Citation Nr: 21023396 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-40 331 DATE: April 20, 2021 REMANDED Service connection for pheochromocytoma status post left adrenalectomy (herein pheochromocytoma). REASONS FOR REMAND The Veteran served on active duty from February 1966 to January 1968. The case is on appeal from a July 2013 rating decision. In November 2018, the Board remanded the case for additional development. When the case was in remand status, in a July 2020 rating decision, the RO granted service connection for hypertension and a gastrointestinal condition. As the benefits sought for those two issues were granted in full, they are no longer on appeal. Service connection for pheochromocytoma. In November 2018, the Board remanded this claim to afford the Veteran a VA examination and obtain a VA opinion addressing “whether it is at least as likely as not (50 percent or better probability) that the Veteran’s pheochromocytoma…(i) began during active service, or (ii) is etiologically related to his active service, to include herbicide exposure therein (notwithstanding the fact that it may not be a presumed association).” The Veteran was afforded a VA examination in November 2019 and a Hematologic and Lymphatic Conditions Disability Benefits Questionnaire (DBQ) was completed by Dr. H.S. The DBQ noted a diagnosis of pheochromocytoma status post laparoscopic left adrenalectomy. Dr. H.S. provided, by way of a marked checkbox, a negative direct service connection nexus opinion that “the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness.” The provided rationale stated in full: [Service Treatment Records (STRs)] do not contain any medical evidence to indicate that the [V]eteran’s pheochromocytoma began during active duty. Furthermore, The National Academy of Sciences, Engineering and Medicine in its 1994 report and other updates (including the most recent one in 2018) has NOT concluded that there is evidence of a positive association between exposure to herbicides used in Vietnam and pheochromocytoma. Therefore, the [V]eteran’s pheochromocytoma, [status post] laparoscopic adren[a]l[e]ctomy, is less likely than not related to environmental exposure(s) during active duty while serving in Vietnam. Upon review of this rationale, the Board finds that it is not entirely sufficient. The Board finds this opinion to be analogous to the one found inadequate by the United States Court of Appeals for Veterans Claims (Court) in Bailey v. O’Rourke, 30 Vet. App. 54 (2018). In Bailey, the Court stated, in the context of evaluating the adequacy of an opinion addressing whether brain cancer was directly related to herbicide agent exposure, that the “examiner’s opinion was inadequate as to the issue of direct service connection because the rationale was based solely on general articles and did not discuss any facts pertaining to [the Veteran’s] condition or individual circumstances, including any risk factors that may contribute to that particular type of cancer.” The Court additionally stated in Bailey that “[b]ecause the examiner did not provide any rationale for his opinion that was specific to [the Veteran’s] particular medical condition and circumstances, the Court finds the June 2010 medical opinion inadequate.” The Board also finds the opinion provided in this case to be analogous to one found inadequate by the Court in Polovick v. Shinseki, 23 Vet. App. 48 (2009). In Polovick, the Court stated, in the context of discussing an opinion addressing whether a brain tumor was directly related to herbicide agent exposure, that a negative opinion was “based solely on the fact that this disease is listed in the ‘Limited Evidence of No Association’ category in the 2002 Agent Orange Update.” The Court stated that “the Agent Orange Updates use only a general statistical analysis to determine whether a disease should be service connected on a presumptive basis” and that “[t]o permit the denial of service connection for a disease on the basis that it is not likely there is any nexus to service solely because the statistical analysis does not support presumptive service connection, would, in effect, permit the denial of direct service connection simply because there is no presumptive service connection.” In the current case, as to the issue of whether the Veteran’s pheochromocytoma was directly related to his in-service herbicide agent exposure, the November 2019 opinion was based solely on the fact that the National Academy of Sciences, Engineering and Medicine had not concluded that there was a positive association between exposure to herbicides used in Vietnam and pheochromocytoma. Stated differently, the rationale was not specific to the Veteran’s particular medical condition and circumstances, did not discuss any facts pertaining to the Veteran’s condition or individual circumstances and was based solely on general articles. This rationale is analogous to the opinions addressed and found to be inadequate by the Court in Bailey and Polovick. Accordingly, the Board finds that remand is warranted to obtain a new VA opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Finally, in light of the remand, outstanding VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records from July 2020. 2. Obtain an opinion from a medical professional that addresses the Veteran’s pheochromocytoma claim. If the medical professional determines that additional examination of the Veteran is necessary to provide an adequate opinion, such examination must be scheduled. The medical professional must provide an opinion addressing the following: Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s pheochromocytoma is related to his exposure to herbicide agents during his active service. The medical professional’s attention is invited to the Veteran’s report that, essentially, his VA doctors have told him that his pheochromocytoma is related to his in-service herbicide agent exposure. See July 2013 VA Form 21-4138 (referencing “my adrenal gland being removed in December 2011” and that VA Dr. P. “says that illness was a result of exposure to Agent Orange”); September 2013 VA Form 21-0958 (“The Long Beach VAMC has confirmed I have…adrenal gland problems…as a direct result of my service to the U.S. while in Vietnam”); September 2013 VA Form 21-4138 (“All of my doctors at Long Beach VAMC have all said all of my conditions are directly related to my exposure to Agent Orange”). (Continued on the next page)   For all opinions provided, the medical professional must include the underlying reasons for any conclusions reached. The provided opinion must address the particularized circumstances of the Veteran and not be based solely on general articles. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Hoopengardner, 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.