Citation Nr: 21002248 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 18-41 880 DATE: January 13, 2021 REMANDED Entitlement to service connection for colon cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1963 to February 1967. He appeals a March 2018 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for colon cancer. In August 2019, the Board of Veterans’ Appeals (Board) remanded the claim for further development. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The claim is now back before the Board. In August 2019, the Board remanded to obtain a VA opinion to determine whether the Veteran’s colon cancer may be attributable to his presumed exposure to herbicide agents while stationed in Thailand. In November 2020, a VA clinician opined the Veteran’s colon cancer was less likely than not caused by his in-service exposure to herbicide agents. As rationale, the VA clinician noted the Veteran’s service treatment records “show no clear evidence of chronic and ongoing issues suggestive of the presence of colon cancer in service” and the Veteran’s diagnosis occurred “five decades after separation” from service. See November 2020 VA examination report. Additionally, the VA clinician noted “there is insufficient evidence in medical literature that colon cancer is due to herbicide exposure. To date VA has not accepted a presumptive connection for colon cancer resulting from herbicide exposure in Vietnam [sic].” Id. The Board finds this opinion in adequate for Board adjudication. First, the VA examiner inexplicably noted the Veteran’s colon cancer was less likely than not “the result of herbicide exposure in Vietnam.” See November 2020 VA examination report. The Veteran never served in Vietnam; rather, his presumed exposure to herbicide agent occurred during his service while stationed at the Korat Royal Thai Air Force Base (RTAFB) in Thailand. See military personnel records. An opinion based on an inaccurate factual premise holds no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Second, a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 120, 124-125 (2007). Here, the November 2020 VA opinion does not provide adequate rationale for the Board to make an informed decision regarding whether there is a relationship between the Veteran’s colon cancer and his in-service exposure to herbicide agents. The VA clinician noted there was “insufficient evidence in medical literature that colon cancer is due to herbicide exposure” but did not provide or even attempt to explain any of medical literature upon which he relied in the formulation of his opinion. He also seemed to place undue weight on the fact that colon cancer is a condition that is not presumptively related to herbicide exposure. Thus, the Board finds this VA opinion conclusory and inadequate regarding whether the Veteran’s colon cancer is related to his in-service exposure to herbicide agents and a remand is required. Id. The matter is REMANDED for the following action: 1. Obtain all relevant updated private and VA treatment records that have not already been associated with the claims file. 2. Thereafter, obtain an opinion from an appropriately qualified clinician, preferably by the VA examiner who provided the November 2020 VA examination, to determine the nature and etiology of the Veteran’s colon cancer, to include exposure to herbicide agents. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician. After a thorough review of the record, the reviewing clinician should answer the following: Is it at least as likely as not (a 50 percent probability or more) that the Veteran’s colon cancer was incurred in or is otherwise related to his time in service, to include his conceded exposure to herbicide agents while serving in Thailand? The reviewing clinician should draw on his or her medical knowledge and a full and complete rationale for his or her opinion must be provided; a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The reviewing clinician should note the Veteran was exposed to herbicide agents for VA purposes; therefore, only a nexus opinion is needed. If the reviewing clinician cannot provide a requested opinion without resorting to mere speculation, it must be stated, and the clinician must provide the reasons why an opinion would require speculation. As such, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. Thereafter, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a Supplemental Statement of the Case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. 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.