Citation Nr: 21042271 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 16-50 340 DATE: July 12, 2021 REMANDED Entitlement to service connection for hypertension as due to herbicide exposure is remanded. Entitlement to service connection for colon cancer as due to herbicide exposure is remanded. Entitlement to service connection for dermatitis of the bilateral hands is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from March 1966 to March 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified at a Board hearing. The transcript is of record. This issue was previously before the Board in January 2020 when it was remanded for further development, which has not been completed. Stegall v. West, 11 Vet. App. 268, 271. In October 2020, hypertension, colon cancer, and dermatitis examinations were completed. In November 2020, a negative VA medical opinion was issued. See November 2020 VA Examination. The examiner opined that the Veteran's hypertension, colon cancer, and dermatitis were less likely than not incurred in or caused by his military service. The examiner stated that there were no treatment notes available that included a diagnosis of colon cancer, dermatitis, or hypertension. As there was no documentation in the Veteran's file, the examiner determined that no nexus had been established and a negative opinion was rendered. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. The VA also has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159(c)(4). 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). The Board finds the November 2020 VA medical opinion inadequate. The Veteran's claims file includes numerous diagnoses and treatment notes for hypertension, colon cancer, and dermatitis of bilateral hands. See Medical Treatment Records; see Internal Medicine Medical Treatment Records. Additionally, notably, the Veteran was found credible at his hearing and is competent to report observable symptoms, such as skin rashes on his hands during service. Any etiology opinion must take into account the Veteran's medical history. Regrettably, for the above reasons 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 medical opinion that complies with the Board's remand directives and considers all the evidence of record. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran's claims file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Once the above has been completed to the extent possible, obtain an addendum opinion from the VA examiner who conducted the October 2020 examinations and November 2020 VA opinion regarding the nature and etiology of the Veteran's hypertension, colon cancer, and dermatitis. The electronic claims file must be made available to the examiner. The examiner should note in the examination report that the claims file has been reviewed. If the October and November 2020 VA examiner(s) is not available, the claims file should be provided to an appropriate medical professional so as to render the requested opinion. If the examiner determines that another VA examination is necessary, one should be scheduled. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the colon cancer condition, or its residuals, is/ are related to service, to include his presumed exposure to herbicides? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's hypertension is related to service, to include his presumed exposure to herbicides? (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's skin condition is related to service, to include his presumed exposure to herbicides? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The examiner must specifically address the recent NAS study regarding hypertension. The examiner is reminded that an opinion that is based solely on the lack of any current presumptive relationship is not adequate. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. (Continued on the next page) All findings should be reported in detail and all opinions must be accompanied by a clear rationale. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall 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 particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.