Citation Nr: 21029483 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 13-21 959 DATE: May 13, 2021 ORDER Service connection for prostate cancer is granted. REMANDED The claim of entitlement to service connection for a left leg disability is remanded. The claim of entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. FINDING OF FACT The Veteran's prostate cancer was related to his service-connected PTSD. CONCLUSION OF LAW The criteria are met for service connection for prostate cancer. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1973 to October 1977. He died in July 2014, during the pendency of his claims. His surviving spouse has been substituted as the Appellant in this appeal. This appeal is from a September 2011 rating decision. In December 2020, these appeals were remanded for additional development. Thereafter, in a March 2021 rating decision, the AOJ (agency of original jurisdiction) granted service connection for chronic obstructive pulmonary disease due to his service-connected posttraumatic stress disorder with depression and smoking associated with posttraumatic stress disorder and depression. Service connection for prostate cancer is granted. Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, the Appellant has asserted that the Veteran's prostate cancer was related to his smoking, which was related to his PTSD. In December 2020, a VA examiner opined that the Veteran's smoking was likely related to his PTSD. Further, he noted that smoking was a well-documented risk factor for the development of prostate cancer. He opined that prostate cancer was as likely as not aggravated beyond its normal progression by the PTSD, citing to a study that found a statistically significant elevated risk of prostate cancer in smokers and former smokers in comparison to nonsmokers. Unfortunately, he did not provide a baseline, and the July 2020 VA examiner indicated that the evidence was insufficient to determine a baseline. The Board notes the examiner did not explain how PTSD or smoking aggravated prostate cancer; rather, the explanation supports secondary service connection based on causation, given the examiner's cited evidence of the elevated risk of developing prostate cancer due to smoking. Accordingly, the Board finds the examiner's opinion probative, and that any remaining doubt should be resolved in his favor. Accordingly, the Board finds that service connection for prostate cancer is warranted on a secondary basis. REASONS FOR REMAND 1. The claim of entitlement to service connection for a left leg disability is remanded. The December 2020 VA examiner opined that the Veteran's left-sided limp was due to the Veteran's left leg arterial insufficiency and intermittent claudication. He did not provide adequate opinion for whether this was caused or aggravated by the Veteran's PTSD and depression with associated smoking. An updated opinion must be obtained. 2. The claim of entitlement to a TDIU is remanded. The Veteran was service-connected for prostate cancer as of this decision, and the disability rating will be assigned by the AOJ in a later decision. That future decision, as well as any future decision as to his left leg, will have an impact on his eligibility and entitlement to a TDIU. Accordingly, the TDIU claim must be remanded along with the left leg for additional consideration. The matters are REMANDED for the following action: Forward the claims file to an appropriate examiner for an addendum VA opinion that addresses whether it is as likely as not (50/50 probability or greater) that the Veteran's left leg arterial insufficiency and intermittent claudication was caused or aggravated by PTSD and depression with associated smoking. "Aggravated" means to cause any increase in severity that is beyond the normal progression of the disability, and it need not be permanent in nature. The Veteran had a 40 pack year smoking history. The December 2020 VA examiner noted the Veteran was a vasculopath in part due to cigarette smoking, and also had coronary artery disease, cardiomyopathy, and bilateral lower extremity arterial insufficiency. He opined that the limp was due to left leg arterial insufficiency and intermittent claudication. He did not opine on whether the cause of the limp (left leg arterial insufficiency and intermittent claudication) was related to the Veteran's PTSD and depression with smoking, but appeared to suggest there may be a relationship. All opinions must be supported with explanation. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Gibson 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.