Citation Nr: 18141409
Decision Date: 10/10/18	Archive Date: 10/10/18

DOCKET NO. 16-29 980
DATE:
REMANDED
Entitlement to service connection for a AL Amyloidosis is remanded.
Entitlement to service connection for a heart condition is remanded.
Entitlement to service connection for nephritic syndrome is remanded.
REASONS FOR REMAND
The Veteran had active service from October 1970 to February 1973.  These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision.  The Veteran testified at a hearing before the Regional Office (RO) in February 2016.  A transcript of that hearing is of record.  The Veteran initially requested a hearing before the Board as well, but withdrew his request for a hearing before the Board in September 2017.
In September 2017, the Veteran’s representative submitted a motion to advance this appeal on the Board’s docket.  The undersigned is granting the motion and advancing the appeal on the docket based upon serious illness.  38 C.F.R. § 20.900(c).
1. Entitlement to service connection for AL Amyloidosis is remanded.
The Board cannot make a fully-informed decision on the issue of entitlement to service connection for AL Amyloidosis because the rationale given by the June 2016 VA examiner for opining that the Veteran’s condition was not at least as likely as not related to his service is unclear.  In the report, the examiner explains that the Veteran’s AL Amyloidosis is not related to his service because “medical literature [does not] link environmental asbestos exposure or any other known toxin exposure” to the development of AL Amyloidosis.  However, VA regulations acknowledge a presumptive connection between at least one known toxin, herbicide agents used in Vietnam, and the development of AL Amyloidosis.  38 C.F.R. § 3.309(d).  On remand, the examiner should provide an addendum clarifying the rationale for the opinion given in this case, and indicate whether a review of the medical literature supports a connection between the development of AL Amyloidosis and a history of exposure to any known toxin or chemical other than tactical herbicide agents such as Agent Orange, to include asbestos or lead.
2. Entitlement to service connection for a heart condition and nephritic syndrome is remanded.
Finally, because a decision on the remanded issue of entitlement to service connection for AL Amyloidosis could significantly impact a decision on the issues of entitlement to service connection for a heart condition and a nephritic syndrome, the issues are inextricably intertwined.  Therefore, a remand of these claims is also required.
The matters are REMANDED for the following actions:
1. Obtain an addendum opinion and rationale from an appropriate clinician regarding whether the Veteran’s AL Amyloidosis is at least as likely as not related to any in-service exposure to toxins or chemicals other than herbicide agents, to include asbestos or lead.
2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to service connection for a heart condition and nephritic syndrome.  If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond.  If necessary, return the case to the Board for further appellate review.
 
A. ISHIZAWAR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Steven H. Johnston, Associate Counsel