Citation Nr: 21072750 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 16-02 832 DATE: December 6, 2021 REMANDED Entitlement to service connection for vasculitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1967 to September 1970, including service in the Republic of Vietnam. The Board sincerely thanks the Veteran for his honorable service to the United States. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). It was previously before the Board in May 2020, when it was remanded to afford the Veteran a VA examination. In July 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. 1. Entitlement to service connection for vasculitis is remanded. Unfortunately, there has not been substantial compliance with the Board's remand directives. Another remand is warranted. At the May 2021 VA examination, the Veteran reported exposure to agent orange and reported rashes on his legs and feet. The examiner noted that the Veteran's medications include Eliquis. The examiner stated that the Veteran does not have a diagnosis of vasculitis, and opined that it is, therefore, less likely than not that the Veteran's vasculitis is less likely than not due to service. As the examiner did not consider the Veteran's July 2013 diagnosis of vasculitis, the RO returned the opinion to the clinician for an addendum opinion considering the Veteran's July 2013 diagnosis and providing a complete rationale regarding whether the Veteran's vasculitis is etiologically related to service, including herbicide exposure, or whether it is proximately due to, a result of, or aggravated by, a service-connected disability. In a June 2021 addendum opinion, the clinician stated that the exact cause of vasculitis is unknown, but "more than likely due to: genetic makeup of the patient; immune system disorders such as rheumatoid arthritis and lupus; certain infections, for example hepatitis B and C; cancers of the blood; reactions to certain drugs; or smoking." The clinician opined that the Veteran's vasculitis is less likely due to service or exposures in service, and less likely related to exposure to herbicide agents. The clinician stated that there is no evidence that the Veteran's vasculitis has been aggravated, reasoned that the only documentation of current treatment in his file was in July 2013, and opined that aggravation is less than likely. While the June 2021 rationale identifies general factors in the development of vasculitis, the impact of such factors specific to the Veteran is not provided. The clinician did not indicate whether the Veteran has an immune system disorder, an infection such as hepatitis B or C, cancer of the blood, smokes, or whether he takes a medication that may cause vasculitis. The June 2021 addendum opinion states only a general proposition and does not suggest that it applies to the Veteran in this case. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (holding that, in the context of claims asserting service connection for a non-presumptive condition based on herbicide agent exposure, an adequate medical opinion must provide a rationale specific to a Veteran's particular condition and circumstances). While the clinician opined as to whether the Veteran's vasculitis is aggravated by a service-connected disability, the rationale was based upon the absence of treatment records. The mere absence of treatment records should not be the primary basis for a negative opinion. See, e.g., Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007) (noting that an examiner cannot rely on the absence of medical records corroborating an injury to conclude that there is no relationship between a veteran's current disability and his military service (citing Smith v. Derwinski, 2 Vet. App. 137, 140 (1992)). Furthermore, the examiner did not address whether the Veteran's vasculitis is due to a service-connected disability. Accordingly, remand is warranted to obtain a new medical opinion. The matter is REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disorder on appeal. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records, to include from: Dr. Hans Weber, High Desert Medical Corporation, 43839 15th St W, Lancaster, CA, 93534, (661) 945-5984. Dr. Anil Kumar, Kumar Medical, 44215 15th St W Ste. 215, Lancaster, CA, 93534, (661) 940-8777. Dr. Jaerajah T Sri, 9278 N Loop Blvd, California City, CA 93505, (760) 373-4809 2. After the action requested in paragraph 1 above is complete, please refer the claim to a clinician for a nexus opinion as to the nature and etiology of the Veteran's vasculitis, as diagnosed in July 2013. The Veteran's claims-file must be made available to and reviewed by the clinician. Based on review of the record, the clinician is requested to provide an opinion as to the following: (a.) Is the Veteran's vasculitis at least as likely as not (a 50 percent or greater probability) related to herbicide exposure in service? (b.) Is the Veteran's vasculitis at least as likely as not (a 50 percent or greater probability) otherwise related to service? (c.) Is the Veteran's vasculitis at least as likely as not (a 50 percent or greater probability) caused by a service-connected disability [the Veteran has established service connection for valvular heart disease (aortic stenosis), atrial fibrillation (heart murmur), hypertension, peripheral vascular disease of the bilateral lower extremities, PTSD with alcohol dependence, chloracne, obstructive sleep apnea, lumbar strain with degenerative disc disease, bilateral lower extremity radiculopathy, tinnitus, and bilateral sensorineural hearing loss] or treatment thereof? (d.) Is the Veteran's vasculitis at least as likely as not (a 50 percent or greater probability) aggravated by a service-connected disability or treatment thereof? The clinician is advised that there is no legal requirement that the in-service event or injury must be the sole cause of the disorder claimed. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the nature and etiology of the vasculitis. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O. Halpern 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.