Citation Nr: 22011305 Decision Date: 02/28/22 Archive Date: 02/28/22 DOCKET NO. 13-27 366 DATE: February 28, 2022 REMANDED Entitlement to service connection for blood clots is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1969 to February 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2010 by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in September 2018 and March 2021 for additional development. It is now before the Board for further appellate review. 1. Entitlement to service connection for blood clots is remanded. The Veteran asserts he is entitled to service connection for blood clots. In March 2021, the Board remanded the issue of entitlement to service connection for blood clots for the purpose of obtaining a new VA examination as well as any outstanding treatment records. In June 2021, a new medical opinion was obtained on this issue. The examiner opined that the Veteran's blood clots were less likely than not related to his military service, to include exposure to herbicides. The examiner explained that there was a lack of in-service medical records showing symptoms and noted that the Veteran would have had symptoms if his condition had begun in service. Further, the examiner stated that if his condition had begun within a year after service, there would be medical evidence to support it; and noted that there was no association with herbicide exposure and blood clots based on current medical evidence. The Board finds this medical opinion to be insufficient. First, the June 2021 VA medical opinion relies on a lack of medical evidence. Lack of evidence cannot be treated as substantive negative evidence. In other words, reliance on the lack of medical evidence, especially without consideration of lay statements, is an inadequate rationale. The United States Court of Appeals for Veterans' Claims (the Court) has held that the mere absence of evidence does not equate to unfavorable evidence. See Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc) (cautioning that negative evidence, meaning actual evidence weighing against a party, must not be equated with the absence of substantive evidence). Second, the June 2021 VA examiner did not provide medical reasons and bases for the conclusion provided. The examiner stated that medical evidence establishing a link between blood clots and herbicides did not exist without providing supporting data on the etiology of the Veteran's blood clots and why this condition could not be caused by exposure to herbicides. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). As such, the June 2021 VA medical opinion is insufficient and a remand is warranted to obtain a new VA examination and opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his blood clots. The examiner must review the claims file. The examiner is asked to provide a response to the following: Are the Veteran's blood clots at least as likely as not related to service, including exposure to herbicides? The examiner is advised that a negative opinion cannot be based solely on the fact that the blood clots are not on the list of diseases that are presumptively associated with exposure to herbicide agents. Provide a rationale to support the opinion(s). Hannah Fisher Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. K. Hall, 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.