Citation Nr: 22036751 Decision Date: 06/27/22 Archive Date: 06/27/22 DOCKET NO. 18-23 024A DATE: June 27, 2022 REMANDED Entitlement to service connection for enlarged prostate is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1966 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The matter was remanded by the Board in July 2016 and March 2022. Unfortunately, the Board finds another remand is necessary as the March 2022 VA medical opinion obtained in accordance with the prior March 2022 Board remand did not substantially comply with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The March 2022 examiner did not provide any opinion as directed in the March 2022 Board decision on whether the conceded herbicide exposure could have caused or resulted in the Veteran's condition. Remand is therefore required to obtain an addendum opinion. Furthermore, if medical literature is relied upon in rendering this determination, the examiner should identify and specifically cite each reference material utilized. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to assess whether: (a) it is "at least as likely as not (50 percent probability or greater)" that the Veteran's enlarged prostate was caused by his conceded herbicide exposure, yes or no? The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. THE EXAMINER SHOULD ALSO BE AWARE THAT IN RENDERING AN OPINION, IT MUST "CONTAIN NOT ONLY CLEAR CONCLUSIONS WITH SUPPORTING DATA, BUT ALSO A REASONED MEDICAL EXPLANATION CONNECTING THE TWO." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Furthermore, if medical literature is relied upon in rendering this determination, the VA examiner should identify and specifically cite each reference material utilized. If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010) (The AOJ should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.) THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Cho, 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.