13-24 529
13-24 529
| Board of Vet. App. | Jul 31, 2017Background
- Veteran served Jan 1968–Jan 1970, with Vietnam tour Jul 1968–Jul 1969; appeal from July 2012 RO rating decision.
- Claims: service connection for skin cancer (including as due to herbicide exposure/Agent Orange), low back disability secondary to service‑connected prostate cancer, and bilateral hip/leg disability secondary to prostate cancer.
- VA exams: Feb 2012 exam addressed back/leg conditions and relation to prostate cancer; Nov 2016 exam diagnosed squamous cell carcinoma, basal cell carcinoma, and actinic keratosis and opined no relationship to Agent Orange (but without rationale).
- Board previously remanded in Jul 2015 for further development; additional medical addendum obtained Sep 2016 addressing prostate cancer causation/aggravation but did not address brachytherapy as a cause or aggravating factor.
- Board finds existing skin‑cancer opinion inadequate (unsupported broad statement denying herbicide link and no rationale); finds back/hip opinions inadequate because they did not address whether brachytherapy caused or aggravated the disabilities.
- Board remanded for further development: obtain/addendum skin‑cancer opinion addressing herbicide exposure with rationale; obtain new exam/opinion on whether brachytherapy caused or aggravated low back and bilateral hip/leg conditions; then readjudicate.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for skin cancer as due to herbicide exposure | Veteran contends diagnosed skin cancers are related to in‑service herbicide (Agent Orange) exposure | VA/RO medical opinion stated no relationship between skin cancer and Agent Orange and attributed cancers to childhood/adolescent sun exposure | Remanded: existing opinion inadequate (overbroad/no rationale); obtain new opinion addressing herbicide link with full rationale |
| Service connection for low back disability secondary to prostate cancer (or its treatment) | Veteran asserts low back pain began/worsened after brachytherapy for prostate cancer | VA exam/addendum found no metastasis or bony lesions and opined conditions not due to prostate cancer; did not address brachytherapy causation/aggravation | Remanded: obtain exam/opinion specifically addressing whether brachytherapy caused or aggravated low back disability |
| Service connection for bilateral hip/leg disability secondary to prostate cancer (or its treatment) | Veteran asserts leg/hip symptoms began/worsened after brachytherapy | VA exam/addendum found hips essentially normal, no bony metastases, and no causal link to prostate cancer; did not address brachytherapy | Remanded: obtain exam/opinion specifically addressing whether brachytherapy caused or aggravated bilateral hip/leg conditions |
Key Cases Cited
- Nieves‑Rodriguez v. Peake, 22 Vet. App. 295 (medical opinions must be supported by rationale and evidence)
- Miller v. West, 11 Vet. App. 345 (bare medical conclusions without factual predicate are not probative)
- Barr v. Nicholson, 21 Vet. App. 303 (VA must ensure examinations are adequate)
- Stegall v. West, 11 Vet. App. 268 (VA must comply with remand instructions)
- Kutscherousky v. West, 12 Vet. App. 369 (claimant may submit additional evidence/argument after remand)