Citation Nr: 21065166 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 19-09 536 DATE: October 25, 2021 REMANDED Entitlement to service connection for metastatic high-grade neuroendocrine carcinoma, to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to October 1967, to include service in the Republic of Vietnam. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois, which denied service connection for metastatic high-grade neuroendocrine carcinoma. This matter was previously before the Board in April 2020. At that time, the Board remanded the claim for further evidentiary development, to include a VA medical opinion. Entitlement to service connection for metastatic high-grade neuroendocrine carcinoma, to include as due to herbicide agent exposure, is remanded. The Veteran contends that he developed metastatic high-grade neuroendocrine carcinoma as a result of herbicide agent exposure during active duty. In the alternative, the Veteran contends that his disability is due to in-service exposure to other chemicals, such as trichloroethylene, as an oxygen acetylene specialist. He also asserts that he was exposed to jet fuel. See September 2016 Notice of Disagreement; Veteran's correspondence received in August 2019. Private treatment records noted, inter alia, diagnoses of malignant neuroendocrine tumors and secondary malignant neoplasm of the liver and intrahepatic bile duct. See private treatment records received in September 2016. In support of his claim, the Veteran has submitted medical literature indicating that dioxin and dioxin-like compounds can cause non-neoplastic and neoplastic liver lesions. Regarding trichloroethylene exposure, the literature indicates that there is some evidence to suggest that trichloroethylene causes liver cancer. Additionally, the medical literature suggests that exposure to jet fuel may cause eye and respiratory mucous membrane irritation, chemical pneumonitis, skin irritation and dermatitis, polyneuropathy, neurologic dysfunction, and other non-specific signs and symptoms. See medical literature received in August 2019. Pursuant to the Board's April 2020 remand instructions, a VA medical opinion was obtained in June 2020. After review of the Veteran's claims file, the examiner rendered a negative etiological opinion. The examiner opined in pertinent part, There is no documentation of a diagnosis, complaints, symptoms of a neuroendocrine tumor on AD. It was not diagnosed until 2015. No Nexus exists. The NAS does not support a neuroendocrine tumor as a presumptive of AO exposure. No Nexus exists. The Board finds that the medical opinion is inadequate. In that regard, the examiner appears to have provided a negative nexus opinion because neuroendocrine carcinoma is not on the list of presumptive disabilities. The U.S. Court of Veterans Appeals (Court) has held that a medical opinion which concludes that a disease is not related to herbicide exposure solely because there is no presumption of service connection (i.e., is not listed in 38 C.F.R. § 3.309) is inadequate. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009) (holding that it is inappropriate to "permit the denial of direct service connection simply because there is no presumptive service connection."). Additionally, the examiner failed to consider the medical literature submitted by the Veteran indicating that dioxin exposure can cause non-neoplastic and neoplastic liver lesions and that there is some evidence to suggest that trichloroethylene exposure causes liver cancer. While the Board greatly regrets further delay, a new medical opinion is necessary. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, the matter is REMANDED for the following action: 1. Obtain an addendum medical opinion from a different examiner addressing the nature and etiology of the Veteran's metastatic high-grade neuroendocrine carcinoma. Access to the Veteran's electronic claims file must be made available to the examiner for review in connection with the opinion. A VA examination may be provided if deemed necessary by the examiner. After reviewing the record (and examining the Veteran if deemed necessary), the examiner should provide an opinion, with supporting rationale, as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's current metastatic high-grade neuroendocrine carcinoma is causally related to his active service or any incident therein, to include his presumed herbicide agent exposure or other claimed chemical exposure. A complete explanation must be provided for any opinion offered. In providing the requested opinion, the examiner should reference any relevant evidence of record, to include the Veteran's statement indicating that he was exposed to trichloroethylene and jet fuel as an oxygen acetylene specialist, as well as medical literature received in August 2019 indicating that dioxin exposure can cause non-neoplastic and neoplastic liver lesions and that there is some evidence to suggest that trichloroethylene exposure causes liver cancer. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Ruddy, 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.