Citation Nr: 21074392 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-05 286 DATE: December 15, 2021 REMANDED Entitlement to service connection for prostate cancer, to include as a result of Gulf War service, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1978 to February 1986, from February 2003 to August 2003, and from January 2005 to December 2005, with additional service in the Reserves The Board most recently remanded the claim in May 2021 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran contends that his prostate cancer is related to his active service in Kuwait when he was exposed to burn pits, oil well flares at ground level, and carcinogens in the sand itself. See May 2015 Notice of Disagreement and September 2019 Board hearing. The Veteran's representative argues that medical opinions obtained on remand are inadequate and the Board agrees. That rationale for the both the June 2021 and August 2021 opinions are based, in part, on the fact that the service treatment records (STRs) were silent regarding the Veteran's prostate cancer. The August 2021 addendum concluded that, according to the American Cancer Society, the current cause of prostate cancer is unknown. Neither opinion addressed the specific facts of this Veteran's case. That is, his conceded exposure to burn pits during service in Southwest Asia. The August 2021 opinion considered the Veteran's age the pertinent risk factor. The opinions did not respond to the specific remand directive to explain why their previous finding that medical literature shows there is inadequate/insufficient evidence to determine an association between the exposure and cancer is the same as there being "no association." Neither opinion addressed specific articles submitted by the Veteran in support of his claim. See May 2015 submission. The matters are REMANDED for the following action: Obtain an addendum opinion, preferably a different examiner than the June 2021 and August 2021 examiner, regarding the likely etiology of the Veteran's diagnosed prostate cancer. Copies of all pertinent records should be made available to the examiner for review. Based on a review of the record, the examiner should provide opinions as to the following: Is it at least as likely as not that the Veteran's prostate cancer is related to his service, to include as due to chemical exposure during his Persian Gulf Service? Why or why not? The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. In providing the opinion, the examiner must consider and address: The medical evidence submitted by the Veteran, (i) USA Today article dated May 2011 titled, "Navy researcher links toxins in war-zone dust to ailments"; (ii) article from U.S. Army Center for Health Promotion and Preventive Medicine titled, "Particulate Matter (PM) Air Pollution Exposures During Military Deployments"; (iii) April 2015 article from the National Academies titled, "Evidence Inconclusive About Long-Term Health Effects of Exposure to Military Burn Pits"; (iv) PowerPoint slide-deck from National Jewish Health titled, "Respiratory Health Effects from Particulate Matter Exposures in SWA." As well as the Veteran's lay evidence, (v) May 2015 Notice of Disagreement, and (vi) September 2019 Board Hearing. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. E. Bresler 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.