Citation Nr: 21073344 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-05 592A DATE: December 8, 2021 REMANDED Entitlement to service connection for prostate cancer is remanded. REASONS AND BASES FOR REMAND The Veteran served on active duty in the U.S. Army from May 1974 to May 1992. He also had a period of active duty for special work (ADSW) from February 1999 to August 1999 and additional service in the Army National Guard. His decorations include the Southwest Asia Service Medal and the Combat Infantryman Badge. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in St. Paul, Minnesota. The issue on appeal was previously before the Board in October 2019, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Entitlement to service connection for prostate cancer is remanded. When this case was remanded in October 2019, the Board requested that the Veteran be scheduled for an examination for prostate cancer. The examiner was to offer an opinion as to whether it was at least as likely as not that the Veteran's prostate cancer was related to an in-service injury, event, or disease, including exposure to chemicals in the Persian Gulf. In so doing, the Board noted than an April 2003 Persian Gulf Registry examination report noted that the Veteran had been exposed to chemicals during service. The Veteran was examined in December 2019. After examining the Veteran and reviewing the claims file, the examiner offered an unfavorable nexus opinion, finding that it was less than 50 percent likely that the Veteran's prostate cancer was related to in-service exposures. The examiner noted that the Veteran had reported that he was not claiming disability related to Agent Orange; that prostate cancer is a diagnosable chronic multi-symptom illness with a partially explained etiology; and that "[t]here is no supporting data in the [claims file] or subjective data that indicates that the claimed condition is related to a specific event of exposure experienced by the Veteran." The Board finds the December 2019 opinion inadequate for purposes of adjudication. Specifically, although the examiner broadly concluded that there was no supporting data to relate the Veteran's prostate cancer to service, the examiner did not discuss the specific in-service chemical exposures outlined in the claims file, which have been identified as exposure cleaning agents, solvents, petrochemical substances, chemical agent resistant compound (CARC), and insect repellent. See April 2003 Persian Gulf Registry examination. The Veteran has also alleged exposure to chemicals from SCUD missiles. Because the examiner did not discuss any of the Veteran's reported exposures with specificity, the Board finds the rationale lacking. Further development is necessary. This matter is REMANDED for the following action: 1. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed, arrange to have a clinician with appropriate experience review the claims file. After reviewing the record, the examiner should offer an opinion as to whether the signs and symptoms associated with the Veteran's prostate cancer are most consistent with: (a) an undiagnosed illness, (b) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, (c) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (d) a disease with a clear and specific etiology and diagnosis. If it is the examiner's conclusion that the Veteran's disability pattern with respect to the signs and symptoms at issue is most consistent with a diagnosable chronic multi-symptom illness with a partially explained etiology, or a disease with a clear and specific etiology and diagnosis, the examiner should offer a further opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's prostate cancer had its onset in, or is otherwise attributable to, service, to include as due to in-service chemical exposures. In so doing, the examiner should comment on the medical significance, if any, of the fact that the Veteran complained of having "pain in urine" during an in-service examination in August 1981. The examiner should also consider the specific in-service chemical exposures outlined in the claims file, which have been identified as exposure to cleaning agents, solvents, petrochemical substances, chemical agent resistant compound (CARC), and insect repellent. The examiner should further consider the Veteran's report of exposure to chemicals from SCUD missiles. See, e.g., April 2003 Persian Gulf Registry examination. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinions. A complete medical rationale for all opinions expressed must be provided. If the examiner cannot provide an opinion without resort to speculation, he or she must provide an explanation as why that is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of the need for additional information, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to a particular question. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board F. H. Lanton, 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.