Citation Nr: 20051632 Decision Date: 08/04/20 Archive Date: 08/04/20 DOCKET NO. 19-22 290 DATE: August 4, 2020 REMANDED Entitlement to service connection for prostate cancer, to include as secondary to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1961 to July 1968, to include service in the Republic of Vietnam. On appeal is a December 2018 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) that denied service connection for prostate cancer. When this matter was initially before the Board of Veterans’ Appeals (Board) in November 2019, the Board remanded for additional development. The requested development has been completed and the matter returned to the Board for adjudication. 1. Entitlement to service connection for prostate cancer is remanded. The Board regrets any additional delay in this matter but finds that additional development is required prior to adjudication of this issue. The Veteran contends that he is suffering from prostate cancer due to exposure to Agent Orange while in service in Vietnam. As noted in the November 2019 Board remand, post-service VA treatment records reflect the Veteran has elevated prostate specific antigen (PSA) levels. Private treatment records include a February 2018 MRI that noted a lesion within the right lateral mid gland peripheral zone that was suspicious for cancer. Because it remained unclear whether the Veteran actually had a diagnosis of prostate cancer at that time, the Board remanded for additional development to include obtaining outstanding VA and private treatment records and scheduling a VA examination. Following the Board remand, a VA examination was completed in January 2020 by a physician who reviewed the Veteran’s records but did not conduct an in-person examination of the Veteran. The examiner opined that it was less likely than not the condition claimed was incurred in or caused by the claimed in-service injury, event or illness. As rationale, the examiner stated there has not been a biopsy of the prostate indicating prostate cancer. After the medical opinion was rendered in January 2020, the Veteran underwent a prostate biopsy in March 2020. The Prostate Biopsy Pathology Report reflects the Veteran had high-grade prostatic intraepithelial neoplasia (High-Grade PIN) and chronic inflammation. In June 2020, the Veteran submitted two pieces of medical literature that suggests these diagnoses may actually represent prostate cancer. Because the January 2020 examiner did not have the opportunity to review the March 2020 prostate biopsy results, or to consider the recently submitted medical literature that suggests the Veteran’s diagnoses of High-Grade PIN and chronic inflammation might actually be cancer, an addendum medical opinion is needed. The matters are REMANDED for the following action: Obtain an addendum medical opinion from the January 2020 examiner regarding the nature and etiology of the Veteran’s claimed prostate cancer. The claims file should be made available to, and reviewed by, the examiner. After a review of the claims file, the examiner must specifically render an opinion as to whether the Veteran has prostate cancer or not. In rendering this opinion, the examiner must specifically comment on: • The March 2020 prostate biopsy reports, diagnosing both chronic inflammation and High-Grade PIN; and • The medical literature submitted by the Veteran and associated with his claims file on June 4, 2020. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. Caroline Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jiggetts, Associate 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.