Citation Nr: 18142633 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-11 563 DATE: October 17, 2018 REMANDED The claim of entitlement to service connection for bile duct cancer is remanded. The claim of entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from August 1961 to August 1964. Regrettably, the Veteran passed away in October 2012. The appellant is the surviving spouse. In June 2017, the appellant testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for bile duct cancer is remanded. The appellant asserts that the Veteran’s bile duct cancer was caused by a liver fluke infection that originated from the water and fish that the Veteran ingested during his service in Korea. The appellant submitted various articles regarding liver flukes in Southeast Asian countries. In the alternative, the appellant asserts that the Veteran’s bile duct cancer was caused by in-service exposure to Agent Orange, radiation, and asbestos. Personnel records show that the Veteran was stationed in Inchon, Korea from March 1962 to February 1963. January 1963 service treatment records show that the Veteran was treated for dysuria and intermittent episodes of crampy abdominal pain for the past three weeks. There was no vomiting, change in bowel habits, or nausea. He was treated with Pyridium, Amphojel, and Bicillin. The assessment was gastroenteritis. In July 1963, the Veteran presented with complaints of vomiting and fever. It appears that he was diagnosed with a virus. February 2012 private treatment records include a diagnosis of cholangiocarcinoma. A VA medical opinion was obtained in February 2016, which addressed the appellant’s theory that the Veteran’s bile duct cancer was caused by exposure to asbestos. The Board finds that another VA medical opinion is needed to address whether his bile duct cancer was caused by liver flukes. As noted above, service treatment records show treatment for gastroenteritis while he was in Korea. The appellant submitted articles to support her argument that liver flukes found in the water and fish in Southeast Asia was one of the risk factors for cholangiocarcinoma. Accordingly, a remand is required to obtain another VA examination. With regard to the appellant’s theory of entitlement involving Agent Orange exposure, the Board notes that the claims file includes a June 2013 VA Memo. The Agency of Original Jurisdiction (AOJ) concluded that there was insufficient information of record to request records from the U.S. Army and Joint Services Records Research Center (JSRRC) for Agent Orange verification. The AOJ explained that the appellant failed to provide a two-month time frame to request assistance from JSRRC. In Gagne v. McDonald, 27 Vet. App. 397 (2015), the Court held that VA’s duty to assist is not bound by the JSRRC’s 60-day limitation for requests and that it was not unreasonable to require the AOJ to submit multiple 60-day inquiries to the JSRRC sufficient to address the entire period of time that a Veteran alleges. In this case, the Veteran alleges Agent Orange exposure during his service in Korea from March 1962 to February 1963. Accordingly, a remand is required to request information from JSRRC regarding the Veteran’s alleged exposure. 2. Entitlement to service connection for cause of death is remanded. The Board finds that his claims for entitlement to service connection for cause of death is inextricably intertwined with the service connection issue and must be deferred. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together. The matters are REMANDED for the following action: 1. The RO or the AMC should undertake appropriate development to obtain any outstanding records pertinent to the appellant’s claim. If any requested records are not available, the record should be annotated to reflect such and the appellant notified in accordance with 38 C.F.R. § 3.159 (e). 2. Contact the Joint Services Records Research Center (JSRRC) and request verification of the Veteran’s alleged exposure to Agent Orange during his service in Inchon, Korea from March 1962 to February 1963. Separate responses must be provided for each 60-day period. 3. Obtain a VA medical opinion from an examiner with sufficient expertise to determine the nature and etiology of his bile duct cancer. The claims file must be made available to and reviewed by the examiner. Following a review of the relevant records and lay statements, the examiner must state an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s bile duct cancer was caused by or is otherwise etiologically related to his military service. In doing so, the examiner must consider and discuss the articles submitted be the appellant and lay statements of record indicating that liver flukes found in the water and fish in Southeast Asia can cause cholangiocarcinoma. The rationale for all opinions expressed must be provided. If the examiner is unable to provide any required opinions, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular question presented. 4. Then, the RO or the AMC should readjudicate the issues on appeal. If the benefit sought on appeal is not granted to the appellant’s satisfaction, the appellant and her representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. N. Nolley, Associate Counsel