Citation Nr: 21067729 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 16-39 076 DATE: November 5, 2021 REMANDED Entitlement to service connection for male breast cancer, claimed as the result of exposure to herbicide agents in the Republic of Vietnam and contaminated water at Camp Lejeune, North Carolina, is remanded. REASONS FOR REMAND The Veteran had active service from July 1969 to May 1971. He served in the Republic of Vietnam and was awarded the Combat Action Ribbon. Entitlement to service connection for male breast cancer, claimed as the result of exposure to herbicide agents and contaminated water at Camp Lejeune, North Carolina, is remanded. The Veteran served at Camp Lejeune, North Carolina. In its July 2021 Remand instructions, the Board requested that the Veteran be afforded further Department of Veterans Affairs (VA) evaluation to address the relationship, if any, between the diagnosed breast cancer and active service. The Board directed that the examiner should opine "whether it is at least as likely as not that the Veteran's breast cancer had its onset during his active service, or is otherwise etiologically related to such service, to include to include his in-service exposure to contaminated water at Camp Lejeune and conceded in-service exposure to herbicide agents (notwithstanding the fact that there may not be a presumed association)" and "address the July 2020 examiner's report that low levels of estrogen are the leading cause of breast cancer and that herbicide agents produce dioxin, which are weak estrogens, highly lipophilic, and capable of persisting in the body for years." A September 2021 evaluation conducted for VA states that "in regards to the condition being related to Camp Lejeune contaminated water, this examiner must defer such opinion to a Camp Lejeune contaminated water subject matter expert." The physician assistant commented that: the "C-file shows in 2012 the Veteran was diagnosed with a high grade right breast invasive ductal carcinoma treated with a modified radical mastectomy with axillary node dissection 3/2/2012, adjuvant chemotherapy with TAC and Tamoxifen;" "review of the literature shows the committee responsible for VAO found that there was inadequate or insufficient information to determine whether an association exists between exposure to the chemicals of interest (2,4-D, 2,4,5-T or its contaminant TCDD, picloram, or cacodylic acid) and breast cancer;" and "therefore, it is less likely than not that the Veteran's breast cancer had its onset during his active service, or is otherwise etiologically related to such service, to include to include his conceded in-service exposure to herbicide agents." The examiner did not "address the July 2020 examiner's report that low levels of estrogen are the leading cause of breast cancer and that herbicide agents produce dioxin, which are weak estrogens, highly lipophilic, and capable of persisting in the body for years." Given that the examiner was not qualified to address the relationship between the diagnosed breast cancer and the Veteran's presumed exposure to contaminated water at Camp Lejeune and failed to address the July 2020 VA examination report, the Board of Veterans' Appeals (Board) finds that that the evaluation is of essentially no probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further VA evaluation is required. Accordingly, this matter is REMANDED for the following action: Refer the claims record to an appropriate medical doctor to assist in determining the etiology of the diagnosed male breast cancer and its relationship, if any, to active service including the Veteran's presumed exposure to herbicide agents in the Republic of Vietnam and to contaminated water at Camp Lejeune, North Carolina. The examiner must review the record, including the July 2020 VA examination report, and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (Continued on the next page) (a) Diagnose all breast cancer residuals found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that the diagnosed breast cancer had its onset during active service or is related to any incident of service, including the Veteran's presumed exposure to herbicide agents in the Republic of Vietnam and to contaminated water at Camp Lejeune, North Carolina. The examiner should specifically discuss the July 2020 VA examination report. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Marsdale 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.