Citation Nr: A21019075 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 210127-133171 DATE: November 30, 2021 REMANDED Entitlement to service connection for esophageal adenocarcinoma, to include as caused by exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1965 to August 1968, to include verified service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in December 2020. The Veteran selected the Direct Review lane without a Board hearing under the Appeals Modernization Act (AMA) by submitting a VA Form 10182 (Decision Review Request: Board (Notice of Disagreement)) in January 2021. Accordingly, the Board's current review is limited to the evidence at the time of Agency of Original Jurisdiction's (AOJ's) December 2020 rating decision. Entitlement to service connection for esophageal adenocarcinoma, to include as caused by exposure to herbicide agents, is remanded. Under the AMA, remand is permissible only for: (a) correction of pre-decisional duty-to-assist errors, to include examinations and medical opinions; and (b) correction of an AOJ error in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802. VA has a duty to assist a claimant in the development of a claim. This duty includes assisting the claimant in the procurement of relevant treatment records and providing an examination when necessary. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA is obligated to provide an examination or obtain a medical opinion in a claim of service connection when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for finding a link between current disability and service is low. McLendon, 20 Vet. App. at 83. The Veteran's reports of a continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service. Id. The Veteran has a current diagnosis of esophageal adenocarcinoma. He asserts that his esophageal cancer is related to his active duty service, including as caused by exposure to herbicide agents. His exposure to herbicide agents has been conceded based on his service in the Republic of Vietnam. See 38 C.F.R. § 3.307(a)(6)(iii). The Veteran submitted a letter by J.M., M.D., in December 2020, prior to the promulgation of the rating decision on appeal. In her letter, Dr. M. confirmed that the Veteran has a diagnosis of esophageal adenocarcinoma. She also noted that the Veteran underwent an esophagectomy in March 2020, and his cancer has been in remission since that procedure. She stated that several studies have indicated a potential association between exposure to dioxins and malignancies of the gastrointestinal sites, including esophageal cancer. The Veteran has presented evidence of a current disability that may be related to his active duty service. Thus, the low threshold for VA to offer an examination has been met. See McLendon, 20 Vet. App. at 83. The RO's failure to provide such an examination constitutes pre-decisional duty-to-assist error; therefore, a remand is warranted to obtain a VA examination and medical opinion. See 38 C.F.R. § 20.802. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his esophageal adenocarcinoma. The entire claims file, including a copy of this remand, must be made available to the examiner, and such review should be noted in the examination report. The examiner is asked to opine as to whether the Veteran's esophageal adenocarcinoma is at least as likely as not (a 50 percent or greater probability) that the Veteran's esophageal adenocarcinoma is related to his active duty service, to include his conceded exposure to herbicide agents. The examiner must provide a comprehensive rationale for the proffered opinion, including a discussion of the studies cited by Dr. J.M. in her December 2020 letter. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. The examiner is also advised that a negative etiology opinion may not rest on the fact that esophageal adenocarcinoma is not on the list of diseases presumptively related to herbicide agent exposure in 38 C.F.R. § 3.309(e). If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Pratt 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.