Citation Nr: 21000863 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 15-40 418 DATE: January 6, 2021 REMANDED Entitlement to service connection for prostate cancer as secondary to service-connected prostatitis is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from March 1971 to March 1993. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board denied the above claim in a January 2019 decision. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In January 2020, the Court granted a December 2019 Joint Motion for Partial Remand (JMPR). The Court found that the Board failed to provide an adequate statement of reasons or bases for its reliance on the September 2011 VA examination, despite it being unclear whether the examiner’s opinion addressed whether the Veteran’s prostate cancer was aggravated by his service-connected prostatitis. In April 2020, the Board remanded to provide an additional medical opinion. The January 2019 Board decision also remanded additional issues. Those issues remain in remand status and are not currently before the Board. Entitlement to service connection for prostate cancer as secondary to service-connected prostatitis is remanded. The Veteran contends that his currently diagnosed prostate cancer is related to his service-connected condition of prostatitis. Pursuant to the previous Board remand, the RO provided the Veteran a VA examination in May 2020 to address the nature and etiology of the Veteran’s prostate cancer as secondary to the Veteran’s service-connected prostatitis. The VA examiner reviewed the Veteran’s claims file and provided the medical opinion that the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected condition. The VA examiner rationalized that prostate cancer is related to changes in the cell type of prostate tissue, and not thought to be related to any type of prostate infection. The examiner opined that prostatitis is not a known cause of a carcinoma of the prostate, as the mechanism of developing the two conditions are different. Further, the May 2020 VA examiner provided the baseline severity of the Veteran’s prostate cancer, noting that the Veteran showed no symptoms of prostate cancer in 2011. The VA examiner provided the medical opinion that the Veteran’s prostate cancer was not at least as likely as not aggravated beyond its natural progression by the service-connected prostatitis. The examiner’s rationale provided that prostatitis does not cause prostate cancer, as the conditions have “two different types of etiology and mechanism of action.” Finally, the examiner opined that the carcinoma of the prostate is in remission and therefore in its natural progression, and thus not aggravated. Remand is needed to provide the Veteran a clarifying medical opinion with adequate rationale addressing whether the Veteran’s service-connected prostatitis aggravated the Veteran’s prostate cancer. See El-Amin v. Shinseki, 26 Vet. App. 136, 138-40 (2012). When VA determines to provide an examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Additionally, the opinion must be adequately supported and explained. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Here, there is ambiguity in the VA examination’s rationale provided in support of the medical opinion addressing aggravation, as the examiner relied on the bases that prostatitis does not cause prostate cancer to show a lack of aggravation in the Veteran’s condition. Additionally, the examiner notes the Veteran’s prostate cancer was, at the time of examination, in remission and thus in its baseline state. However, the medical evidence of record shows the Veteran received treatment for his prostate cancer after filing and pursuing his claim for compensation benefits. Accordingly, a clarifying opinion is required to address whether at any point during the period on appeal the Veteran’s claim disability progressed beyond the proscribed baseline identified by the examiner as the period in which the Veteran was symptom free. Thus, an addendum opinion is needed to determine whether the Veteran’s service-connected prostatitis aggravated his prostate cancer. Further, adequate rationale is necessary for the Board to adequately weigh the probative value of the VA medical opinion. The matter is REMANDED for the following action: 1. Obtain an addendum opinion as to the etiology of the Veteran’s prostate cancer, from the examiner who provided the May 2020 VA opinion, or, if not available, another appropriately qualified VA medical professional. If the examiner deems it necessary, afford the Veteran a VA examination. The examination may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. Provide the claims file, including a copy of this REMAND, to the examiner for review. Following a review of the entire record, including all available lay statements, private and VA medical treatment records, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) the Veteran’s prostate cancer was aggravated by the Veteran’s service-connected prostatitis. In providing this opinion, the examiner should discuss the medical records noting the Veteran’s treatment for prostate cancer during the period on appeal and address any progression beyond the baseline of the condition as determined in the May 2020 VA examination. A clearly stated rationale for any opinion offered should be provided, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, 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.