Citation Nr: 18142934 Decision Date: 10/17/18 Archive Date: 10/17/18 DOCKET NO. 16-23 093 DATE: October 17, 2018 REMANDED The claim of entitlement to service connection for pancreatic cancer secondary to service-connected disease or injury is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from February 1969 to December 1976, he passed away in April 2014. The Certificate of Death reflects that the cause of death was hemorrhagic shock, gastrointestinal bleed and metastatic pancreatic cancer, with a contributing factor of liver failure. The appellant is the surviving spouse and was appropriately recognized as the lawful substitute for this claim in accordance with the provisions of 38 C.F.R. §§ 3.103(b)(1), 3.1010 (2018). See October 2014 VA Memo. This matter is before the Board of Veteran’s Appeals (Board) on appeal from an April 4, 2013, rating decision denying the Veteran’s claim for service connection for pancreatic cancer. Secondary service connection for pancreatic cancer is remanded. The appellant contends that the Veteran was entitled to service connection for pancreatic cancer. The appellant’s only contention in this claim is for service connection for pancreatic cancer secondary to the Veteran’s service connected disability(ies). She contends that the medications that the Veteran was prescribed for service-connected disabilities caused or aggravated his pancreatic cancer. See Form 9. To date, the claim was not submitted for a VA examination. A thorough review of the record indicates that further development is warranted prior to adjudicating the appellant’s claim for service connection for pancreatic cancer. As the issue before the Board has not been adequately addressed during a VA exam, the Board finds that a remand is now warranted such that a competent etiological opinion may be obtained. The matter is REMANDED for the following actions: Arrange for a retrospective VA examiner’s medical opinion to determine the nature and etiology of the Veteran’s pancreatic cancer. The entire casefile is to be reviewed, as well as a copy of this remand. The record should indicate that these items were in fact reviewed. The examiner must opine as to whether it is at least as likely as not that the Veteran’s pancreatic cancer was caused by or aggravated (i.e. permanently worsened) by the medications and coinciding side effects the Veteran was prescribed for his service connected disability(ies): psoriasis vulgaris scalp, trunk, extremities and face, posttraumatic stress disorder (PTSD), coronary artery disease with post myocardial infarction (MI) and post-operative stent placement (claimed as heart condition), status post of joint mice left knee with psoriatic arthritis secondary to psoriasis vulgaris, peripheral neuropathy of the left upper extremity due to psoriatic arthritis, psoriatic arthritis of the left hand, left wrist, right wrist, right hand, right knee, left ankle, right ankle all secondary to psoriasis vulgaris, peripheral neuropathy of the right upper extremity due to psoriatic arthritis, ), coronary artery disease with post myocardial infarction (MI) and post-operative stent placement [Agent Orange – Vietnam/Ischemic Heart Disease], or otherwise related to said disability(ies). The Veteran’s medications included but were not limited to: Etanercept, Adalimumab, Albuterol, Artificial Tears polyvinyl, Budesonide, Cyanocobalamin, Desonide, Docusate Na, Flunisolide, Folic Acid, Gabapentin, Hydrocodone/Acetaminophen, Lisinopril, Meloxicam, Metoprolol Succinate, Nitroglycerin, Omeprazole, Polyethylene Glycol, Sertraline Hcl, Simvastatin, Tiotropium, Tramadol Hcl, Trazodone Hcl, Vitamin D3. The VA examiner’s medical opinion shall include all of the medications prescribed to the Veteran which were located in the casefile, not just the list above. The VA examiner’s medical opinion will review the possible side effects of the Veteran’s medications which were required to have “black box” as listed in the casefile in the medical records of August 2013 from the Pharmacist of the VA Bremerton Clinic. The VA examiner’s medical opinion will also consider the doctor’s warnings and educational information provided to the Veteran in August 2004 from the Rheumatology Section Chief at the Sepulveda VAMC about the risks of the medications prescribed to the Veteran for malignancy and other side effects. 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 resort to mere speculation, the examiner should fully explain why this is the case and identify what (if any) additional information or evidence may allow for a more definitive opinion. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record, perform any necessary development, and readjudicate the claim on appeal. If the appeal is denied, the AOJ should issue an appropriate Supplemental Statement of the Case (SSOC), afford the Appellant and her representative an opportunity to respond, and return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment, as required by law for claims remanded by the Board. 38 U.S.C. §§ 5109B, 7112. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.A. Teich, Associate Counsel