Citation Nr: 20020719 Decision Date: 03/20/20 Archive Date: 03/20/20 DOCKET NO. 19-36 558 DATE: March 20, 2020 REMANDED Entitlement to service connection for brain cancer to include as due to herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from December 1970 to March 1972 with service in the Republic of Vietnam. The Veteran passed away in October 2017. In April 2018, the Appellant, the Veteran’s surviving spouse, requested substitution upon the death of the Veteran. In June 2019, the Regional Office granted the request for substitution. Although the Board regrets the delay, remand is required to ensure there is a complete record on which to decide the claim. 1. Entitlement to service connection for brain cancer to include as due to herbicide agent exposure is remanded. The Appellant contends the Veteran’s brain cancer is due to exposure to herbicide agents while serving in the Republic of Vietnam. In May 2017, a VA examiner opined the Veteran’s brain cancer was not related to Agent Orange exposure, because it is not on the presumptive list of diseases related to Agent Orange exposure. The examiner concluded the Veteran’s brain tumor was therefore less likely than not incurred in or caused by Agent Orange exposure. The Board finds the May 2017 examiner’s opinion inadequate. The Court has found reliance solely on a disability being on the presumptive list insufficient and an examiner must point to something other than the category in which the National Academy of Sciences’ placed the disease to support the opinion rendered, such as the reason the expert finds cited studies persuasive or unpersuasive, “whether the Veteran has other risk factors for developing the claimed condition, and whether the claimed condition has manifested itself in an unusual manner.” Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, the Board reviewed the opinion by Dr. S.S. in which he discusses the Veteran’s diagnosis and treatment with glioblastoma multiforme (GBM) and evidence that Agent Orange is associated with soft tissue sarcoma and a number of lymphoproliferative and hematological malignancies. Dr. S.S. also notes a “striking” disproportionate number of veterans who served in the Vietnam War having lost their lives to cancer, including GBM. Unfortunately, Dr. S.S. did not provide an opinion specifically addressing whether the Veteran’s GBM was related to his exposure to herbicide agents. Therefore, the opinion is insufficient evidence for the Board to grant service connection. Accordingly, a remand is necessary to request an additional medical opinion as related to entitlement to service connection for brain cancer. The matter is REMANDED for the following action: 1. Obtain a medical opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s brain cancer. The examiner is asked to respond to the following: (a.) Was the Veteran’s brain cancer at least as likely as not related to herbicide agent exposure in service or otherwise related to his service? The examiner should note that herbicide agent exposure has been conceded. Further, the examiner must provide sufficient rationale as to the basis of the medical opinion and cannot simply rely on the fact that brain cancer is not a disease legally presumed associated with herbicide agent exposure. In rendering the requested opinions, the examiner is asked to consider the October 2019 letter from Dr. S.S., who stated that there is sufficient evidence that Agent Orange is associated with soft tissue sarcoma and a number of lymphoproliferative and hematological malignancies. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, the examiner should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. P. Armstrong Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura C. Owens 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.