Citation Nr: 18143585 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 15-05 779 DATE: October 23, 2018 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1948 to June 1970, with service in the Republic of Vietnam. The Veteran died on May [redacted], 2005. The appellant is his surviving spouse. Entitlement to service connection for the cause of the Veteran's death is remanded. The appellant asserts that service connection is warranted for the cause of the Veteran’s death. Essentially, she contends that the conditions which caused the Veteran’s death are due to Agent Orange exposure during military service. Specifically, it is alleged that the Veteran’s cancer of the scalp, which was first diagnosed in approximately 1999, later metastasized to his lungs, ultimately resulting in his cause of death. At the outset, the Veteran’s Form DD-214 shows that was awarded the Vietnam Campaign Medal and VA has confirmed in-country service in the Republic of Vietnam. Thus, exposure to Agent Orange is conceded. A review of the Veteran’s initial death certificate shows that his immediate cause of death was “cardiopulmonary arrest” and “metastatic poorly differentiated squamous cell carcinoma.” Notably, private treatment records dated from April 2005 appear to document that the Veteran’s lungs were affected by cancer that may have metastasized from his initial cancer of the scalp, originally diagnosed in approximately 1999. The impression included “Findings of chronic interstitial disease with areas of metastatic and nodular involvement of the left lung. A density previously seen on 4/21/05 of the right lung base, having a more nodular configuration, appears more infiltrative on this study at the right lung base.” It is important to determine whether the cancer in the lungs was metastasis from other cancers, or whether that was a primary cite. It is also noted that the April 2005 private records contain chest X-ray findings of a “moderately sclerotic aorta.” It is unclear whether this may represent ischemic heart disease and if so, whether it played any part in the cardiopulmonary arrest that was listed as a cause of death. The Board observes that VA never obtained an etiological opinion as to whether the Veteran’s cause of death is service-connected. Given the above medical evidence that the Veteran’s cancer may have metastasized and arguments pertaining to exposure to Agent Orange, a VA opinion would be of considerable assistance in resolving this issue. The matter is REMANDED for the following action: 1. Arrange to have the Veteran’s electronic claims file reviewed by an examiner of appropriate expertise to determine whether the Veteran’s cause of death of cardiopulmonary arrest and metastatic poorly differentiated squamous cell carcinoma was directly related to his conceded Agent Orange/herbicide agent exposure. The examiner must review the electronic claims file and note that review in the examination report. The examiner must provide the rationale for all opinions expressed. If the examiner is unable to provide the required opinion, the examiner should explain why that is. The examiner should opine as to whether it is at least as likely as not (a 50 percent probability or more) that the Veteran’s causes of death, listed as cardiopulmonary arrest and metastatic poorly differentiated squamous cell carcinoma, was causally or etiologically related to the Veteran’s active service exposure to an herbicide agent, to include the conceded Agent Orange/herbicide exposure. In making the determination, a finding should be made as to whether any cancer in the lungs was of a primary site or was metastasis from another site. The examiner is also asked to comment on the finding of a moderately sclerotic aorta, to include whether this is indicative of ischemic heart disease, and if so, whether it played in role in causing the death of the Veteran. The examiner is requested to provide a rationale which supports the opinion with specific references to clinical data and medical literature, as appropriate. A mere assertion that cardiopulmonary arrest is not one of the presumptive diseases of herbicide agent exposure recognized by VA is insufficient. Any findings pertaining to the apparent metastasis of his initial diagnosis of cancer of the scalp to his lungs or other parts of the body should also be set out, as necessary. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Miller, Associate Counsel