Citation Nr: 21063544 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 18-42 896A DATE: October 14, 2021 REMANDED Entitlement to service connection for colon cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to January 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran presented testimony at a virtual Board hearing before the undersigned Veteran Law Judge. Entitlement to service connection for colon cancer with metastases to the lung. The Veteran contends he is entitled to service connection for colon cancer which he contends was incurred from exposure to asbestos and/or contaminants in the water supply at Camp Lejeune. In the alternative, the Veteran contends his colon cancer is related to exposure to tactical herbicide agents. See March 2021 hearing transcript; February 2018 Notice of Disagreement. The record indicates that the Veteran has been diagnosed with colon cancer during the appeal period. The RO has found that the Veteran was exposed to contaminated waters in Camp Lejeune and asbestos while aboard the U.S.S. America. See September 2020 Supplemental Statement of the Case. With respect to the Veteran's statement that he was exposed to tactical herbicide agents, the service personnel records show that he served aboard the U.S.S. America and participated in operations in the Gulf of Tonkin. Given these records, in combination with the Veteran's virtual Board hearing testimony in which he stated that he was in the coastal waters of the Republic of Vietnam, the RO should conduct additional research to determine if the Veteran is presumed to have been exposed to tactical herbicides based on the location of his service. As discussed, the record contains evidence of a current disability, and evidence of an in-service injury, what remains to be established is whether there is a nexus between the diagnosed disability and his active duty service. In this regard, the Board observes that the Veteran's colon cancer is not on the list of diseases enumerated in 38 C.F.R. § 3.309(e) or (f) for which presumptive service connection is warranted based on herbicide agent exposure or contaminated water exposure at Camp Lejeune. Despite asbestos exposure being conceded there is no presumptive basis for service connection for asbestos exposure. This does not, however, preclude a claimant from establishing service connection for the claimed disorders on a direct basis, to include as due to exposure to asbestos, herbicide agents or Camp Lejeune water contamination. See Combee v. Brown, 34 F.3d at 1039 (Fed. Cir. 1994). VA's duty to assist includes obtaining a medical examination or medical opinion when it is necessary to make a decision on a claim. See 38 U.S.C. § 5103A(d). Furthermore, when VA undertakes to provide an examination or opinion, it must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In this regard, the probative value of a medical opinion comes from its reasoning. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). A medical opinion that provides no rationale or an incomplete analysis is not adequate to decide a claim. Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Veteran was afforded a September 2020 VA examination. However, the attached opinion did not address whether the diagnosis of colon cancer was at least as likely or not related to exposure to contaminated waters in Camp Lejeune. As a result, an additional opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). In support of his contention, the Veteran submitted a May 2021 private medical opinion which states that his colon cancer was at least as likely as not caused by an exposure the Veteran experienced as a member of the military and references the exposure to contaminated water, asbestos, and the alleged tactical herbicide exposure. However, the private examiner does not identify the exposure that could have caused the disease but refers to "an exposure" in the conclusion. As noted, it's unclear whether the Veteran was exposed to herbicide agents based on his presence on the U.S.S. America and it is unclear what "exposure" the private physician was referencing in his opinion. As noted above, once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr, 21 Vet. App. at 311-12. Here, the Board notes that a direct nexus opinion considering the Veteran's currently diagnosed colon cancer to exposure to contaminated waters in Camp Lejeune and/or to herbicide agents has not been obtained. Accordingly, on remand, an addendum opinion should be obtained. This matter is REMANDED for the following action: 1. Request a search of the deck logs for the U.S.S. America, and perform any additional development indicated, to confirm the route of the U.S.S. America from May 1968 to October 1968 to determine whether the U.S.S. America served within 12 nautical miles of the Republic of Vietnam. 2. Arrange for an appropriate health care provider to review the Veteran's claim file and provide an opinion as to whether it is least as likely as not (50 percent probability or greater) that colon cancer with metastases to the lung is related to exposure to contaminated waters in Camp Lejeune and/or, if warranted, tactical herbicide agents exposure. In rendering the opinion, the examiner's attention is drawn to the December 2020 and May 2021 private medical opinions. If the reviewing health care provider finds that physical examination or telehealth interviews of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Oquendo, L., 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.