Citation Nr: 21021250 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 17-58 731 DATE: April 12, 2021 REMANDED Entitlement to service connection for left breast lobular cancer, to include as secondary to service-connected prostate cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1955 to May 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). The Veteran contends his left breast lobular cancer is related to his exposure to herbicide agents. In a March 2021 Informal Hearing Presentation (IHP), the Veteran asserted an alternative theory that his left breast cancer was due to his service-connected prostate cancer. The Board notes herbicide agent exposure is established, and the Veteran’s medical records indicate that he has diagnoses of left breast lobular cancer and prostate cancer. After careful review of the record, the Board finds several references to possible metastasis of the Veteran’s prostate cancer. For example, a July 2008 treatment note indicates the Veteran was evaluated for metastases of his prostate cancer. Dr. J.V. noted increased activity on the whole-body images within the mediastinum and could not exclude nodal metastatic disease. Further, in a subsequent July 2008 treatment note, Dr. J.V. noted evidence of sclerotic metastases. As there is an indication that the Veteran's service-connected prostate cancer may have metastasized, an examination is necessary. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (VA is obliged to provide an examination where there is insufficient information to decide the claim and there is an indication the current disability may be associated with service). The Board notes the Veteran also contends herbicide agent exposure caused his left breast lobular cancer. Left breast lobular cancer is not listed in 38 C.F.R. § 3.309(e) as diseases associated with exposure to herbicide agents and there is currently no competent evidence that suggests the Veteran’s left breast lobular cancer may be associated with herbicide agent exposure and his lay assertion that such a link exists is insufficient to trigger VA's duty to assist through the provision of a nexus opinion. See Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician to determine whether the Veteran’s left breast lobular cancer is related to his military service. If the examiner determines that an in-person examination is required, one should be scheduled. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the left breast lobular cancer is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran's service-connected prostate cancer. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the left breast lobular cancer prior to aggravation by the service-connected prostate cancer. Please note, causation and aggravation are separate concepts and must be addressed independently of each other. The examiner is advised that if a negative opinion is provided for the secondary service connection claim, the rationale provided must go beyond noting that left breast lobular cancer was diagnosed before prostate cancer was diagnosed as there is no requirement in VA regulation that the primary disability must be diagnosed prior to the secondary disability in order to establish entitlement to service connection on a secondary basis. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. K. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zachery S.C. Luce, 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.