Citation Nr: 21068485 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-35 353 DATE: November 10, 2021 REMANDED Entitlement to service connection for prostate cancer, claimed as due to exposure to herbicide agents and/or chemicals is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from July 1975 to September 1992. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision, which denied service connection for prostate cancer. In January 2020, a videoconference hearing was held before the undersigned; a transcript is in the Veteran's record. In March 2020 and June 2021, the matter was remanded for additional development. Entitlement to service connection for prostate cancer The Board is aware that the claim has been remanded before (and regrets the delay inherent with another remand); but because there was not substantial compliance with previous remand instructions, another remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In June 2021, the Board remanded this matter for an addendum medical opinion addressing the likely etiology of the Veteran's prostate cancer. Prior development revealed that the Veteran was exposed to a number of contaminants of concern (COCs) in the groundwater during his service at Ford Ord. See March 2021 correspondence from the U.S. Environmental Protection Agency (EPA). A prior (March 2021) VA medical opinion against the claim was inadequate, as it lacked rationale and employed an improper standard of review in finding that,"...after review of each of the agents listed none conclusively [emphasis added] cause prostate cancer" (employing the more stringent standard of "conclusively cause" versus the standard of proof required in claims for VA compensation benefits "at least as likely as not" (a 50% or greater probability)). In July 2021, the March 2021 examiner re-reviewed the record and provided a negative nexus (to service) opinion. The negative opinion was again based on a finding that, "Chemical Contaminants were listed that was found in Groundwater at Ford Ord however, none conclusively cause prostate cancer." The examiner repeated the March 2021 opinion, but added a paragraph about the EPA cleanup of Fort Ord and a line which notes that "Having a father or brother with prostate cancer more than doubles a man's risk of developing prostate disease. Veteran's father died of prostate cancer." The Board finds the opinion inadequate for rating purposes, as it again employs an improper standard of review which the Board explicitly directed against using in its June 2021 remand. Stegall v. West, 11 Vet. App. at 271. Furthermore, while the opinion suggests a familial/genetic relationship in the development of prostate cancer, that does not preclude causation by a chemical exposure in service. In summary, the opinion fails to answer the medical question integral to this appeal: Is it at least as likely as not that the Veteran's prostate cancer is etiologically related to his service, including his acknowledged exposure to groundwater chemical contaminants at Ford Ord. Remand for an adequate, advisory medical opinion is necessary. The matter is REMANDED for the following: 1. Secure for the record updated (to the present, all not already associated with the record) complete clinical records of VA evaluations and treatment the Veteran has received for his prostate cancer (and any residuals). 2. Thereafter, arrange for the Veteran's claims file to be forwarded to an appropriate clinician (other than the March 2021/July 2021 provider) for an advisory medical opinion addressing the likely etiology of the Veteran's prostate cancer, specifically whether it is related to any acknowledged environmental exposures in service (including to TCE). The entire record (including this Remand and the March 2021 EPA correspondence) must be reviewed. The provider should respond to the following: (a) Identify the likely etiology of the Veteran's prostate cancer. Specifically, is it at least as likely as not (a 50% or greater probability) that it is etiologically related to the Veteran's active service, to include as due to exposure in service to the contaminants of concern identified in the March 2021 EPA correspondence, including specifically: 1,1-Dichlorethane; 1,2-Dichloroethane; 1,1-Dichlorethene; 1,2-Dichlorethene; 1,1,1-Trichloroethane; Benzene; Chloroform; Methyl ethyl ketone; Tetrachloroethene (perchloroethylene, PCE); Trichloroethylene (TCE); Dichloropropane; Dichloromethane; Vinyl chloride; and Carbon tetrachloride. (b) If the Veteran's prostate cancer is determined to be unrelated to his service and the environmental exposures therein, identify the etiology that is considered to be more likely (and explain why that is so). The examiner should include rationale with all opinions, citing to supporting factual data, medical principles, and medical texts or treatise, as deemed appropriate. The opinion must be expressed in terms of the standard of proof required in claims for VA compensation benefits (at least as likely as not [50 percent or better]), rather than the more stringent (conclusively cause) terms previously applied. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.