Citation Nr: 18143061
Decision Date: 10/17/18	Archive Date: 10/17/18

DOCKET NO. 16-28 643
DATE:	October 17, 2018
REMANDED
Entitlement to service connection for the cause of the Veteran’s death is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1967 to June 1969.  The appellant is the Veteran’s surviving spouse.
Entitlement to service connection for the cause of the Veteran’s death is remanded.
The Board finds that further development of the medical evidence is required prior to adjudicating the appellant’s service connection claim for the cause of the Veteran’s death.  Generally, in a cause of death claim, VA must make reasonable efforts to assist a claimant in obtaining a medical opinion when such opinion is “necessary to substantiate the claimant’s claim for a benefit.”  De La Rosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008); see also 38 U.S.C. § 5103A (a).
The Veteran died in September 2015.  His death certificate lists the immediate cause of death as cardiac arrest.  Malignant neoplasm of esophagus was documented as the underlying cause of his death.  At the time of his death, he was service connected for the following: bilateral lower extremity peripheral artery disease; diabetes mellitus, type II (DMII), with erectile dysfunction (ED); bilateral lower extremity peripheral neuropathy, associated with DMII and ED; and diabetic nephropathy, associated with DMII and ED.
The appellant contends that the Veteran’s death was the result of exposure to Agent Orange and herbicide agents while in service, which in turn caused his cardiac arrest and malignant neoplasm of esophagus.  See April 2016 notice of disagreement.  She also indicated that his service-connected disabilities caused his death.  She specifically noted in her June 2016 Form 9 correspondence that the Veteran’s physician agreed that his service-connected disabilities significantly contributed to his death.  As the medical evidence of record does not include any opinion as to the relationship and cause of the Veteran’s listed cause of death, the Board finds that it would not be unreasonable to request a medical opinion.  Therefore, on remand, an opinion must be obtained regarding the cause of the Veteran’s death.
The matter is REMANDED for the following action:
1. Arrange to obtain a medical opinion addressing any relationship between the Veteran’s death and his service.  The claims file must be provided to and reviewed by the examiner.  Following a review of the claims file, the examiner is requested to furnish an opinion with respect to the following questions:
(a.) Is it at least as likely as not (a probability of 50 percent or greater) that any of the conditions listed on the Veteran’s death certificate (cardiac arrest as the immediate cause and malignant neoplasm of esophagus as an underlying cause) had its onset during service or is otherwise causally related to the Veteran’s active service, to include his presumed exposure to herbicide agents?
(b.) Is it at least as likely as not (a probability of 50 percent or greater) that any of the disabilities diagnosed before the Veteran’s death, alone or in combination, caused or contributed substantially or materially to his death?  The disabilities listed below are not an exhaustive list.  Please consider this question for additional disabilities noted upon review of the Veteran’s medical treatment records.
The service-connected disabilities included: bilateral lower extremity peripheral artery disease; diabetes mellitus, type II (DMII) with erectile dysfunction (ED); bilateral lower extremity peripheral neuropathy, associated with DMII and ED; and diabetic nephropathy, associated with DMII and ED.
A complete rationale should be given for all opinions and conclusions expressed.
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3. Readjudicate the appeal.
 
R. FEINBERG
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	I. Warren, Associate Counsel