Citation Nr: 21027861 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 16-22 620 DATE: May 7, 2021 REMANDED Entitlement to service connection for colon cancer, to include as secondary to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from October 1965 to April 1985, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board for further development in September 2019. The matter returns to the Board for appellate consideration. Entitlement to service connection for colon cancer, to include as secondary to herbicide exposure, is remanded. The Veteran contends that his colon cancer is related to his in-service exposure to herbicide agents in the Republic of Vietnam. Pursuant to the September 2019 Board remand, a February 2020 VA examination was administered, and a nexus opinion was obtained. The examination reflected a diagnosis of mucinous colon adenocarcinoma and the examiner opined that the Veteran's condition is less likely than not caused by Agent Orange exposure. The examiner noted that exposure to Agent Orange is conceded based on his Vietnam service but indicated there were no manifestations of colon cancer during active duty and that a diagnosis was not made until 30 years following separation. The examiner also noted that the Veteran has conventional colon cancer risk factors, to include age, obesity, history of colonic polyp, and exposure to an excess amount of processed meat, and that medical literature does not support an association between herbicide exposure and colon cancer. The examiner cited to medical literature in support of this conclusion. The Board finds the February 2020 VA opinion is inadequate. Service treatment records (STRs) document numerous complaints and treatments for decrease in sphincter tone in September 1977, anal discomfort and fistula in November 1978, a radiographic report for barium enema and fecal incontinence in December 1979, and a history of stool leakage and a "questionable" polyp around the anal region in August 1980. As such, the Board finds an addendum opinion is needed to discuss the relationship between these documented conditions and the development of colon cancer. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the February 2020 VA examiner, or if unavailable, another qualified physician (such as an oncologist). The examiner providing the opinions must be provided access to the electronic claims file and indicate review of the file in the examination report. The claims folder and a copy of this remand in its entirety must be provided to the examiner in conjunction with the addendum opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements; the examiner must indicate on the examination report that such review was undertaken. If examination of the Veteran is necessary, such should be arranged. The examiner must determine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's colon cancer, or symptoms thereof, had its onset during service, or is/was caused by any in-service event, injury, disorder, or disease. The examiner must discuss the documented STRs in September 1977, November 1978, December 1979, and August 1980, specifically to include the noted questionable polyp around the anal region. The examiner must provide a rationale in support of all opinions provided. If the examiner cannot provide the opinion without conducting an examination of the Veteran, then an examination must be scheduled. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.