Citation Nr: 18150518 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 18-24 370 DATE: November 16, 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 in the U.S. Army from May 1967 to May 1969, to include service in Vietnam. His decorations included the Combat Infantryman Badge, the Purple Heart, and the Vietnam Service Medal with two Campaign Stars and two Overseas Service Bars. He also served in the Army National Guard of Maryland. Unfortunately, he died in September 2017. The appellant is his surviving spouse. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. Service connection for the cause of the Veteran’s death. The Veteran’s death certificate reflects that the immediate cause of his death was renal cell carcinoma with metastasis; the condition having had its onset approximately two months prior to death. The appellant contends that this disease was caused by the Veteran’s exposure to herbicide agents (e.g., Agent Orange) in Vietnam. The Veteran’s death certificate lists Agent Orange exposure, hyperlipidemia, and dementia as significant conditions contributing to death, but not resulting in the underlying cause. In February 2018, the appellant submitted a letter from the Veteran’s treating physician stating that “[e]xposure to toxic elements of Agent Orange may reasonably have caused or contributed to [the Veteran’s] renal cell carcinoma, contributing to his death.” Neither the death certificate nor the treating physician advance any rationale for the connection drawn between the Veteran’s death and his in-service exposure to herbicide agents. Indeed, the physician stated earlier in his letter that the cause of the Veteran’s renal cell carcinoma was “unknown.” Renal cancer has not been determined by VA to be linked to exposure to herbicide agents. Notwithstanding, in light of the positive evidence cited above, a VA medical opinion is required to fully evaluate the appellant’s contentions with respect to her claim. See 38 U.S.C. § 5103A; Wood v. Peake, 520 F.3d 1345, 1348 (Fed. Cir. 2008) (noting that VA is obligated to obtain a medical opinion when there is a reasonable possibility that such would aid in substantiating the claim); see also Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994) (holding that, even if a claimant is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis). This matter is REMANDED for the following action: 1. Arrange to have a clinician with appropriate experience review the record and offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the cause of death (identified on his death certificate as renal cell carcinoma with metastasis) is at least as likely as not related to service, to include his presumed exposure to herbicide agents while serving in Vietnam. In so doing, the clinician should discuss the medical significance of the fact that the Veteran’s death certificate lists Agent Orange exposure as a significant condition contributing to death, but not resulting in the underlying cause. The clinician should also discuss the significance of the February 2018 opinion from a private physician to the effect that “[e]xposure to toxic elements of Agent Orange may reasonably have caused or contributed to [the Veteran’s] renal cell carcinoma, contributing to his death.” A complete medical rationale for all opinions expressed must be provided. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraph, the appellant’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the appellant and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Minot, Associate Counsel