Citation Nr: 22017927 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 17-45 842 DATE: March 27, 2022 REMANDED Service connection for a prostate disability, to include as due to herbicide agent exposure, and/or as secondary to the service-connected diabetes mellitus, type II, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to December 1967. He died in August 2016. The Appellant is the Veteran's surviving spouse who has been substituted as the claimant in this matter. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision. In January 2020, the Appellant testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In April 2021 and December 2021, the Board remanded this matter for further development. Initially, the Veteran appealed the denial of his service connection claim for a kidney disability. The RO granted the claim in January 2022. This represents a complete grant of the Veteran's appeal regarding this claim. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Therefore, this issue of service connection is no longer before the Board. Service connection for a prostate disability, to include as due to herbicide agent exposure, and/or as secondary to the service-connected diabetes mellitus, type II, is remanded. Another remand is required as there has not been substantial compliance with the directives of the December 2021 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance, rather than absolute compliance, with remand orders). In this regard, the December 2021 remand directed the RO obtain an opinion addressing the nature and etiology of the Veteran's prostate disability. The examiner was specifically directed to address whether any disability was caused by the Veteran's herbicide exposure or was caused or aggravated by his service-connected diabetes mellitus, type II. The January 2022 VA medical opinion provided a negative nexus opinion. In addressing whether the Veteran's prostate disability was related to his conceded herbicide exposure, the examiner stated that benign prostatic hypertrophy has not been associated with herbicide exposure. The examiner further concluded the Veteran's prostate disability was not secondary to his service-connected diabetes mellitus to include as a result of any medications prescribed. The Board finds the January 2022 VA opinion is inadequate for adjudicative purposes. Specifically, the examiner states, "BPH is not one of the VA's Agent Orange presumptive conditions;" however, the presumptive regulations do not preclude a claimant from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Additionally, the examiner did not provide a rationale for why the Veteran's prostate disability was not secondary to the medications he had been prescribed for his service-connected diabetes mellitus. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (finding that the probative value of a medical opinion comes from whether it is factually accurate, fully articulated, and has sound reasoning for the conclusion, not from the mere fact that the claims file was reviewed); Stefl v. Nicholson, 21 Vet. App.120, 124 (2007) (finding that "[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). It is unclear from the opinion whether the examiner reviewed the Veteran's medical records for any Based on the inadequacy of the VA medical opinion, the Board finds there has not been substantial compliance with its previous remand directives. As such, this matter must be remanded for an addendum VA opinion. The matters are REMANDED for the following action: 1. Refer the claims file to an appropriate medical professional for an addendum opinion. The entire claims file, to include a copy of this REMAND, must be reviewed by the examiner in conjunction with the opinion. The examiner should confirm in the examination report they have reviewed the folder in conjunction with the opinion. Following a review of the claims file, the examiner should provide the following opinion: Identify, by diagnosis, all prostate disabilities found to be present prior to the Veteran's death. (a.) For each prostate disability found, opine whether it is at least as likely as not (50 percent probability or greater) related to the Veteran's in-service exposure to herbicide agents. ***The examiner is advised a negative opinion cannot be based solely on the fact the identified prostate disability is not on the list of diseases that are presumptively associated with herbicide exposure.*** In other words, the examiner should determine in this specific case, whether the Veteran's BPH is related to his Agent Orange exposure, regardless of the fact that it is not considered presumptive conditions. The examiner must take into account the Veteran's personal circumstances and how the recognized risk factor(s) apply in his particular case. Other factors may affect the analysis, such as whether the examiner finds studies persuasive, whether there are other risk factors that might be the cause of the Veteran's BPH, whether his BPH manifested in an unusual manner, etc. (Continued on the next page) (b.) If the answer to (a.) is no, then whether it is at least as likely as not (50 percent probability or greater) the Veteran's prostate disability (i) was caused (in whole or in part) or (ii) aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by the medications taken for his service-connected diabetes mellitus. The examiner must provide separate opinions and rationales for secondary causation and secondary aggravation. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached. P. M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buck Denton 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.