Citation Nr: 18142487 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 14-10 079 DATE: October 16, 2018 REMANDED Entitlement to service connection for the cause of death is remanded. Entitlement to burial benefits and plot allowance is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to July 1968, including service in the Republic of Vietnam. The Veteran died in July 2011, and the Appellant is his surviving spouse. This appeal to the Board of Veterans’ Appeals (Board) arose from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Appellant filed a notice of disagreement in August 2013 and a statement of the case was issued in December 2013. The Appellant filed a VA Form-9 in March 2014 and appeared before the undersigned in October 2016 for a Board hearing. 1. Entitlement to service connection for the cause of the Veteran’s death The Veteran’s death certificate lists the following immediate causes of death: 1) disseminated intravascular coagulation, 2) adenocarcinoma of the pancreas, 3) hypotension, and 4) acute renal failure/shock liver. The Appellant contends that the Veteran’s exposure to herbicides in service caused his pancreatic cancer, which ultimately led to his death. In a May 2018 opinion, a VA physician opined that it is unlikely that the Veteran’s presumed Agent Orange exposure caused his adenocarcinoma of the pancreas. In this regard, the Board is unable to ascertain whether the May 2018 VA medical opinion specifically considered the May 1990 article submitted by the Appellant, which she purports to suggest a link between pancreatic cancer and exposure to Agent Orange. As such, the Board finds that additional development should be undertaken, to include providing the Appellant an opportunity to submit additional medical evidence in support of her appeal. 2. Entitlement to burial benefits and plot allowance The Board notes that the claim for burial benefits and plot allowance is inextricably intertwined with the issue of service connection for the cause of the Veteran’s death. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, consideration of the burial benefits and plot allowance claim must be deferred pending resolution of the cause of death claim. The matters are REMANDED for the following action: 1. Ask the Appellant to provide the names, addresses, and approximate dates of treatment by health care providers who have treated the Veteran for pancreatic cancer during his lifetime, which are not already of record d associated with the record. After securing the appropriate authorization, if required, obtain any potentially relevant and available records that have not been previously received from each health care provider the Appellant identifies. 2. Advise the Appellant that she may submit a supplemental medical opinion from the Veteran’s treating physician (or the medical doctor who prepared the amended death certificate, or any other medical professional) that addresses whether the Veteran’s exposure to herbicide agents (Agent Orange) contributed in any way to cause his pancreatic cancer. If the Appellant provides a supplemental medical opinion, the medical professional should address the following: is it at least as likely as not (i.e., a 50-50 chance) that this Veteran’s fatal adenocarcinoma of the pancreas was related to his exposure to the herbicide agents (Agent Orange) used in Vietnam, given his medical history, family history, and the absence or presence of other risk factors? ****In responding to the above question, the medical professional is asked to review (1) the scientific, medical, and statistical data mentioned in the May 1990 report prepared by Admiral Zumwalt; (2) the scientific, medical, and statistical data mentioned in the “Veterans and Agent Orange Update 2014”; and (3) any additional pertinent literature on the subject, and then to address whether there is a medically sound basis to attribute the Veteran’s fatal adenocarcinoma of the pancreas to his exposure to the herbicide agents (Agent Orange) used in Vietnam. 3. Once all available relevant medical records have been received, and noted in the claims file, the AOJ should arrange to have the claims file referred to a medical professional with appropriate expertise for the preparation of an addendum opinion. The claims file and copy of this remand is to be made available to and reviewed by the medical professional assigned in this study of this case. The reviewing medical professional is asked to address the following: Is it at least as likely as not (i.e., a 50-50 chance) that this Veteran’s fatal adenocarcinoma of the pancreas was related to his exposure to the herbicide agents (Agent Orange) used in Vietnam, given his medical history, family history, and the absence or presence of other risk factors? ****In responding to the above question, the medical professional is asked to review (1) the scientific, medical, and statistical data mentioned in the May 1990 report prepared by Admiral Zumwalt; (2) the scientific, medical, and statistical data mentioned in the “Veterans and Agent Orange Update 2014”; and (3) any additional pertinent literature on the subject, and then to address whether there is a medically sound basis to attribute the Veteran’s fatal adenocarcinoma of the pancreas to his exposure to the herbicide agents (Agent Orange) used in Vietnam. ****Please Note: the Board is cognizant that there is no presumption of service connection for pancreatic cancer due to exposure to herbicide agents (Agent Orange) used in Vietnam. The question here is, what is the likelihood that this Veteran’s pancreatic cancer is related to his exposure to herbicide agents, given his medical history, family history, absence or presence of other risk factors, etc. 4. After the above development, and any additionally indicated development has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to burial benefits and plot allowance. If the benefits sought are not granted to the Appellant’s satisfaction, send the Appellant and her representative a Supplemental Statement of the Case and provide her an opportunity to respond. If necessary, return the case to the Board for further appellate review. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Morrad, Associate Counsel