Citation Nr: 21074733 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 14-34 232A DATE: December 16, 2021 REMANDED Entitlement to service connection for renal calculi of the kidneys is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to August 1973. This matter returns to the Board of Veterans' Appeals (Board) following the issuance of a Board remand decision in June 2021 which directed the Regional Office (RO) to undertake additional development. 1. Entitlement to service connection for renal calculi of the kidneys is remanded. The Veteran is seeking service connection for renal calculi of the kidneys, which he attests is due to exposure to toxic herbicides while he was stationed in Thailand. Importantly, the Veteran has been previously found to have been exposed to toxic herbicides. This matter was remanded by the Board in June 2021 including for the provision of a new VA examination to determine the etiology of the Veteran's claimed disorder. In the resulting examination opinion issued in July 2021, the examiner opined that the Veteran's renal calculi of the kidneys was less likely than not related to his conceded exposure to toxic herbicides, noting that Agent Orange, specifically, is not the established primary etiology of renal calculi of the kidneys according to the medical literature. While the June 2021 remand specifically asked the examiner to discuss Agent Orange, it was one of many toxic herbicides used by the military and should not have been the only considered cause by the examiner. Additionally, in opining that the Veteran's renal calculi of the kidneys was unrelated to service, to include due to toxic herbicide exposure, the examiner noted only that medical literature did not support such a finding. The United States Court of Appeals for Veteran's Claims (the Court) has held that nexus opinions premised on the absence of general medical literature supporting nexus without discussing the specific facts of the case are inadequate. Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018). In light of above, the Board concludes that the VA opinions are inadequate because the examiner's rationale was premised on the absence of general medical literature supporting nexus without discussing the specific facts of this Veteran's case. Id.; Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). Moreover, the examiner's opinion and brief rationale does not provide enough information for the Board to consider both presumptive service connection and direct service connection for the Veteran's claimed disorder, or delineate that the examiner was discussing either or both possibilities. The July 2021 examiner's opinion is inadequate for the purposes of adjudication by the Board. Finally, the RO identified that the July 2021 examiner's opinion and rationale were not adequate and requested an updated opinion and rationale from the examiner. The examiner provided an addendum opinion that was identical to their original opinion, including the lack of an adequate rationale. Thus, the Board determines that a remand is necessary for the Veteran's renal calculi of the kidneys claim so that an addendum opinion can be sought. The matters are REMANDED for the following action: 1. Invite the Veteran to submit any evidence in support of his claim. 2. The RO should obtain an addendum opinion from an appropriate clinician, other than the July 2021 examiner, to address the etiology of the Veteran's renal calculi of the kidneys. The complete claims file should be made available to the examiner. The examiner should provide opinions as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's renal calculi of the kidneys are etiologically related to the Veteran's period of service, to include as due to exposure to toxic herbicides. The examiner's rationale should discuss the etiology of the claimed disorder based on direct and/or presumptive bases. The examiner is reminded that the Veteran has been presumed to have been exposed to toxic herbicides. Moreover, the conceded exposure is not only limited to Agent Orange. It is noted that the fact that renal calculi of the kidneys is not on the list of diseases presumptively associated with toxic herbicide exposure is not a sufficient rationale. All opinions should be accompanied by adequate reasons and bases. If the examiner cannot provide the requested opinion without resorting to mere speculation, they should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that they have exhausted the limits of current medical knowledge in providing an answer to that particular question(s). B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor