Citation Nr: 21077087 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 08-07 529 DATE: December 28, 2021 REMANDED Entitlement to service connection for residuals of a neck tumor excision is remanded. REASONS FOR REMAND The Veteran had active service in the Army from April 1973 to September 1976. He also served in the Air National Guard from August 1977 to August 1978. The appeal originates from a November 2008 decision of a Department of Veterans Affairs (VA) Regional Office. The Veteran appeared for a hearing before the undersigned in April 2015. The matter was remanded in July 2019, June 2020, and July 2021 to comply with a Joint Motion for Remand entered in November 2018. The previously remanded issues of service connection for vertigo and chronic otitis externa were granted in a September 2021 rating decision and are no longer before the Board. The July 2021 remand included the instruction to obtain an addendum opinion regarding whether a neck tumor was related to in-service exposures insecticides and pesticides (other than herbicide agents (Agent Orange)) or caused or aggravated by any service-connected disability. As the examiner identified glucose intolerance as a risk factor for the development of lipoma, the Board specified that the relationship between diabetes mellitus and a neck tumor needed to be addressed. An opinion was obtained in September 2021. The examiner opined that a neck tumor was less likely as not related to service or caused or aggravated by any service-connected disability. A full explanation as to the relationship between diabetes mellitus and lipoma was not provided. Instead, the examiner reiterated that glucose intolerance is a risk factor for the development of lipoma and acknowledged that the Veteran had diabetes mellitus. Yet the examiner's rationale only addresses aggravation and does not explain why the neck tumor was not caused by diabetes mellitus. Accordingly, a new opinion must be obtained. The matter is REMANDED for the following action: Provide the Veteran's file to a physician with the appropriate knowledge and expertise to opine on a neck tumor. The examiner is asked to address the following: 1. Is it at least as likely as not that a neck tumor disability (lipoma) had its onset in or is otherwise etiologically related to active service, including exposure to insecticides and pesticides (separate from herbicides)? 2. Is it at least as likely as not that a neck tumor disability (lipoma) was caused by any service-connected disability, including type II diabetes mellitus? The examiner should address the medical literature referenced in the September 2021 VA opinion indicating that glucose intolerance is a risk factor for the development of lipoma. 3. Is it at least as likely as not that a neck tumor disability (lipoma) underwent any incremental increase in disability, regardless of its permanence, due to any service-connected disability, including type II diabetes mellitus? MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alhinnawi 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.