Citation Nr: 21066268 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 17-42 460 DATE: October 29, 2021 ORDER The issue of entitlement to service connection for prostate cancer is denied. REMANDED The issue of entitlement to service connection for erectile dysfunction is remanded. VETERAN CONTENTIONS The Veteran contends that he developed prostate cancer as a result of his possible exposure to asbestos and Red Lead paint during ship duty while in service. In addition, he attributes his erectile dysfunction to having been given Saltpeter while in service to decrease his libido. FINDING OF FACT The Veteran's prostate cancer is not attributable to his active duty service. CONCLUSION OF LAW The criteria for service connection for prostate cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1974 to February 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). There was a May 2021 Board hearing before the undersigned Veterans Law Judge (VLJ), and the transcript is of record. This matter was previously before the Board in July 2021 at which time it was remanded for further development. The RO has complied with the remand directives and this matter has been properly returned to the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). SERVICE CONNECTION To establish service connection, a showing of competent medical, or in certain circumstances, lay evidence must confirm (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163, 116667 (Fed. Cir 2004). Service connection may also be granted on a presumptive basis for chronic, tropical, or prisoner of war related disease as well as diseases related to exposure to an herbicide agent while in service. 38 C.F.R. § 3.307(a). Only those diseases listed in 38 C.F.R. § 3.309 are subject to presumptive service connection. With regard to chronic disease, the disease must become manifest to a degree of 10 percent or more within 1 year from the date of separation. The issue of entitlement to service connection for prostate cancer is denied. Here, the Veteran is currently diagnosed with prostate cancer. See 9/2/2014 CAPRI. Although he attributed his prostate cancer to asbestos exposure while in service, prostate cancer is not one of the conditions VA recognizes as being presumptively attributable to asbestos exposure. Moreover, while malignant tumors are included in the list of chronic diseases subject to presumptive service connection, the Veteran's prostate cancer did not manifest until 37 years after separation. Therefore, the Veteran is not entitled to presumptive service connection for his prostate cancer. The Veteran did, however, receive treatment for acute urethritis due to gonococcus while he was in service. Thus, the Board, in its July 2021 remand, sought a medical nexus opinion to determine whether the Veteran's in-service gonococcus exposure could ultimately have resulted in prostate cancer. One VA genitourinary examination was conducted in furtherance of this claim and the examiner determined that the Veteran's prostate cancer was not related to his prior gonococcus exposure and resultant acute urethritis. See 7/27/2021 C&P Examination. According to the examiner, urethritis due to gonococcus is neither related to, nor causative of prostate cancer. Instead, the examiner opined, prostate cancer is related to genetic factors, advanced age (greater than 50 years old), race, and positive family history. Because the opinion was cogent and well-reasoned, the Board affords it significant probative value. The Board also acknowledges the Veteran's statements regarding exposure to asbestos, Red Lead paint, and Saltpeter. However, as the Veteran is not competent to relate his prostate cancer to in-service exposures including asbestos, Red Lead paint, and Saltpeter, the Board affords them no probative weight. See 5/17/2021 Hearing Transcript. Because there is otherwise no competent evidence relating the Veteran's prostate cancer to service, no nexus is established between the Veteran's in-service urethritis and his subsequent prostate cancer, service connection is denied. REASONS FOR REMAND The issue of entitlement to service connection for erectile dysfunction is remanded for further development. A July 2021 VA examination was conducted in response to the July 2021 Board remand. While the examiner opined regarding whether there was a relationship between the Veteran's erectile dysfunction and his treatment for acute urethritis while in service, she failed to opine upon the Veteran's contention that the provision of Saltpeter in service to reduce sexual appetite may have later caused erectile dysfunction. Due to the foregoing, the Board finds that the RO did not substantially comply with the Board's remand directives regarding the requested medical opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, remand to obtain an addendum opinion is necessary. The matter is REMANDED for the following action: Return the claims file to the VA examiner who conducted the July 28, 2021 C&P Examination, if available. If that examiner is not available, send the claims file to another examiner to address the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran's erectile dysfunction had its onset in, was caused by, or is otherwise related to service? The examiner should specifically address the Veteran's contention that the provision of saltpeter in service to reduce his sexual appetite may have caused him to later develop erectile dysfunction. A complete rationale for the examiner's opinions should be provided, citing to specific evidence of record, as necessary. Citation to relevant peer reviewed medical literature reviewed in rendering the opinion would be of considerable assistance to the Board. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sloley, 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.