Citation Nr: 18141379 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 10-11 444 DATE: October 10, 2018 REMANDED Entitlement to service connection for cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1951 to April 1954 and May 1960 to November 1977 in the United States Army. The Veteran died in February 2008; the Appellant is his surviving spouse. Entitlement to service connection for cause of the Veteran's death is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for cause of death because the VA opinions obtained to date are inadequate as to whether the Veteran’s primary or contributory cause of death is due to his presumed exposure to herbicides or proximately due to or the result of (caused or aggravated by) his service-connected hypertension. The VA opinions obtained pursuant to the last Board remand determined that the Veteran’s metastatic cancer originated in his kidneys; that kidney cancer was less likely than not secondary to herbicide exposure; that his service-connected residuals, cerebrovascular accident (CVA) associated with hypertension did not contribute in any way to his death, and; that the hypertension did not materially or substantially contribute to his death. See January 2015, July 2016 and August 2018 VA opinions. The Veteran’s representative submitted a brief in September 2018 alleging that the opinions of record had not addressed medical literature indicating an increased risk and “significant” association between exposure to herbicides and pesticides and the development of kidney cancer. Specific medical literature was cited and quoted. The addendum opinion obtained on remand should address the literature in determining the likelihood of whether the renal cancer is related to herbicide exposure. Service connection for the cause of death on a secondary basis can be established if it shown that the veteran’s disability which is the primary or contributory cause of death, is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (a). Moreover, secondary service connection may also be established by any increase in severity (i.e., aggravation) of a primary or contributory cause of death that is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (b), effective October 10, 2006. See 71 Fed. Reg. 52,744-52,747 (September 7, 2006). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); Tobin v. Derwinski, 2 Vet. App. 34, 39 (1991). Entitlement to DIC cause of death can be established if the cause of death was “incurred or aggravated by” a service-connected disability. In other words, secondary service connection can be considered within the context of a DIC claim. The August 2018 VA opinion addressed the Veteran’s service-connected hypertension but the examiner limited his opinion to whether the Veteran’s service-connected hypertension materially or substantially contributed to the Veteran’s death. On remand an addendum opinion must be obtained to determine whether the Veteran’s cause of death, determined to be metastatic adenocarcinoma originating in the kidneys, was proximately due to or aggravated by his service-connected hypertension. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s cause of death. The examiner should answer the following: (a) Is it least as likely as not that the metastatic adenocarcinoma originating in the kidneys was caused by his conceded exposure to herbicides. The examiner must specifically address the contentions and medical literature cited by the September 2018 Appellate Brief. The examiner is advised that the absence of kidney cancer from the list of presumptive conditions which are presumed to be the result of exposure to herbicides in Vietnam (see 38 C.F.R. § 3.309 (e)) is not, by itself, a sufficient explanation for a negative opinion. (b) If the opinion provided in (a) is negative, is it at least as likely as not that adenocarcinoma originating in the kidneys is proximately due to or aggravated by the service-connected hypertension. The examiner is informed that for this question, aggravation is defined as any increase in disability.   A complete rationale must be provided for all opinions rendered. If the examiner cannot provide an opinion without resorting to speculation, the examiner must provide a thorough explanation for why this is so. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.S. McLeod