Citation Nr: 21039847 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 13-09 790 DATE: July 1, 2021 REMANDED Entitlement to service connection for a prostate disorder, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from June 1969 to December 1971. This issue comes before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Inasmuch as the Board regrets any further delay in the adjudication of this appeal, an additional remand is necessary to ensure complete and proper development of the claim. The Veteran contends that his prostate disorder is the result of in-service herbicide exposure while serving in the Republic of Vietnam. The Board initially remanded this matter in 2015 so that an examination could be conducted, and again in April 2020 in order to obtain a new VA examination with an opinion regarding the etiology of the Veteran's benign prostatic hyperplasia (BPH). Specifically, the Board directed the VA examiner to opine as to whether the BPH is directly related to active service, including due to exposure to herbicide agents. The most recent VA examination was conducted in January 2021. The Veteran was diagnosed with BPH. In addition, the examiner noted voiding dysfunction as a result of the BPH. The examiner then gave a negative opinion that the BPH was due to active service. As rationale, the VA examiner noted no urinary or prostate disabilities associated with the BPH and stated that BPH was not recognized by VA as a presumptive condition of herbicide agent exposure. The Board finds that the VA examination report is inadequate for adjudicative purposes. The VA examiner merely stated that VA does not recognize BPH as a presumptive disease secondary to service connection. The VA examiner did not directly address whether the Veteran's BPH is directly related to his active service. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (reliance on the absence of medical literature supporting nexus without discussing the specific facts of the case renders an opinion inadequate). The Board notes that the Veteran's BPH is not listed as a disease that has been associated with exposure to herbicide agents, and therefore may not be service connected on a presumptive basis under 38 C.F.R. §§ 3.307 (a) (6) and 3.309 (e). Nevertheless, the presumptive regulations do not preclude a claimant from establishing service connection with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). In addition, the examination is internally inconsistent, as the examiner both noted associated voiding dysfunction as a result of the BPH, but then found no urinary disabilities. As such, this opinion cannot be afforded probative value. Based on the inadequacies of the VA examination, the Board finds that there has not been substantial compliance with its previous remand directives. As such, this matter must be remanded for an addendum VA opinion that directly addresses whether the BPH is due to in-service herbicide exposure. The matter is REMANDED for the following action: 1. Invite the Veteran to submit any additional evidence in support of his claim. 2. Obtain an addendum opinion from an appropriate VA examiner. The electronic claims file must be made available to the examiner. Based on a review of the record, and a new examination if necessary, the examiner must address the following: Whether it is at least as likely as not that the Veteran's BPH is related to the Veteran's conceded in-service herbicide exposure? A complete rationale should be provided for all opinions rendered, and should discuss the nature and history of the Veteran's condition. In providing the requested opinion, the examiner is notified that any opinion based exclusively on the fact that VA does not associated BPH with herbicide exposure on a presumptive statutory basis will be deemed inadequate. M. Pryce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.T. Massey, 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.