Citation Nr: 21031378 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 14-09 568 DATE: May 21, 2021 REMANDED Entitlement to service connection for enlarged prostate is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to June 1968. He died in December 2019. The appellant is the Veteran's surviving spouse. Although the Agency of Original Jurisdiction (AOJ) has not issued a decision specific to substitution, the April 2021 Supplemental Statement of the Case essentially acknowledged that the Veteran's surviving spouse was a valid substitute by deciding the underlying claim on the merits. Additionally, the Veteran's surviving spouse has already been granted DIC for the cause of the Veteran's death. As such, the Board will proceed with this appeal with the Veteran's surviving spouse as substitute. In a March 2018 decision, the Board, in relevant part, denied entitlement to service connection for enlarged prostate. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a May 2019 Joint Motion for Remand (JMR), the parties agreed to vacate and remand the March 2018 Board decision. Subsequently, the Board remanded the case in January 2020 for further action consistent with the Board's remand directives. As such, the case has returned to the Board for further appellate proceedings. Notably, the Veteran has since been service-connected for prostate cancer. See September 2020 rating decision. An April 2021 VA medical opinion was rendered regarding the nature and etiology of the Veteran's claimed enlarged prostate. The reviewing clinician opined that it was less likely than not that the Veteran's enlarged prostate was caused by his active military service, to include as due to presumed herbicide exposure. See April 2021 VA medical opinion. The clinician reasoned that there is no medical literature to suggest that Agent Orange causes benign prostatic hyperplasia (BPH), no strong evidence is noted in any literature, and that BPH is a common occurrence in elderly men and has not been shown to be more pronounced in Agent Orange exposure. Id. However, this medical opinion did not address the Veteran's service-connected prostate cancer in relation to his enlarged prostate condition. The Veteran was diagnosed with prostate cancer in 2015. See April 2021 VA medical opinion. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the question remains as to whether the Veteran's prostate cancer may have caused or aggravated his enlarged prostate. As such, the Board finds that remand is necessary in order to obtain a secondary service-connection opinion with respect to the Veteran's now service-connected prostate cancer. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriately qualified VA clinician to determine the nature and etiology of the Veteran's enlarged prostate. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician. The opinion must include a notation that this record review took place. 2. After the record review, the reviewing clinician is asked to respond to the following: (a) Is it at least as likely as not that the Veteran's enlarged prostate is related to his active duty service, to include conceded exposure to lead paint, asbestos, and/or herbicides therein? (b) Is it at least as likely as not that the Veteran's enlarged prostate was proximately caused OR aggravated by his service-connected prostate cancer? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the examiner should attempt to identify the baseline level of the disability that existed before aggravation occurred. Any amount of aggravation is sufficient to establish secondary service connection; permanent aggravation/worsening of a non-service-connected disability is not required. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question 3. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the appellant and her representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, 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.