Citation Nr: 21061406 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-10 396 DATE: October 4, 2021 REMANDED Entitlement to service connection for residuals of a pilonidal cyst is remanded. Entitlement to service connection for esophageal cancer, to include as secondary to in-service exposure to herbicides, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Navy from June 1963 to May 1967, including service in the Republic of Vietnam. In April 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. This case was most recently before the Board in November 2020, at which time the issues on appeal were remanded for additional development. The Board notes that the Veteran's claim of entitlement to service connection for hypothyroidism was granted in a July 2021 rating decision. As this represents a full grant of the benefit sought on appeal, that issue is no longer before the Board. The remaining issues have since returned to the Board for appellate consideration. 1. Entitlement to service connection for residuals of a pilonidal cyst In its November 2020 remand instructions, the Board directed the RO to obtain an addendum opinion concerning whether the Veteran's pilonidal cyst, for which he had surgery, was etiologically related to service. The RO obtained the requested opinion in July 2021. The examiner noted the Veteran's surgical history of pilonidal cyst removal in May 1968, and his post-surgery history of residuals such as redness and leakage. The examiner determined that the condition was less likely than not incurred in or caused by an in-service injury, event, or illness, stating only that the Veteran's service treatment records (STRs) were silent for the removal of a pilonidal cyst. The examiner did not explain whether the pilonidal cyst removed 1968, within a year of discharge from active service, could have had its onset during or was otherwise etiologically related to service or an in-service injury, event, or illness. Therefore, remand is warranted to obtain an adequate opinion with detailed rationale concerning etiology. 2. Entitlement to service connection for esophageal cancer In its November 2020 remand instructions, the Board directed the RO to obtain an addendum opinion that addressed treatise evidence the Veteran submitted in support of his claim in March 2013. The treatise evidence consists of a copy of the May 1990 Report to the Secretary of the Department of Veterans Affairs on the Association Between Adverse Health Effects and Exposure to Agent Orange (reported by Special Assistant Admiral E.R. Zumwalt, Jr.) (the "Zumwalt report"), which, in pertinent part, found that there was adequate evidence to reasonably conclude that it is at least as likely as not that there is a nexus relationship between exposure to herbicide agents and esophageal cancer. The RO obtained the requested addendum opinion in July 2021; however, the opinion did not address the May 1990 Zumwalt report submitted by the Veteran. Therefore, the Board finds that another remand is warranted to obtain an addendum opinion that specifically addresses the findings contained in the May 1990 Zumwalt report. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion concerning the etiology of the residuals of the Veteran's pilonidal cyst, including scarring associated with surgical removal of the cyst. The need for another examination is left to the discretion of the examiner. For any related disability existing at the time the claim was filed or during the pendency of the appeal, including any scarring associated with surgical removal of a pilonidal cyst, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disability is causally or etiologically related to the Veteran's period of active service. This includes an opinion as to the etiology of the pilonidal cyst for which the Veteran had surgery. The examiner should provide a complete rationale for the opinion provided and reconcile any opinion with any contradictory evidence of record 2. Obtain an addendum opinion concerning the etiology of the Veteran's esophageal cancer. The need for another examination is left to the discretion of the examiner. After a thorough review of the Veteran's entire claims file, the examiner is asked to opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's esophageal cancer is causally or etiologically related to his period of active service, to include as due to in-service exposure to herbicides. The examiner should provide a complete rationale for the opinion provided and should specifically consider and address the May 1990 Zumwalt report, which found a positive relationship between esophageal cancer and exposure to herbicides. 3. Then, readjudicate the Veteran's claims based on the entirety of the evidence. If the claims remain denied, issue the Veteran and his representative a supplemental statement of the case. An appropriate time should be allowed for response. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. T. Raftery, 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.