Citation Nr: 21025781 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-19 637 DATE: April 29, 2021 REMANDED Entitlement to service connection for a prostate disorder, to include as due to exposure to agent orange, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from April 1967 to November 1970 and from January 1971 to November 1977. He also had service in the Army National Guard. The Veteran’s decorations include the Purple Heart and Combat Infantryman Badge. This matter comes to the Board of Veterans’ Appeals (the Board) on appeal from a June 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in October 2018 and August 2020 for further development. Unfortunately, as explained below, the Board is not satisfied that there was substantial compliance with its most recent remand; therefore, the appeal must once again be remanded.  See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008).   Entitlement to service connection for a prostate disorder, to include as due to exposure to agent orange, is remanded. The Veteran seeks entitlement to service connection for a prostate disorder, which has been diagnosed as benign prostatic hyperplasia (BPH), which he generally contends is due to his military service. Pursuant to the August 2020 remand, the RO obtained an addendum medical opinion in February 2021. In the remand, the Board specifically instructed that a medical opinion be obtained to address the nature and etiology of the Veteran’s BPH, to include as due to agent orange exposure. Upon examination, the VA examiner opined that the Veteran's BPH is less likely than not incurred in or caused by the Veteran’s active service, to include as due to exposure to agent orange. The examiner opined that the Veteran’s BPH was due to normal aging. To support this finding, the examiner explained that BPH is “ubiquitous in the aging male, with worldwide autopsy-proven histological prevalence at age 40 to 45 years, reaching 60 percent at age 60, and 80 percent at age 80.” The examiner also stated the Veteran’s BPH is not related to agent orange exposure; however, the examiner provided no medical rationale for this conclusion. The Board finds the February 2021 opinion to be inadequate because the examiner's determinations are not supported by sufficient medical rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two); see also Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (a mere conclusory opinion is insufficient to allow the Board to make an informed decision as to the weight to assign to a medical opinion). In light of the above, the Board finds that the Veteran's claim must be returned the February 2021 examiner for a supplemental opinion. See Stegall, 11 Vet. App. at 268. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Douglas v. Shinseki, 23Vet. App.19, 26 (2009). Finally, the Board notes that pursuant to its most recent remand, the RO sent the Veteran an August 2020 request to complete and return VA Form 21-4142 (General Release for Medical Provider Information to the Department of Veterans Affairs (VA)). To date, the form has not been received, and the Veteran should be afforded an additional opportunity to submit it on remand. The Board reminds the Veteran that the duty to assist is a two-way-street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). The matter is REMANDED for the following actions: 1. Send the Veteran VA Form 21-4142 and request that he identify, and provide appropriate releases for, any care providers who may possess new or additional evidence pertinent to the issue on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. §3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran should be notified. 2. Forward the Veteran’s claims file to the February 2021 VA examiner for a supplemental opinion, or if unavailable, to a qualified VA examiner (M.D.), A full VA examination should not be scheduled unless deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety, to include a copy of this REMAND, and that review must be noted in the report. Thereafter, the examiner is asked to provide a rationale for the opinion that was provided in February 2021 that “the Veteran has a prostate condition that is not related to agent orange.” Discussion of pertinent medical literature would be helpful for the Board. It should be noted that a lack of documented treatment for the claimed disability in service, while probative, cannot serve as the sole basis for a negative finding. The examiner must provide a complete rationale for any opinions offered, citing to the examiner's own expertise, medical principals, and/or evidence in the record, when necessary, to support the conclusion reached. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. The Board reminds the examiner that failure to comply with the examination directives outlined herein will render the medical opinion inadequate and will result in further remand of the Veteran's claim. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Gates 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.