comprehensive and well-controlled studies that contradict the findings. The Board finds the opinion insufficient. Absent from the opinion, as noted in the March 2018 remand instructions, is any consideration or discussion of how the Veteran’s in-service duties in France working at a garbage dump and burn pits, where he was required to dispose of and burn waste, which included chemical waste, could have affected his health. As such, the Board must remand for a new medical opinion. 2. Entitlement to service connection for prostate cancer is remanded. VA obtained a medical opinion in August 2018. The examiner found the Veteran’s prostate cancer was less likely than not incurred in or caused by the Veteran’s active service or exposure to chemical and hazardous waste and/or asbestos. The Board finds, for the reasons discussed above, that this opinion is also inadequate. Accordingly, the Board must remand for a new medical opinion. The matters are REMANDED for the following action: 1. Obtain the Veteran’s outstanding VA treatment records. 2. Thereafter, arrange for an appropriate clinician(s) to review of the Veteran’s file and provide opinions concerning his prostate cancer and heart disorder(s). The Veteran’s entire claims file, including a copy of this remand, must be made available to and reviewed by the clinician(s). The report(s) must reflect that such a review was undertaken. The clinician(s) must provide opinions on the following: (a.) Whether it is at least as likely as not (i.e., 50% or greater probability) the Veteran’s prostate cancer is related to his in-service chemical and hazardous waste exposure and/or asbestos exposure? (b.) Whether it is at least as likely as not (i.e., 50% or greater probability) any current heart disorder, including atrial fibrillation, is related to the Veteran’s in-service chemical and hazardous waste exposure and/or asbestos exposure? In providing these opinions, the clinician(s) must consider the following: i. The Veteran’s in-service duties in France working at a garbage dump and burn pits, where he was required to dispose of and burn waste, to include chemical waste. ii. The Veteran’s statement that during service he worked around burn pits for seven months and he never wore any protection or mask of any type, and that he was a nonsmoker and developed a cough from his working conditions. iii. The literature submitted by the Veteran, as follows: Environmental and Occupational Causes of Cancer New Evidence, 2005-2007; Diesel –Toxicological Overview; and Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan. iv. The report found at http://www.nationalacademies.org/hmd/Reports/2016/Gulf-War-and-Health-Volume-10.aspx If the clinician(s) finds that the literature submitted by the Veteran (Environmental and Occupational Causes of Cancer New Evidence, 2005-2007; Diesel –Toxicological Overview; and Long-Term Health Consequences of Exposure to Burn Pits in Iraq and Afghanistan) is not applicable or not persuasive, then he/she should provide an explanation as to why. The clinician(s) should determine, in this specific case, whether the Veteran's prostate cancer and any heart disorder was caused by his in-service chemical and hazardous waste exposure and/or asbestos exposure. The clinician(s) must take into account the Veteran's personal circumstances and how any recognized risk factor(s) apply in his particular case. Other factors may affect the analysis, such as whether the clinician finds studies persuasive, whether there are other risk factors that might be the cause of the Veteran's prostate cancer and/or heart disorder, whether either condition manifested itself in an unusual manner, etc. The clinician(s) must provide a comprehensive report(s) including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. P. M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck