Citation Nr: 21062502 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 13-25 173A DATE: October 7, 2021 REMANDED Entitlement to service connection for a back condition to include as due to exposure to herbicide agents is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) to include as due to exposure to herbicide agents is remanded. Entitlement to service connection for basal cell carcinoma to include as due to exposure to herbicide agents is remanded. Entitlement to service connection for hypothyroidism to include as due to exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran had active service from December 1967 to July 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2012 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO) The Board remanded these matters in August 2020 and April 2021 for additional development. Entitlement to service connection for a back condition, GERD, basal cell carcinoma, and hypothyroidism, all to include as due to exposure to herbicide agents is remanded. The Veteran served in Vietnam during the Vietnam War and, therefore, is presumed to have been exposed to herbicides during service. In August 2020, the Board remanded this matter to obtain medical opinions regarding the etiology of the claimed back, stomach, basal cell, and thyroid disorders, to the include the question of whether the claimed disorders were related to the presumed herbicide exposure during service. A November 2020 VA medical opinion, the VA physician opined that the claimed disorders were unrelated to service, and provided a list of risk factors for the claimed disorders; however, the November 2020 VA opinion did not specifically address whether the back, stomach, basal cell, and/or thyroid disorders were related to the herbicide agent exposure in service, as specifically directed by the August 2020 Board remanded noted in the instructions to the VA examiner. Due to the inadequacy of the November 2020 VA opinion, the Board remanded the matter once again in April 2021 and requested that the VA examiner provided etiological opinions addressing whether the disabilities were related to herbicide exposure. In July 2021, a VA examination was conducted and the VA examiner did not provide adequate opinions. The examiner remarked that the conditions were not recognized as being caused by environmental exposures include herbicides. The examiner did not cite to any medical literatures or studies to support the opinions and seemed to base the negative opinion on the basis that the back disability, basal cell carcinoma, GERD, and hypothyroidism were not recognized by VA as presumptively related to herbicide exposure. The Board is aware of the current disabilities listed in 38C.F.R. §3.309(e) for which presumptive service connection is warranted, however a medical opinion based on direct service connection was requested to determine if the Veteran's back disability, basal cell carcinoma, GERD, and hypothyroidism were related to his exposure to herbicide agents while serving in the Republic of Vietnam. In sum, the Board finds that the July 2021 VA opinions are inadequate and new opinions and a remand is warranted for addendums. These matters are REMANDED for the following action: Obtain an addendum medical opinion from an appropriate examiner that has not examined the Veteran or provided an opinions in this matter regarding this Veteran's back disability, basal cell carcinoma, GERD, and hypothyroidism. Following a thorough review of the claims file, the examiner should provide the following opinion: a) Is it at least as likely as not (50 percent or better probability) that the Veteran's back disability is etiologically related to his active service, to include his exposure to herbicide agents while serving in the Republic of Vietnam? b) Is it at least as likely as not (50 percent or better probability) that the Veteran's basal cell carcinoma is etiologically related to his active service, to include his exposure to herbicide agents while serving in the Republic of Vietnam? c) Is it at least as likely as not (50 percent or better probability) that the Veteran's GERD is etiologically related to his active service, to include his exposure to herbicide agents while serving in the Republic of Vietnam? d) Is it at least as likely as not (50 percent or better probability) that the Veteran's hypothyroidism is etiologically related to his active service, to include his exposure to herbicide agents while serving in the Republic of Vietnam? **ALERT: It is insufficient for an opinion to be based solely upon the absence of back disability, basal cell carcinoma, GERD, and hypothyroidism from the presumptive disease list.** All findings must be reported in detail and all opinions must be accompanied by a comprehensive rationale. If the VA examiner determines the Veteran's back disability, basal cell carcinoma, GERD, and hypothyroidism is not related to his active service, to include exposure to herbicide agents, a detailed medical explanation as to why this is so must be provided. Presumptive service connection regarding back disability, basal cell carcinoma, GERD, and hypothyroidism need not be addressed, only direct service connection regarding exposure to herbicide agents is at issue. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.