Citation Nr: 22018000 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 14-23 046 DATE: March 27, 2022 REMANDED Entitlement to service connection for colon cancer, to include as due to exposure to contaminated water at Camp Lejeune and/or due to exposure to herbicide agents in Vietnam, is remanded. INTRODUCTION The Veteran served on active duty in the United States Marine Corps from February 1966 to February 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this claim in November 2019 for additional development. In July 2020, the Board denied this issue which was appealed to the Court of Appeals for Veterans Claims (CAVC). Pursuant to a Joint Motion for Remand, the CAVC issued a March 2021 Order to vacate the July 2020 denial and remanded the underlying claim to the Board for readjudication. The Board remanded the claim in July 2021. This case has since been returned to the Board for further appeal review. REASONS FOR REMAND Although the Board regrets further delay, remand is necessary to ensure compliance with previous remand directives and proper development. When there is not substantial compliance with Board remand requests, the Board errs as a matter of law when it does not ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). As part of the July 2021 Board remand, the RO was required to obtain appropriate VA medical examination(s) and opinion(s) regarding the nature and etiology of the Veteran's colon cancer. The remand specifically requested opinions regarding the Veteran's conceded exposure to contaminated water at Camp Lejeune and herbicide agents in Vietnam. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The RO obtained a November 2021 medical opinion regarding the Veteran's conceded exposure to contaminated water at Camp Lejeune. The November 2021 examiner concluded the Veteran's colon cancer was less likely than not caused by the Veteran's exposure to contaminated water at Camp Lejeune. To support this conclusion, the examiner expressly discussed the facts, medical principles, and scientific literature related to the Veteran's claim. The RO also obtained an addendum medical opinion in December 2021 to address the Veteran's colon cancer and his conceded exposure to herbicides in Vietnam. However, the Board finds December 2021 medical opinion to be inadequate. The December 2021 examiner concluded the Veteran's colon cancer was less likely than not incurred in service, to include his exposure to herbicides. In support of this conclusion, the examiner indicated "on review of the medical literature no conclusive evidence was found that contaminated water or herbicides cause colon cancer." However, the examiner failed to discuss the relevant medical literature or provide citations to support her conclusion. In this respect, the VA examiner must consider and expressly discuss the facts, medical principles, and scientific literature relevant to the specific claim that the Veteran's exposure to herbicides agents caused his colon cancer. As such, the Board finds a remand is necessary in order to obtain an addendum medical opinion. Accordingly, this matter is REMANDED for the following action: Obtain an addendum medical opinion to address the etiology of the Veteran's colon cancer. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether the Veteran's colon cancer 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 as a result of his exposure to herbicide agents. The examiner is asked to consider and expressly discuss the facts, medical principles, and scientific literature relevant to this case. In regard to herbicide exposure, the Board is cognizant that colon cancer is not a presumptive disease associated with herbicide exposure. The Board seeks a medical opinion on the likelihood that this Veteran's colon cancer is related to his herbicide exposure given his medical history, family history, existence of or absence of other risk factors, and any other additional factors deemed relevant by the examiner. In particular, the examiner should consider any risk factors the Veteran may have had for the development of colon cancer, as well as the current scientific literature and studies. The examiner must provide a complete rationale for all proffered opinions. 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 Nestander, Jessica S. 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.