Citation Nr: 22013530 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 12-35 692 DATE: March 9, 2022 REMANDED Entitlement to service connection for residuals of breast cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1977 to October 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2011 rating decision. In May 2013, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing. A transcript of that hearing is of record. The Veteran's claim for service connection was remanded by the Board in April 2014, September 2017, and July 2020. Unfortunately, her claim must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide her claim, so she is afforded every possible consideration. Entitlement to service connection for residuals of breast cancer is remanded. In July 2020, the Veteran's claim for service connection was remanded by the Board to afford her an addendum medical opinion concerning the etiology of her current breast condition, to include breast cancer and any residuals. In particular, the examiner providing the opinion was instructed to determine whether the Veteran's current condition had its clinical onset in or is otherwise related to her active service, including her diagnosis of fibrocystic breast disease. The examiner was instructed to consider address certain evidence cited by the Board, including service treatment records, post-service treatment records, lay statements, a May 2013 positive private medical opinion, and cited medical literature. Subsequently, an October 2021 medical opinion was obtained. The medical opinion states that the claimed condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support, the medical opinion provides that fibrocystic changes are pretty routine, do not require treatment, and do not raise the risk of breast cancer and cites to https://www.breastcancer.org/symptoms/benign/fibrocystic-changes. The Board finds that the October 2021 medical opinion is inadequate because it is conclusory, without sufficient rationale, and fails to discuss the Veteran's specific circumstances. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The examiner did not cite to the medical or lay evidence of record, and failed to discuss the Veteran's service treatment records, post-service treatment records, lay statements, the May 2013 positive private medical opinion, and cited medical literature. Therefore, the Veteran's claim for service connection must be remanded so that she can be afforded an adequate medical opinion. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's current breast condition, to include breast cancer and any residuals. The clinician must review the Veteran's claims folder. The clinician must: (a.) Opine whether it is at least as likely as not (50 percent probability or greater) that any current breast condition, to include breast cancer and any residuals, had its clinical onset during active service or is related to any in-service disease, event, or injury, including to her diagnosis of fibrocystic breast disease. In providing the above opinion, the clinician should consider: A May 1979 service treatment records that notes lump in the Veteran's left breast and includes an impression of fibrocystic disease and a May 1979 surgical referral describing a "1 cm cystic mass medial to the (L) nipple." A September 1979 service treatment record noting a firm, movable mass at the border of her areola. The December 1976 entrance examination reflecting no noted clinical abnormalities of the breast and the September 1982 separation examination reflecting no noted clinical abnormalities of the breast. May 2001 mammogram and ultrasound reports identifying a mass in the left breast and a May 2001 biopsy report diagnosing invasive ductal carcinoma. A July 2001 report of operation and pathology report following a diagnosis of infiltrating ductal carcinoma and resultant double mastectomy and a September 2002 record reflecting the excision of a benign cyst from the left breast, post mastectomy. May 2013 hearing testimony from the Veteran in which she indicated a link exists between fibrocystic breast disease and breast cancer, and noted the residual symptoms of her cancer, including painful surgical scarring, tooth loss due to chemotherapy, and impaired memory and concentration. The May 2013 opinion of T.J.M., O.D., asserting a "well-established" relationship between breast cancer and fibrocystic breast disease, and supporting medical articles titled "Relationship of Fibrocystic Disease to Carcinoma," "Risk of breast cancer in women with history of benign disease of the breast," "A Critique of the Methodology of Studies of Benign Breast Disease and Breast Cancer Risk," "Benign Breast Disease and the Risk of Breast Cancer," and "Clinicopathological Relationship Between Fibrocystic Disease Complex and Breast Cancer: A Case Report." The May 2014 Breast Conditions and Disorders Disability Benefits Questionnaire, which shows that the Veteran has a diagnosis of infiltrating ductal carcinoma left breast, status post bilateral mastectomy and that she had a left-sided breast lump during her active service that was "always there" and never went away. (Continued on the next page) The case report from the Journal of Krishna Institute of Medical Sciences University mentioned in the July 2017 Appellate Brief. A complete rationale must be provided for all opinions and conclusions reached. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.