Citation Nr: 21065578 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 16-40 331 DATE: October 26, 2021 REMANDED Entitlement to service connection for pheochromocytoma, status post left adrenalectomy is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1966 to January 1968. The matter was previously before the Board in November 2018, April 2021, and July 2021 at which time it was remanded for development. While the Board regrets the further delay, for the reasons stated below, additional remand is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). During the pendency of the appeal, the Veteran was granted service connection for hypertension and a gastrointestinal disability in an April 2021rating decision. Because this grant represents a full grant of the benefits sought, these issues are no longer on appeal. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997). Entitlement to service connection for pheochromocytoma, status post left adrenalectomy is remanded. The Veteran maintains that numerous VA treating doctors have told him that his pheochromocytoma is directly related to his exposure to Agent Orange. Specifically, the Veteran reported in July 2013 that his adrenal gland was removed in December 2011, and at that time, his VA physician told him that the illness was a result of exposure to Agent Orange. Additionally, the Veteran reported in September 2013 that the Long Beach VAMC confirmed that he has adrenal gland problems as a direct result of his service in Vietnam. The Veteran also reported in September 2013 that all of his doctors at Long Beach VAMC have said that all of his conditions are directly related to his exposure to Agent Orange. In November 2018, the Board remanded the Veteran's claim to obtain a VA examination and opinion to determine the nature and etiology of the Veteran's pheochromocytoma. This examination was performed in November 2019, at which time the examiner provided a negative nexus opinion. The Board concluded the opinion was inadequate as to the issue of direct service connection because the examiner did not discuss any facts pertaining to the Veteran's condition or individual circumstances. Instead, the examiner's rationale was based on the fact that NASEM has not concluded that there is a positive association between exposure to herbicides used in Vietnam and pheochromocytoma. An addendum opinion was provided by another VA examiner in April 2021. However, in its July 2021 decision, the Board found that this opinion was also inadequate. The April 2021 examiner did not provide any opinion at all. Instead, he included a copy of a prior decision in which the Board denied entitlement to service connection for pheochromocytoma for a different Veteran who alleged that his condition was directly related to service. Pursuant to the most recent remand, a new VA examiner provided a nexus opinion in August 2021. The examiner opined that the Veteran's pheochromocytoma was not etiologically linked to his active-duty service. The examiner reasoned that the Veterans pheochromocytoma had been surgically removed in 2011 and declared resolved in 2014, that there was no documentation to corroborate the Veteran's assertion that his medical doctors had told him his condition was caused by herbicide exposure, and that the causes of pheochromocytoma were either genetic or otherwise unknown. Initially, the Board acknowledges that the first prong of the examiner's rationale goes to a current disability rather than a nexus. As this element of service connection has already been established in the Veteran's favor, the examiner's opinion is inconsequential. However, the Board must note for purposes of establishing service connection, a "current disability" includes a disability which existed at the time a claim for VA disability compensation is filed or during the pendency of the claim, even if that disability is currently in remission or has completely resolved. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). As to the remainder of the rationale, the Board finds that the August 2021 opinion is inadequate. Although the examiner noted that approximately two thirds of cases are due to genetic inheritance or genetic predisposition, the examiner's rationale did not discuss whether this Veteran fell into either category. Importantly, the examiner noted that the cause of isolated pheochromocytoma was unknown but proceeded to rule out herbicide exposure as a potential cause of the disability without adequate explanation. On remand, an opinion with supporting rationale should be obtained. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran's claims file any outstanding treatment records. 2. Obtain an addendum opinion from the August 2021 VA examiner regarding the nature and etiology of the Veteran's pheochromocytoma. Access to the records in the Veteran's electronic claims file should be made available to the examiner for review in connection with his or her opinion. A VA examination may be provided if deemed appropriate. The examiner should provide an opinion as to whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's diagnosed pheochromocytoma is causally related to the Veteran's active service, to include herbicide exposure, or any incident therein. The examiner should NOT base their opinion on the fact that pheochromocytoma is not a presumptive disability by the National Academy of Sciences as due to herbicide exposure but must address the Veteran's individual circumstances. References to general statistics regarding genetic predisposition must be explained in the context of the Veteran's individual situation. Specifically, the examiner must address February 2012 treatment records which indicate the Veteran's treating physicians were unable to assess a genetic predisposition. Additionally, if the examiner endeavors to rule out herbicide exposure as a cause of the Veteran's pheochromocytoma, a thorough explanation of the examiner's specific considerations would be of considerable help to the Board. 3. After ensuring that the opinion complies with the terms of this remand, the AOJ should re-adjudicate the claim. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Sherman 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.