Citation Nr: 21069522 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 14-10 127 DATE: November 18, 2021 REMANDED Entitlement to service connection for liver cyst as secondary to service-connected COPD is remanded. Entitlement to service connection for pancreatic cyst as secondary to service-connected COPD is remanded. Entitlement to service connection for renal cyst as secondary to service-connected COPD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1960 until October 1963. In March 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been advanced on the Board's docket pursuant to 38C.F.R. §20.902 (c). 38U.S.C. §7107 (a)(2). This appeal was most recently before the Board in September 2021 when it was remanded for addendum etiology opinions. For the reasons described below, there has not been substantial compliance with the remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for liver cyst as secondary to service-connected COPD is remanded. Entitlement to service connection for pancreatic cyst as secondary to service-connected COPD is remanded. Entitlement to service connection for renal cyst as secondary to service-connected COPD is remanded. The claims must be remanded again because the September 2021 VA opinion is inadequate. Despite specific instructions as to the correct legal standard for aggravation, the opinion provider again used the incorrect legal standard of aggravation beyond the natural progression of the disease. The correct legal standard for aggravation in this circumstance is any increase in disability. On remand, addendum etiology opinions that apply the correct legal standard and are otherwise adequate for adjudication must be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician other than the July 2021 and September 2021 opinion provider on the likely etiology of the liver, pancreas, and kidney cyst conditions, to include whether secondary to his service-connected COPD. The opinion provider should be provided a copy of all pertinent documents, including the studies submitted by the Veteran's representative in April and June 2021. The examiner must answer the following: a. For each disability, is it at least as likely as not that the (i) liver cyst, (ii) pancreatic cyst, and (iii) kidney cyst is caused by his service-connected COPD? b. For each disability, is it at least as likely as not that the (i) liver cyst, (ii) pancreatic cyst, (iii) kidney cyst is aggravated by (any increase in disability) his service-connected COPD? In answering the above, the opinion provider must consider, and discuss as appropriate, the medical literature submitted by the Veteran in April and June 2021. All provided opinions must be supported by complete rationale. Any opinion that applies a legal standard for aggravation other than any increase in disability will be inadequate and further delay adjudication of the claim. If the opinion provider determines that a requested opinion cannot be made without resort to speculation, they must state why. Specifically, they must state whether the inability to provide an opinion is due to specific medical or other scientific studies that have concluded the condition is not proximately due to or aggravated by COPD or if the insufficient support is due to a lack of studies in the subject area. 2. Confirm that the obtained medical opinions comport with this remand. Specifically, verify that the opinion provider used the correct legal standard for aggravation in this circumstance, which is any increase in disability. The opinion form may contain the incorrect definition for aggravation. If the incorrect aggravation standard is used or if the opinion is otherwise inadequate, obtain an addendum prior to readjudicating the claim. After adjudicating the claim, return the matter to the Board for further appellate review, if appropriate. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.