Citation Nr: 1320031 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 09-50 469 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUE Entitlement to service connection for amyloidosis of the lungs, to include as secondary to herbicide exposure. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. Erdheim, Counsel INTRODUCTION The Veteran served on active duty from August 1966 to September 1969. This matter comes before the Board of Veterans' Appeals (Board) from an October 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for amyloidosis of the lungs. In April 2011, the Veteran withdrew his request for a hearing before the Board, thus, that request has been withdrawn. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Additional development is necessary prior to further disposition of the claim. First, in March 2010, the RO sought and obtained further medical clarification as to whether the Veteran's amyloidosis of the lungs was the kind that was contemplated by the VA presumptive regulation under 38 C.F.R. § 3. 309. However, no supplemental statement of the case was issued following that response. Prior to Board review of that pertinent evidence, a supplemental statement of the case must be issued. While on remand, the Board finds that further clarification of the provided medical opinions should be obtained. Specifically, the November 2009 VA examiner determined that the Veteran did not suffer from true systemic AL amyloidosis, but rather suffered from localized amyloidosis because there was no evidence of monoclonal immunoglobulins in the serum or urine on July 2005 serum protein electrophoresis. The examiner also stated, however, that the Veteran's amyloid fibrils were more likely than not light chain-derived which was found with patients who had localized amyloidosis. According to a June 2009 official VA memorandum located in the claims file, AL (amyloid light chain) amyloidosis was the type contemplated by the presumption. Thus, it is unclear why the VA examiner determined that the Veteran did not have the type of AL amyloidosis contemplated by the regulation, if it is also a light chain type. It is also unclear if a finding of "no true systemic amyloidosis," made by the same VA examiner makes the diagnosis one other than primary, or, AL amyloidosis. Accordingly, the case is REMANDED for the following actions: 1. Forward the claims file to a qualified VA examiner to obtain clarification as to the type and kind of the Veteran's amyloidosis. The examiner should note a review of the claims file. The examiner should provide a clear and well-explained rationale for the opinion reached. The examiner should answer the following: a) In reference to the November 2009 VA opinion finding that the Veteran's localized amyloidosis was more likely than not light chain-derived, does the Veteran's type of amyloidosis differ from that contemplated by VA presumptive regulation, which was described in a June 2009 VA memorandum as AL (amyloid light chain) amyloidosis? In other words, if the Veteran's localized amyloidosis is light chain-derived, is that the same or is it different than the AL (amyloid light chain) amyloidosis that is considered to be a presumptive VA disease under 38 C.F.R. § 3.309? b) If the Veteran's amyloidosis is considered to not be true systemic amyloidosis, does that mean that it is not AL amyloidosis, but rather another type, such as AA (secondary) or hereditary amyloidosis? 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. The Board intimates no opinion as to the outcome of this case. The Veteran need take no action until so informed. The purpose of this REMAND is to ensure compliance with due process considerations. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ MICHAEL MARTIN Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).