Citation Nr: 20007245 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 18-13 976 DATE: January 28, 2020 REMANDED Entitlement to service connection for fibroadenomas of the breasts, to include as due to exposure to chemical and/or herbicide agents, is remanded. Entitlement to service connection for the residuals of breast cancer, to include as due to exposure to chemical and/or herbicide agents, is remanded. Entitlement to service connection for chronic disability of the ovaries and/or uterus, to include as due to exposure to chemical and/or herbicide agents, is remanded. Entitlement to service connection for residuals of a bowel perforation, to include as secondary to surgery for fibroid uterus, is remanded. REASONS FOR REMAND These matters come before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. They were previously before the Board in April 2019, when they were remanded for further development. The Board finds additional development is necessary based upon evidence received after its April 2019 remand. First, in a December 2019 written statement, the Veteran reported she receives disability benefits from the Social Security Administration (SSA). When there has been a determination regarding SSA benefits, the records concerning that decision must be obtained, if relevant. Tetro v. Gober, 14 Vet. App. 100, 108-09 (2000); Murincsak v. Derwinski, 2 Vet. App. 363, 372 (1992). In cases where VA is uncertain as to the relevance of the records, such as this case, VA should be guided by the principles underlying the pro-claimant VA system. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010). As a result, the Veteran’s SSA records should be requested to ensure compliance with VA’s duty to assist. Second, in September 2019, the Agency of Original Jurisdiction (AOJ) received a response from the Joint Service Records Research Center (JSRRC) regarding the Veteran’s assertion that she was exposed to Agent Orange during her service at Fort McClellan, Alabama. Although JSRRC provided a negative response regarding Agent Orange exposure, it suggested the AOJ should submit a request to the Armed Forces Pest Management Board regarding the use of other herbicides during the Veteran’s service at Fort McClellan. There is no indication the AOJ requested information from the Armed Forces Pest Management Board as suggested by the JSRRC. Thus, the Board deems additional development necessary in this regard. Finally, the Board finds an addendum to the October 2019 opinion regarding the Veteran’s service connection claims for fibroadenomas of the breasts and the residuals of breast cancer is necessary. The October 2019 VA examination report indicates the right breast lump noted in service treatment records supports an in-service diagnosis of fibroadenoma of the breast. The Board notes that it is not necessary for the Veteran’s military duties to have caused a condition to establish service connection, so long as that condition first manifest during active service. There are no defects noted on the Veteran’s August 1976 entrance examination report, so she is presumed to have been in sound condition at her entry to service in January 1977. The October 2019 VA examiner provided a conclusory statement that the Veteran has no permanent residual or chronic disability as a result of the in-service fibroadenoma of the breast without a supporting rationale and rather discussed the prevalence of fibroadenoma in the general female population. The October 2019 VA examiner further concluded the Veteran’s breast cancer is less likely than not the result of the fibroadenoma of the breast, indicating fibroadenomas “do not increase one’s risk for breast cancer.” Yet, the October 2019 VA examiner’s opinion is not entirely consistent with the medical literature she cited to support her opinion. The cited literature from breastcancer.org indicates “complex fibroadenoma” appears to raise a slight risk for breast cancer. The October 2019 VA examiner did not discuss the possibility that the Veteran may have had a risk for breast cancer as a result of “complex fibroadenoma.” The Board is not permitted to address this type of medical question without expert evidence to guides its analysis. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). As a result, it deems an addendum to the October 2019 opinion necessary to ensure its decision of the Veteran’s claims is fully informed. The matters are REMANDED for the following action: 1. Request the Veteran’s SSA records. 2. Submit a request to Armed Forces Pest Management Board regarding any potential herbicide/chemical exposure the Veteran may have experienced during her service at Fort McClellan. 3. Request an addendum to the October 2019 opinion regarding the Veteran’s service connection claims for fibroadenomas of the breasts and the residuals of breast cancer. The October 2019 VA examiner must be asked to provide a rationale to support her conclusion that the Veteran has no permanent residual or chronic disability as a result of fibroadenoma of the breast, to include a discussion of whether the Veteran has any symptoms related to the in-service fibroadenoma of the breast and, if so, whether these symptoms are productive of functional impairment in earning capacity. The October 2019 VA examiner must also be asked to address the cited literature from breastcancer.org that indicates “complex fibroadenoma” appears to raise a slight risk for breast cancer and discuss the likelihood that the Veteran’s in-service fibroadenoma of the breast was a manifestation of “complex fibroadenoma” and, if so, whether it at least as likely as not led to the development of breast cancer in her case with a complete rationale to support the opinion provided. If the October 2019 VA is unavailable or cannot otherwise provide the requested opinion, the opinion may be obtained from another examiner. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. S. Kyle, 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.