Citation Nr: 25006288 Decision Date: 05/08/25 Archive Date: 05/08/25 DOCKET NO. 14-44 102A DATE: May 8, 2025 REMANDED The issues of entitlement to service connection for kidney (renal) cancer, liver cancer, and breast cancer, are remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force National Guard from March 1978 to August 1978 and from September 1994 to April 1995. This case is before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. This matter was previously remanded by the Board in May 2018, June 2021, March 2023, and August 2023 for additional development. Most recently, the Board instructed the Agency of Original Jurisdiction (AOJ) to verify dates of ACDUTRA and, if verification was not possible, to prepare a memorandum for the file to that effect. Notably, those instructions were included because of noncompliance with the prior March 2023 remand directives. The AOJ was also instructed to obtain nexus opinions. After reviewing the evidence of record, the Board finds that, once again, there has not been substantial compliance with the Board's prior remand directives such that another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Initially, while it appears that attempts to verify ACDUTRA dates were made on remand, first in October 2023, it is unclear whether a definitive response was received, or that all efforts were exhausted. In that regard, an October 2024 response references attachments entitled "[Veteran's last name] No Active Aug-Sep 02" and "[Veteran's last name] 02-03 No Active LESs" that do not otherwise appear in the record. Additionally, while the October 2024 response noted that a review of Military Pay Files "returned no records for the SSN as provided," the next paragraph instructed that "a Chronological Breakdown of Military Service for the period you are requesting" to verify was required. However, it does not appear that any further action was taken. Additionally, the Board observes that the requests had differing dates, to include incorrect ones. For example, the initial October 2023 request included as the requested period for verification from August 2022 to December 2002, and an additional period from March 1978 to August 1978. Then, in the "Additional Information" section, dates in 2002 and 2003 were noted. Thereafter, it appears that dates were corrected in February 2024 under the same ticket number. However, it appears that a different request for verification was opened under a different ticket number and, in September 2024, the noted date of the Veteran's separation was July 2013. However, that was neither the Veteran's date of separation from active service nor the date of separation from Reserve service. Given the foregoing, it is unclear whether an adequate request was made, whether an adequate response was received, and/or whether further steps are necessary to verify dates of ACDUTRA. Indeed, according to an Air Force Point Credit Summary sheet generated in January 2004, the Veteran did have active duty/active duty for training days in 2002. Additionally, given the opinion of a VA examiner in that hypertension may have contributed to kidney cancer, and evidence that the Veteran's hypertension began around May 2000, the dates for verification should be expanded to include whether the Veteran had ACDUTRA in May 2000. The Board also finds that an addendum opinion is required. In the prior remand directives, the examiner was instructed to address positive opinion evidence dated in April 2022 if s/he was opining against nexus. However, the September 2023 VA examiner failed to address the April 2022 VA opinions regarding a potential link between breast cancer or renal cancer and chemical or environmental exposures. Additionally, in support of the opinions offered, the September 2023 examiner relied upon a "long history of hypertension as shown in the STR." However, at the time of diagnoses of kidney cancer and breast cancer, the Veteran had only a two year history of hypertension, which was expressly noted in the prior remand. It is also unclear whether the examiner fully considered the Veteran's exposures, including those while stationed in Alexandria, Egypt, the cleaning chemicals, or the combined effect of all exposures. Based on the rationale provided, it seems that the examiner primarily focused on asbestos and RF exposures. Thus, the rationale provided was inadequate. Indeed, the Board finds that further rationale is necessary given that (1) the Veteran was diagnosed with two different cancers within months of each other and just a few years after her service in Egypt; (2) she did not fit the profile of those most commonly affected by renal cancer as identified by the September 2023 examiner (i.e., elderly persons aged 60 to 70 years old and males); and (3) there was no reported family history. Parenthetically, the Board points out that it does not seek specifically a positive or negative opinion, but rather one that is accurate, clear, and fully supported. Thus, an addendum is necessary. Based on the foregoing deficiencies, the Board finds that a remand is required. See Stegall, 11 Vet. App. at 268. The matters are REMANDED for the following action: 1. Take appropriate steps to verify any and all dates of active duty for training (ACDUTRA) in May 2002, August 2002, September 2002, November 2002, December 2002, and January 2003. Alternatively, verify whether the Veteran had ACDUTRA on the following dates in addition to any time in May 2002: August 22, 2002; September 20, 2002; November 26, 2002; December 4, 2002; December 31, 2002; January 14, 2003; and January 28, 2003. Please ensure that the information provided in the request is correct. Also note that the Veteran formerly went by the name Sarah L. Wilkins. If the dates cannot be verified after reasonable efforts have been made, please prepare a memorandum for the file indicating that this is the case. 2. Obtain an addendum opinion from a qualified VA examiner regarding nexus between the Veteran's renal (metastasized to the liver) and breast cancers based on all exposures. (a.) For purposes of the opinion, please accept as true the Veteran's exposure to asbestos, potentially high levels of radiofrequency radiation, cleaning chemicals during her service with the 261st Combat Communication Squadron in Van Nuys, California, and exposure to unspecified carcinogens while stationed in Alexandria, Egypt. In other words, please opine as to whether, IF the Veteran's reported exposures occurred, it is at least as likely as not that her renal cell or breast cancer was related to those exposures, individually or cumulatively/in combination. The Board advises the Veteran that in asking the examiner to accept her testimony, the Board does not at this time make a finding as to that testimony's credibility. (b.) If the response is negative for either or both renal cell cancer or breast cancer, please reconcile the opinion with: (i) the April 2022 examiner's positive findings of associations between occupational/environmental chemical exposures and renal cell cancer/breast cancer; and (ii) the Veteran's diagnoses of two different cancers within months of each other and just a few years after her service in Egypt combined with the facts that the Veteran did not fit the profile of those most commonly affected by renal cancer as identified by the September 2023 examiner (i.e., elderly persons aged 60 to 70 years old and males), and had no reported family history. (c.) Please provide a fully articulated medical rationale for each opinion, citing to peer-reviewed medical literature referenced in formulating it, if any. If the examiner finds that an opinion cannot be provided, this conclusion should also be clearly explained (e.g., lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). S. C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Fagan 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.