Citation Nr: 21068441 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-55 691 DATE: November 10, 2021 REMANDED Entitlement to service connection for residuals of breast cancer, to include as due to smokestack hazard and to include as due to herbicide agent exposure, and as secondary to service-connected testicular cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from November 1970 to December 1972, with service in the Vietnam War. In June 2021, the Board remanded the issue for additional development to include a VA medical examination. Although regrettable, remand is again required to obtain a medical opinion sufficient for adjudication purposes. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). Entitlement to service connection for residuals of breast cancer, to include as due to smokestack hazard and to include as due to herbicide agent exposure, and as secondary to service-connected testicular cancer is remanded. As an initial matter, the Board notes that the Veteran's exposure to herbicide agents, commonly called Agent Orange, is conceded. See Procopio v. Wilkie, 913 F.3d 1371 (In Procopio, the Federal Circuit interpreted "served in the Republic of Vietnam" in 38 U.S.C. § 1116(a)(1) to unambiguously include service in the territorial sea of that country.); see also 38 U.S.C. § 1116A(c). Moreover, VA had determined that this Veteran had herbicide agent exposure in an October 2016 rating decision based on the Veteran's "boots on the ground" when he went ashore while serving on the USS Midway. However, in the recent addendum opinion obtained in June 2021, the examiner repeatedly stated that the Veteran was not exposed to herbicide agents. As this premise is incorrect, the opinion offered is insufficient for adjudication purposes. In addition, the examiner's opinion regarding the residuals of breast cancer secondary to service-connected testicular cancer did not address the entire period on appeal and simply concluded that in the October 2020 "examination demonstrates breast cancer is in remission with no residual symptoms. This falls within the projected natural history of the condition and does not represent aggravation (beyond natural progression)." The Board notes that the Veteran's initial claim for breast cancer residuals secondary to his service-connected testicular cancer began in August 2013 and has been continuously on appeal since then. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. For an opinion to be adequate, it must include consideration of the Veteran's statements, be based on accurate factual premises, and contain a rationale sufficient to support its conclusions. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). If an examiner does not consider the Veteran's history, complaints, and lay statements, any negative opinion is inadequate for rating purposes. See Dalton v. Nicholson, 21 Vet. App. 23 (2007); see also Nieves-Rodriguez, 22 Vet. App. 295 (2008) (explaining that a medical report without "a reasoned medical explanation" lacks probative value). Accordingly, the Board finds that a remand is necessary to obtain medical opinions for each of the Veteran's claimed theories of entitlement for his residuals from breast cancer. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his breast cancer residuals with an oncology physician, if possible. The examiner must review the claims file. The examiner is asked to provide a response to the following: Are the residuals of the Veteran's breast cancer, for the entire period on appeal beginning in August 2013, at least as likely as not related to service, including the Veteran's conceded exposure to smokestack soot (industrial and hazardous chemical processes)? In providing an opinion, the examiner is asked to address the October 2019 VA examiner's statement regarding the positive relationship between testicular cancer and smokestack exposure and whether there is a positive relationship between smokestack exposure and breast cancer. Are the residuals of the Veteran's breast cancer, for the entire period on appeal beginning in August 2013, at least as likely as not related to service, including the Veteran's conceded exposure to herbicide agents? In providing an opinion, the examiner is advised that a negative opinion cannot be based solely on the fact that breast cancer is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Are the residuals from the Veteran's breast cancer at least as likely as not proximately due to his service-connected testicular cancer? In providing an opinion, the examiner must address the Veteran's assertion that his private physician stated there are medical studies showing a relationship between testicular cancer and developing breast cancer many years later. Are/were the residuals from the Veteran's breast cancer, at any time during the period on appeal, at least as likely as not aggravated, i.e., worsened beyond their natural progression, by the Veteran's service-connected testicular cancer, to include the treatment he received for his testicular cancer? Provide a complete rationale to support the opinions, as the Board is precluded from making medical determinations. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Nelson 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.