Citation Nr: 25005175 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 17-51 595 DATE: April 16, 2025 REMANDED Entitlement to service connection for brain cancer (also claimed as cancer tumors), to include on a secondary basis is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1968 to May 1971, to include service in Vietnam. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in July 2023. A transcript of that hearing is of record. The Board remanded the claim for further development in August 2023. There has not been substantial compliance with the Board remand, and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for brain cancer (also claimed as cancer tumors), to include on a secondary basis. This claim must be remanded to address the Veteran's assertions that his in service exposures to carcinogenic elements placed him at risk of developing cancer and that his immune system, weakened by his service-connected bladder cancer, placed him at risk of developing cancers in other parts of his body. See August 2024 Appellate Brief. The claim was previously remanded for a VA examination and opinion on whether the Veteran's brain cancer was caused by his conceded exposure to herbicide agents. See August 2023 Board decision. A June 2024 negative nexus medical opinion found the available records provided no objective evidence of a brain tumor in service. The examiner also provided a negative toxic exposure risk activity (TERA) medical opinion that the Veteran's diagnosed brain cancer, glioblastoma, is not subject to presumptive service connection and is not a common sequela of TERA. This opinion is inadequate as it does not address the Veteran's arguments that his toxic exposures and service-connected bladder cancer weakened his immune system and placed at risk of developing his brain cancer. Remand for an addendum opinion is necessary. The matters are REMANDED for the following action: Obtain an addendum medical opinion from an appropriate clinician to determine the nature and likely etiology of the Veteran's brain cancer. Copies of all pertinent records should be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. After reviewing the pertinent records, the examiner is asked to answer the following: (a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's brain cancer began in or was due to service, to include toxic exposures? In providing the requested opinion, the examiner should consider and discuss all pertinent medical and lay evidence of record, to include the Veteran's arguments that his toxic exposures weakened his immune system and placed him at risk of developing brain cancer. (b) If the answer to (a) is no, (i) State whether, but for the Veteran's bladder cancer, he would not have had a diagnosis of brain cancer. (ii) State whether the Veteran's brain cancer would have been less severe and result in less functional impairment but for the service-connected bladder cancer. (iii) If the examiner opines that the brain cancer would have resulted in less functional impairment but for his service-connected bladder cancer, the clinician must attempt to establish a baseline level of severity of the diagnosed brain cancer prior to aggravation by the service-connected bladder cancer. The examiner is advised that a service-connected disability need only be a contributing cause, not the contributing cause, to establish secondary service connection. In providing the requested opinion, the examiner should consider and discuss all pertinent medical and lay evidence of record, to include the Veteran's argument that his service-connected bladder cancer weakened his immune system and placed him at risk of developing brain cancer or aggravated his brain cancer. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state why and what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Wayne, 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.