Citation Nr: 21027930 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 15-43 613 DATE: May 7, 2021 REMANDED The claim of entitlement to service connection for ulcerative colitis, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Air Force from September 1967 to September 1971. Among other commendations, the Veteran was awarded the Vietnam Service Medal (VSM). This matter is before the Board of Veteran's Appeals (Board) from a March 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge, in March 2019. A written transcript of that hearing has been prepared and associated with the evidence of record. In July 2019, the Board remanded this matter to provide the Veteran with a medical examination on the nature and etiology of his claimed condition. Although regrettable, additional remand is required for substantial compliance with the Board's remand instructions; specifically, the medical opinion provided insufficient rationale for its conclusions and did not address lay evidence. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The claim of entitlement to service connection for ulcerative colitis, to include as due to exposure to herbicide agents, is remanded. The Veteran contends that he is entitled to service connection for ulcerative colitis. Specifically, he asserts that he while he was in Vietnam, he was exposed to herbicide agents, like Agent Orange, and this exposure may have led to his condition. He further contends that his "current condition began during military service" and that another remand is needed to obtain "an additional thorough examination with a focus on the etiology of the veteran's current condition." He contends that the existing VA medical opinion provides only summary conclusions and fails to adequately address the Veteran's contentions that his condition began in service. See As the Board noted in its prior decision, the existence of a present disability and the Veteran's in-service exposure to Agent Orange is not in dispute. The outstanding question for the Board remains whether the Veteran's ulcerative colitis is etiologically related to his active service, to include as due to his exposure to herbicides. A June 2014 statement from the Veteran's primary care physician, Dr. T.E., suggested a possible connection between the Veteran's diagnosed ulcerative colitis and Agent Orange, however, Dr. T.E. indicated only that he had "no evidence to suggest his diagnosis of ulcerative colitis was not caused by Agent Orange." For VA purposes, this statement did not provide the sufficient certainty regarding the etiology of the opinion and the Board found it inadequate. On remand, the Veteran received an in-person VA examination in December 2019. The examiner opined that it was less likely than not that the Veteran's condition was related to service, noting that ulcerative colitis is not a condition presumed to be related to herbicide exposure and that there is no current medical evidence linking it to Agent Orange. While this opinion addresses the lack of a presumptive relationship between herbicides and ulcerative colitis, it does not provide sufficient rationale as to whether the Veteran's condition is nevertheless directly related to the Veteran's service. See Combee v. Brown, 34 F.3d 1039,1042 (Fed. Cir. 1994). The examiner also failed to address lay statements made by the Veteran that his condition began during his service. As such, remand is warranted for an adequate opinion. The matter is REMANDED for the following action: 1. Obtain an addendum VA medical opinion from an examiner with sufficient expertise to determine the nature and etiology of the Veteran's ulcerative colitis. If a new examination is deemed necessary, one should be provided. The claims file must be made available to and be fully reviewed by the examiner including a copy of this remand. Following a review of the casefile and this remand, the examiner must state an opinion as to whether: (a.) It is at least as likely as not (50 percent probability or greater) that the Veteran's ulcerative colitis was caused by or is otherwise etiologically related to his military service. This opinion must address whether the Veteran's condition is at least as likely as not directly related to his active service. The opinion must address whether, in this Veteran's case, his exposure to herbicide agents is causally related to his ulcerative colitis. The examiner must consider and address relevant lay statements of record indicating that his ulcerative colitis may have started in service (such as contained in the Board hearing transcript, service treatment records, and statements filed in support of his claim). The examiner should identify the reasons behind his or her conclusions by identifying the facts and information that support the opinion, and then explaining how that evidence justifies the opinion. If the examiner is unable to the required opinion, he or she should explain why. 2. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record, perform any necessary development, and readjudicate the claim on appeal. If the appeal is denied, the AOJ should issue an appropriate Supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, 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.