Citation Nr: 21023264 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-10 876 DATE: April 20, 2021 REMANDED Entitlement to service connection for aortic abdominal aneurysm, to include as due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran served with the United States Army from September 1968 to April 1971. This matter was previously remanded by the Board of Veterans’ Appeals (Board) in October 2018. The Board’s October 2018 remand directives and the subsequent actions of the agency of original jurisdiction (AOJ) will be discussed below. The Veteran’s appeal has been returned to the Board for further appellate consideration.    Entitlement to service connection for aortic abdominal aneurysm, to include as due to Agent Orange exposure, is remanded. Although the additional delay is regrettable, the Board finds that remand is, once again, necessary. In particular, a remand is required to obtain an adequate medical opinion. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Moreover, the Court of Appeals for Veterans Claims (Court) has held “that a remand by this Court or the Board confers on the veteran or other claimant, as a matter of law, a right to compliance with the remand orders.” Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, compliance with the terms of the remand is necessary prior to further appellate review, and if not, “the Board itself errs in failing to ensure compliance.” Id. The Board previously remanded this matter in October 2018 for further development, including a VA examination. Regarding the VA examination, the examiner was directed to opine whether the Veteran’s aortic adnominal aneurysm had onset in, or was otherwise related to, active military service. Following the Board remand, the Veteran was afforded a VA examination in July 2020. The examiner concluded the Veteran’s aortic abdominal aneurysm was less likely than not incurred in or caused by the claimed in-service injury, service, or illness. The examiner reasoned that given the Veteran’s 41-year separation from service before symptoms or care, no nexus was reasonable. Further, the examiner noted that Veteran’s treatment records reflected a diagnosis of an aortic abdominal aneurysm in 2012 with following and acute concern in 2016 when an endograft was placed. See July 2020 VA examination. The Board finds that the examiner’s rationale regarding service connection is conclusory, with no discussion of the medical principles involved nor discussion of the Veteran’s medical history. The examiner was instructed to consider the in-service complaints of cramping, stomach burning, and upper gastrointestinal pain in formulating the opinion, but the examiner did not address these records in the opinion. In addition, the opinion relies in part on an inaccurate factual predicate. The examiner relied on the Veteran’s 2012 diagnosis for his negative nexus opinion reasoning that the Veteran had a 41-year separation from service before exhibiting symptoms or care for his aortic abdominal aneurysm. However, the Veteran was initially diagnosed with an aortic abdominal aneurysm in March 2010. Additionally, a September 2011 ultrasound reflects history of abdominal aortic aneurysm, with aneurysm documented on ultrasound. This opinion lacks sound reasoning and is partially based on an inaccurate predicate; therefore, the examination lacks probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the probative value of a medical opinion is derived from its factually accurate, fully articulated, and sound reasoning for the conclusion); Reonal v. Brown, 5 Vet. App. 458 (1993) (noting that a medical opinion based on an inaccurate factual predicate lacks probative value). Moreover, the July 2020 examiner also did not address the Veteran’s contention that he believed his abdominal aortic aneurysm is potentially related to his exposure to Agent Orange. See February 2016 Form 9. The Veteran’s military personnel records reflect service in the Republic of Vietnam from May 1969 to April 1971. See DD-214 Form. Accordingly, the Veteran is entitled to the presumption of exposure to Agent Orange. While the Board notes that an abdominal aortic aneurysm is not on the list of diseases enumerated in 38 C.F.R. § 3.309(e) for which presumptive service connection is warranted based on herbicide exposure, this does not preclude a claimant from establishing service connection for the claimed disorder on a direct basis, to include as due to exposure to herbicides. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). As such, a remand is needed for an addendum opinion which adequately address’s the Veteran’s contentions that his aortic abdominal aneurysm was due to his exposure to Agent Orange. The matter is REMANDED for the following action: Forward the claims file to a VA clinician to obtain an addendum opinion regarding the etiology of the Veteran’s aortic abdominal aneurysm. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. The examiner must provide an opinion as to whether it is at least as likely as not that the Veteran’s aortic abdominal aneurysm was related to an in-service injury, event, or disease, including conceded exposure to Agent Orange while stationed in Vietnam. In formulating the opinion, the examiner should specifically consider and address the complaints of cramping, stomach burning, and upper gastrointestinal pain contained in the service treatment records and the treatment records noting abdominal aortic aneurysm as early as 2010. The examiner should further note the Board concedes Agent Orange exposure as the Veteran served in the Republic of Vietnam. See DD-214 Form. In considering whether herbicide exposure caused the Veteran’s aortic abdominal aneurysm, please keep in mind that the mere fact that VA has not included a certain diagnosis on a list of presumptive conditions is not, in and of itself, a sufficient rationale for finding that the condition is not related to service. In other words, the Board needs opinions as to the likelihood that the Veteran’s aortic abdominal aneurysm, without regard to the conditions VA recognizes as being due to herbicide exposure, were nevertheless at least as likely as not related to his exposure to herbicides in Vietnam. The examiner must provide the complete rationale for all opinions expressed. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Emily A. Kotroco 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.