Citation Nr: 21041881 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 14-10 127 DATE: July 10, 2021 REMANDED Entitlement to service connection for a liver cyst condition as secondary to service-connected COPD is remanded. Entitlement to service connection for a pancreatic cyst condition as secondary to service-connected COPD is remanded. Entitlement to service connection for a renal cyst condition as secondary to service-connected COPD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1960 until October 1963. In March 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902 (c). 38 U.S.C. § 7107 (a)(2). This appeal was most recently before the Board in April 2021 when it was remanded for additional development. Unfortunately, for the reasons described below, there has not been substantial compliance with the remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a liver cyst condition as secondary to service-connected COPD is remanded. Entitlement to service connection for a pancreatic cyst condition as secondary to service-connected COPD is remanded. Entitlement to service connection for a renal cyst condition as secondary to service-connected COPD is remanded. The claims must be remanded again because the May 2021 medical opinions obtained subsequent to the Board's remand are inadequate. The May 2021 opinion provider offered a negative nexus opinion for each claimed condition, stating that there is insufficient supporting evidence in the medical literature to conclude that COPD causes or aggravates the claimed condition. However, the opinion provider failed to state whether the insufficient support in medical literature is due to specific medical or other scientific studies that have concluded the condition is not proximately due to or aggravated by COPD or if the insufficient support is due to a lack of studies in the subject area. See Jones v. Shinseki, 23 Vet. App. 382 (2010). The opinion on secondary service connection is also inadequate because the conclusion and rationale provided are contrary to the legal standard for secondary service connection, which requires causation and aggravation be considered as two distinct questions. Finally, the Veteran has submitted additional medical literature to support his claim since the May 2021 medical opinions. On remand, the opinion provider should consider the newly submitted evidence and provide an adequate addendum medical opinion. The matters are REMANDED for the following action: 1. Obtain and addendum medical opinion from an appropriate clinician other than the May 2021 opinion provider to address whether the Veteran's liver, pancreas, and kidney cyst conditions are secondary to his service-connected COPD. The opinion provider should be provided a copy of all pertinent documents, including the studies submitted by the Veteran's representative in June 2021. If the clinician determines a requested opinion cannot be made without examination of the Veteran, one should be scheduled. After a review of the record and examination of the Veteran, if necessary, the clinician must specifically answer the following questions for each of the claimed disabilities: liver, pancreas, and kidney cyst: (a.) Is it at least as likely as not that the (i) liver cyst (ii) pancreatic cyst (iii) kidney cyst is proximately due to or caused by his service-connected COPD? (b.) Is it at least as likely as not that the (i) liver cyst (ii) pancreatic cyst (iii) kidney cyst is aggravated by (any increase in disability) his service-connected COPD? In answering the above, the opinion provider must consider, and discuss as appropriate the medical literature submitted by the Veteran in June 2021 as well as the medical literature previously submitted by the Veteran. All provided opinions must be supported by complete rationale. If the opinion provider determines that a requested opinion cannot be made without resort to speculation, they must state why. Specifically, whether the inability to provide an opinion is due to specific medical or other scientific studies that have concluded the condition is not proximately due to or aggravated by COPD or if the insufficient support is due to a lack of studies in the subject area. See Jones, 23 Vet. App. at 382. 2. Confirm that the obtained medical opinions comport with this remand. Specifically, verify that the opinion provider used the correct legal standard for aggravation in this circumstance, which is any increase in disability. The opinion form may contain the incorrect definition for aggravation. If the incorrect aggravation standard is used or if the opinion is otherwise inadequate, obtain an addendum prior to readjudicating the claim. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.