Citation Nr: 21076859 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 15-28 532 DATE: December 28, 2021 REMANDED Entitlement to service connection for prostate cancer, with resulting kidney and urinary-tract disorders, to include as a result of exposure to toxic chemicals, is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD)/hiatal hernia with thickening antrum, to include as a result of exposure to toxic chemicals, is remanded. REASONS FOR REMAND In June 2021, the Board remanded the Veteran's service connection claims to ensure compliance with VA's duty to assist due to inadequacies in previously obtained opinions. Unfortunately, the post-remand, September 2021 opinions are also inadequate for VA adjudication purposes. Initially, the Board notes the rationales provided by the September 2021 examiner are somewhat incoherent, switching back and forth between references to the claimed disabilities without a clear rationale regarding either claim. Regarding the service connection claim for prostate cancer, with kidney and urinary-tract disorders, the examiner noted the Veteran's "unprotected exposure to DS2, STB, and other unknown chemicals" and subsequently cited a "List of Chemicals Known to Cause Cancer or Reproductive Toxicity" but did not discuss whether any chemical to which the Veteran was allegedly exposed appears on such list. The Board may not base a decision on its own unsubstantiated medical conclusions; therefore, it is imperative that the expert evidence in this case analyze the Veteran's alleged exposures in the context of the current state of research into cancer causing agents with a well-articulated rationale to support the conclusions reached regarding the Veteran's claim. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). In addressing the second claim for service connection for GERD, the examiner, under the same positive opinion statement, explained in her rationale hiatal hernia was diagnosed in 2001 "while on active duty," the thickening antrum and GERD resulted from this, thereby making it more likely the result of hiatal hernia "that occurred on active duty." The Board notes 2001 is not an active-service year for the Veteran and this opinion is therefore based on an inaccurate reading of the record. In sum, the September 2021 opinions are inadequate to make an informed decision on the Veteran's claims because they do not include a well-articulated rationale based on an accurate factual history of the claimed disabilities, requiring a remand to ensure compliance with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Contact the Veteran and/or his representative for information pertaining to any current treatment for prostate cancer, with resulting kidney and urinary-tract disorders, and GERD/hiatal hernia with thickening antrum at any VA facility and by any private treatment provider. Obtain any records of the above treatments not yet associated with the claims file and associate them with the claims file. The assistance of the Veteran and/or his representative should be requested in obtaining any records of recent treatment as indicated. All attempts to obtain records should be documented in the claims file. 2. After completing the development above, arrange for review of the claims file by an examiner(s), other than the VA examiners who produced the September 2021 and October 2019 opinions, with appropriate specialties for producing findings for prostate cancer, with resulting kidney and urinary-tract disorders, and GERD/hiatal hernia. The complete electronic claims file must be made available to the examiner(s) in conjunction with the review. The examiner(s) should detail all findings. If the examiner(s) deems a new VA examination to be necessary, arrange for that examination(s). The examiner(s) is requested to render opinions addressing the following: a. Whether it is at least as likely as not (a 50 percent or greater probability) prostate cancer, with kidney and urinary-tract disorders, was incurred during active service or is caused by an event, injury or illness occurring in active service, to include exposure to DS2 decontaminant and/or any other toxic chemical or substance to which the Veteran might have been exposed. b. Whether it is at least as likely as not (a 50 percent or greater probability) GERD)/hiatal hernia with thickening antrum was incurred during active service or is caused by an event, injury or illness occurring in active service, to include exposure to DS2 decontaminant and/or any other toxic chemical or substance to which the Veteran might have been exposed. The examiner is requested to use the exact language and terminology as stated above in response to the questions, as deviation from such language and terminology or the use of equivocal language such as "not related to" and similar phrases have been held on appeal to the Board's reviewing court to be an incorrect evidentiary standard for VA adjudication purposes. The examiner is advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. Each opinion rendered by the examiner must be accompanied by a rationale, by which conclusions are supported by references to and discussion of findings on examination, to clinical findings in the medical evidence of record and/or to accepted medical literature. The examiner is requested to comment on any relevant opinions found in the record. L. S. Kyle Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Franke, 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.