Citation Nr: 21041729 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 05-37 934 DATE: July 10, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran's active service included a tour in the Republic of Vietnam (RVN); hence, the appellant's past assertion that his fatal cancer was due to his presumed exposure to herbicide agents while there. On last review of this appeal, in compliance with a vacatur and remand by the Court of Appeals for Veterans Claims (Court), the Board remanded it to the Agency of Original Jurisdiction (AOJ) for additional development. See 03/16/2021 Remand BVA. The AOJ endeavored to comply with the remand directives, but the Board finds less than substantial compliance. Hence, the case must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for the cause of the Veteran's death is remanded. As noted in the March 2021 remand, this appeal has been twice denied by the Board and twice vacated and remanded by the Court. The Board desires to bring closure to this appeal, but to accomplish this goal, VA medical examiners must provide medical opinions that address the remand directives in a comprehensible manner. In the instant case, the Board asked for a medical opinion that addressed whether it is at least as likely as not that the Veteran's colon cancer was due to his presumed exposure to herbicides while in RVN, and whether it was otherwise causally related to his active service, to include as due to the solvents he may have been exposed to in his MOS. The addendum report reflects that the VA clinician only noted his raw research, without any discussion or explanation as to how it applied to the Veteran's case. See 03/31/2021 C&P Exam, 2nd Entry. Hence, the Board is constrained to find that the addendum report is inadequate for appellate review purposes. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: The AOJ shall send the claims file to a physician for a review or an addendum. The Board is neither directing nor prohibiting that the file be sent to the same physician who provided the March 2021 addendum report. The Board is not allowed to make medical determinations. Colvin v. Derwinski, 1 Vet. App. 171, 172 (1991). Hence, ask the physician reviewer to please read this and the prior remand closely, so that it is fully understood what the Board needs from medical authorities. Inform the physician that the Board has previously determined that the Veteran had colon cancer. Ask the physician to opine on whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's colon cancer was causally related to his active service, to include as due to his presumed exposure to herbicide agents. The Board requests that the physician address potential service connection as due to presumed exposure to herbicide agents and direct service connection separately, so that it will be clear to higher reviewing authorities such as the Court of Appeals for Veterans Claims that both were addressed. When addressing whether the Veteran's colon cancer was due to his presumed exposure to herbicide agents, the physician is asked to discuss the relevant medical studies and literature that address a link between colon cancer and exposure to herbicide agents (including any submitted by the appellant), and whether they apply to the Veteran's individual case. Please remind the physician that a negative nexus opinion must have a rationale other than the fact that colon cancer is not on VA's list of diseases deemed associated with presumed exposure to herbicide agents. (Continued on the next page) When addressing service connection on a direct basis, the physician is asked to discuss the risk factors for colon cancer noted in prior examination reports (see, e.g., 03/13/2018 C&P Exam, 2nd and 3rd Entries), and whether they apply to the Veteran and his active service. If the absence of documented treatment records is deemed significant, the physician is asked to explain why. The AOJ must review the examination report received and ensure that it addresses all facet of the remand directives. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. T. Snyder 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.