Citation Nr: 21065451 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 15-35 036A DATE: October 26, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to July 1969, to include service in the Republic of Vietnam (RVN) from March 2, 1967 to March 2, 1968. He died in November 2013. The appellant is the surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. By that rating action, the RO denied service connection for the cause of the Veteran's death. The appellant disagreed with this rating action and the RO's determination therein. In August 2016, the appellant testified at a videoconference Board hearing. A transcript of the hearing is of record. In August 2018 the issue was remanded for additional development. In January 2020, the Board denied service connection for the cause of the Veteran's death. The appellant appealed to the United States Court of Appeals for Veterans Claims (Court), and in a November 2020, Order, the Court granted a Joint Motion for Remand (JMR) vacating that decision and remanding it to the Board. Entitlement to service connection for the cause of the Veteran's death. In the November 2020 JMR, the parties agreed that the June 2019 VA opinion failed to comply with the August 2018 Board remand directives. First, they noted it was unclear if the June 2019 VA examiner considered the Veteran's treatment for gastroenteritis and viral gastroenteritis during service. Second, they found that the examiner did not adequately explain whether the Veteran's exposure to Agent Orange during service was directly related to his lethal esophageal adenocarcinoma. They noted that a remand was warranted because the Board relied on the June 2019 VA medical opinion. In the April 2021 remand, the Board requested in part that the examiner opine whether the Veteran's metastatic adenocarcinoma was directly linked to his presumed exposure to herbicides in service. The Board specifically cautioned that a medical opinion stating that medical literature does not support an association between a disability and herbicide exposure without discussing the specific facts of the case will render the opinion inadequate. The subsequent VA opinion obtained in April 2021 is inadequate because while the examiner addressed whether the Veteran's esophageal cancer was directly related to his treatment during service for gastroenteritis, the examiner in addressing whether the lethal esophageal cancer was related to his herbicide exposure in service stated that cancers of the gastrointestinal system, esophagus, stomach, liver, pancreas, colon, and rectum have been extensively studied in Vietnam veterans groups with herbicide exposure and these studies have not found a significant link between these exposures and any gastrointestinal cancer. However, the examiner did not explain why in the Veteran's specific case his esophageal cancer was not directly related to his herbicide exposure during service as requested by the Board. Thus, the examiner did not comply with the Board's remand directives. The Board is required to ensure compliance with the instructions of its remands. Stegall v. West, 11 Vet. App. 268 (1998). By this remand the Board makes no determination, expressed or implied, as to the credibility of any statements on file. The matter is REMANDED for the following action: Return the file to the clinician who provided the April 2021 VA opinion, if available for an addendum. Otherwise, provide the record to another clinician who will have an opportunity to review the complete file, to include a copy of this remand and provide the requested opinion. The examiner must note that exposure to Agent Orange is presumed. Following review of the entire record, the clinician should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's metastatic adenocarcinoma (from the esophageal junction) was directly related to his presumed in-service exposure to herbicides. In providing the opinion the clinician is asked to address why the Veteran's esophageal cancer was or was not related to his presumed exposure to herbicides during service based on the specific facts of the instant case to include the Veteran's service treatment records. The opinion provided should be accompanied by a clear rationale consistent with the evidence of record. The clinician must explain the underlying rationale for all opinions expressed, citing to supporting factual data/medical literature, as deemed indicated. A medical opinion stating only that there is nothing in the medical literature supporting an association between a disability and a Veteran's conceded herbicide agent exposure without discussing the specific facts of the case will render the opinion inadequate. If the clinician cannot render an opinion without resorting to mere speculation, a full and complete explanation for why an opinion cannot be rendered should be provided. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mac, 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.