Citation Nr: A26036282 Decision Date: 04/20/26 Archive Date: 04/20/26 DOCKET NO. 250702-560776 DATE: April 20, 2026 REMANDED Entitlement to service connection for benign prostate hypertrophy with urinary dysfunction is remanded. Entitlement to service connection for hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 1994 to May 1996. In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. However, because the Board is remanding the Veteran's claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). In an August 2025 correspondence, the Veteran's representative requested the qualifications of the February 2025 VA examiner. The Board acknowledges that the Veteran has the right to receive the examiner's qualifications. See Francway v. Wilkie, 940 F.3d 1304, 1308 (2019). However, this request was not raised prior to the AOJ rating decision on appeal. As such, there can be no pre-decisional duty to assist error, and it would be improper under the AMA for the Board to remand the matter to fulfill the request at this time. The Veteran can file a supplemental claim requesting the examiner's qualifications and the AOJ will be obligated to provide information regarding the examiner's qualifications at that time. Inadequate Medical Opinions The Veteran contends that service connection is warranted for his benign prostate hypertrophy and hypothyroidism as a result of his exposure to chemicals and toxins while performing his duties as Navy Machine Repairman. In a February 2025 memorandum, VA acknowledged exposure/ingestion of asbestos, aqueous film forming foam (AFFF), burn pit particulate matter, fuel and petroleum distillates, bacteria, food and waterborne diseases, endemic diseases, noxious fumes, lead inhalation and ingestion, industrial chemical splash, carbon monoxide, and hydraulic fluids. In February 2025, the AOJ obtained medical opinions addressing the etiology of the Veteran's benign prostate hypertrophy and hypothyroidism. The VA examiner opined that the Veteran's benign prostate hypertrophy and hypothyroidism were less likely than not caused by the Veteran's toxic risk exposure activities (TERA). In support of these opinions, the VA examiner stated that there is no documented medical evidence indicating that the Veteran's benign prostate hypertrophy and hypothyroidism could be caused by or be the result of his toxic exposure, noting medical literature is silent for evidence that the toxic exposures during military service caused the Veteran's claimed conditions. However, the VA examiner was asked to address the synergistic, combined effect of the Veteran's TERA and any potential toxic exposures from his military occupational specialty (MOS) duties. As noted above, VA documented several toxic exposures. The VA examiner did not discuss the combined effect of these toxic exposures. To be considered adequate, the medical opinions must address the combined effect of the Veteran's TERA and any potential toxic exposures from his MOS. Additionally, the VA examiner attributed the Veteran's hypothyroidism to an autoimmune thyroid disease unrelated to military service and his benign prostate hypertrophy to testosterone deficiency, however the VA examiner failed to discuss the likelihood of whether the Veteran's TERA contributed to or caused his autoimmune disease and/or testosterone deficiency. The AOJ's reliance on inadequate medical opinions constitutes a pre-decisional duty to assist error. Thus, this case must be remanded to obtain addendum medical opinions that adequately address the nature and etiology of the Veteran's benign prostate hypertrophy and hypothyroidism. Accordingly, this matter is REMANDED for the following actions: 1. Obtain an addendum medical opinion from an examiner with sufficient expertise to address the nature and etiology of the Veteran's benign prostate hypertrophy. The examiner must answer the following and provide thorough rationales: - Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's benign prostate hypertrophy was incurred in or is otherwise etiologically related to active service? - Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's benign prostate hypertrophy is etiologically related to his conceded toxic exposure risk activity (TERA)? The examiner should address whether the Veteran's testosterone deficiency is at least as likely as not related to his conceded TERA. The examiner must address the synergistic, combined effect of the Veteran's TERA and any potential toxic exposures from his military occupational specialty (MOS) duties. The examiner must provide complete rationales and medical explanations for all opinions rendered. If the examiner cannot provide any of the required opinions without resorting to mere speculation, he or she must explain why that is the case. 2. Obtain an addendum medical opinion from an examiner with sufficient expertise to address the nature and etiology of the Veteran's hypothyroidism. The examiner must answer the following and provide thorough rationales: - Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypothyroidism was incurred in or is otherwise etiologically related to active service? - Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's hypothyroidism is etiologically related to his conceded toxic exposure risk activity (TERA)? If the Veteran has a diagnosed autoimmune thyroid disease, the examiner should address whether it is at least as likely as not related to his conceded TERA. (Continued on the next page) ? The examiner must address the synergistic, combined effect of the Veteran's TERA and any potential toxic exposures from his military occupational specialty (MOS) duties. The examiner must provide complete rationales and medical explanations for all opinions rendered. If the examiner cannot provide any of the required opinions without resorting to mere speculation, he or she must explain why that is the case. 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.