Citation Nr: 21014236 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-42 582 DATE: March 11, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1956 to June 1981. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran died in April 2013. The appellant is the Veteran’s surviving spouse. This issue was previously before the Board in May 2016, when it was remanded to provide the appellant with a Board hearing. The appellant testified before the undersigned Veterans Law Judge in a March 2019 hearing. The case returned to the Board in October 2020, when it was remanded for further development. That development was completed, and the case has since been returned to the Board for appellate review. Entitlement to service connection for the cause of the Veteran's death is remanded. Remand is required for substantial compliance with the October 2020 Board remand directives, and for an addendum VA medical opinion. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. 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). When a Veteran has provided competent lay statements of an in-service injury, the examiner must consider and address them when developing his rationale. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that when the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The RO obtained a medical opinion in December 2020 where the examiner opined that the colon cancer is at least as likely as not as a contributing cause of death. The examiner explained that the Veteran was diagnosed with colon cancer and treated with oral Xeloda. The examiner noted that the Veteran had complications of treatment consisting of ileus, diarrhea, renal failure, and lactic acidosis. The examiner explained that chemotherapy puts the body at risk for infections due to an immunocompromised disease state. The examiner stated that the cause of death was sepsis which is an infection of the blood stream, and that treatment of the colon cancer allowed an increased susceptibility to infection. Regarding service connection on a direct basis, the examiner provided a negative nexus opinion. The examiner explained that the Veteran was diagnosed with colon cancer in 2013, many years after service, and is unrelated. However, the examiner failed to provide any other supporting rationale. Regarding service connection secondary to the service-connected residuals of prostate cancer, the examiner also provided a negative nexus opinion. The examiner explained that the conditions of colon cancer and prostate cancer are not medically related, and that colon cancer is a separate entity entirely from the prostate cancer. The examiner stated that a thorough review of the medical literature failed to demonstrate a causal relationship, and that the Veteran’s claims folder is also silent for metastatic prostate cancer. The examiner explained that the Veteran was diagnosed with colon cancer in 2013 with lymph node metastases, and that this is a primary cancer, and not caused or aggravated by the resolved prostate cancer. The October 2020 Board remand directed the examiner to address both the 2013 private medical opinion, and the appellant’s March 2019 Board hearing testimony. The examiner failed to address these. Accordingly, remand is required for an addendum VA medical opinion. The matters are REMANDED for the following action: Obtain a medical opinion. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. (a) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that colon cancer had onset in, or is otherwise related to, active service. (b) The examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the colon cancer was caused by the service-connected residuals of prostate cancer. (c) The examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the colon cancer was aggravated by the service-connected residuals of prostate cancer. (d) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed colon cancer and/or prostate cancer was an immediate or underlying cause of death, etiologically related to the cause of death, or a contributory cause of death. (e) The examiner must address the following: 1) the appellant’s March 2019 Board hearing testimony; and 2) the November 2013 private medical opinion. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rogos 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.