Citation Nr: 21007889 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 15-18 872A DATE: February 11, 2021 REMANDED Entitlement to service connection for primary thrombocythemia, arthritis thrombocytosis (leukemia) with bone marrow infection and erysipelas (blood disorder), to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1967 to November 1969, to include service in Korea from September 1968 to November 1969. This matter comes before the Board of Veterans Appeals (Board) on appeal from a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in June 2020 and December 2018 when it was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. Herbicide agent exposure in Korea was conceded in the June 2020 Board decision. Prior to adjudication of the issue on appeal additional development is needed. The matter was previously remanded by the Board in June 2020 for a VA examination. The Veteran received a VA examination in August 2020. The examiner provided a negative opinion. However, the examiner noted there was no evidence of the claimed thrombocytosis and that the correct diagnosis was polycythemia vera. The Veteran’s private treatment records show a diagnosis of thrombocytosis as recently as August 2019. See Medical Treatment Record – Non-government facility, received September 2019. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Accordingly, the matter must be remanded for an additional opinion to clarify the Veteran’s diagnoses and determine if his conditions are related to his active duty service. The matters are REMANDED for the following action: Obtain an addendum opinion to determine the nature and etiology of the Veteran’s primary thrombocythemia, arthritis thrombocytosis (leukemia) with bone marrow infection and erysipelas (blood disorder). Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. After examining the Veteran—if deemed necessary by the examiner—and considering his pertinent medical history and lay statements regarding his reported symptoms, the examiner should clarify: (a) What the Veteran was diagnosed with during the appellate period, to include primary thrombocythemia, arthritis thrombocytosis (leukemia) with bone marrow infection, erysipelas (blood disorder), and polycythemia vera; and (b) Whether it is at least as likely as not (a 50 percent probability or greater) that his primary thrombocythemia, arthritis thrombocytosis (leukemia) with bone marrow infection, erysipelas (blood disorder), and polycythemia vera was incurred in, aggravated by, or etiologically related to his military service, to include as due to the conceded herbicide agent exposure. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Javed 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.