Citation Nr: 21042247 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 14-26 352 DATE: July 12, 2021 REMANDED Entitlement to service connection for residuals of right tonsil squamous cell cancer is remanded. Entitlement to service connection for Buerger's disease is remanded. Entitlement to service connection for hypertension is remanded. INTRODUCTION The Veteran served on active duty from July 1962 to October 1966, with service in the Republic of Vietnam from August 1965 to June 1966. In November 2016, the Veteran attended a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that proceeding is of record. When this case was previously before the Board in September 2017 and April 2019, the above-noted issues were remanded for additional development. The case has since been returned for further appellate review. REASONS FOR REMAND While additional delay is unfortunate, the Board finds further development is required before the Veteran's claims are decided. As previously noted in the Board's April 2019 remand, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). During the April 2019 remand, the Board instructed the RO to obtain medical opinions addressing the above-noted claims. In particular, the Board indicated the examiner should consider and expressly discuss the Veteran's assertions that although not considered presumptive disabilities, service connection has been afforded to other veterans based on their exposure to herbicides. In particular, the examiner was asked to discuss the various Board decisions that awarded service connection, as well as the National Academy of Sciences Institute of Medicine conclusion that there was some "suggestive evidence of an association" between herbicide exposure and hypertension. The RO subsequently obtained addendum medical opinions in January 2020; however, the examiner provided a cursory remark with respect to the National Academy of Sciences Institute of Medicine conclusion indicating "those findings are not currently endorsed by credible literature." Unfortunately, the examiner failed to provide any such credible literature to support this assertion. Additionally, the examiner wholly failed to acknowledge or discuss the prior Board decisions provided by the Veteran which established service connection for claimed conditions. Based on these insufficiencies, the Board finds substantial compliance with the Board's prior remand instructions has not been achieved. In this regard, the Board finds medical opinions from a Physician specializing in Environmental Health and Toxic Exposures are necessary prior to final adjudication of this matter. Accordingly, this case is REMANDED for the following actions: Obtain medical opinions from a Physician specializing in Environmental Health and Toxic Exposures with sufficient expertise to address the etiology of the Veteran's claimed tonsil cancer residuals, Buerger's disease, and hypertension. All pertinent evidence of record must be made available to and reviewed by the examiner. Another examination of the Veteran should be performed only if deemed necessary by the Physician providing the opinions. Following a review of the relevant records and lay statements, the examiner is asked to state an opinion with respect to the Veteran's tonsil cancer residuals, Buerger's disease, and hypertension. Specifically, the examiner should state whether any diagnosed disability at least as likely as not (a 50 percent probability or greater) originated during his period of active service or is otherwise etiologically related to his active service, to specifically include his exposure to Agent Orange. The examiner must provide a complete rationale for all proffered opinions. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. The examiner must also consider and expressly discuss the evidence provided by the Veteran indicating service connection has been established in other cases for right tonsil cancer, hypertension, and Buerger's disease, as a result of those veterans' exposure to herbicides. In this respect, the examiner must also consider and discuss the recent National Academy of Sciences Institute of Medicine study, which concluded there is "limited or suggestive evidence of an association" between herbicide exposure and hypertension. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.