Citation Nr: 18151180
Decision Date: 11/19/18	Archive Date: 11/16/18

DOCKET NO. 16-34 940
DATE:	November 19, 2018
REMANDED
Entitlement to dependency and indemnity compensation based on service connection for the cause of the Veteran’s death is remanded.
REASONS FOR REMAND
The Veteran served on active duty from April 1986 to September 2007.  The appellant is his surviving spouse.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota.
Cause of Death
The Veteran died of pancreatic cancer in March 2012.  The appellant states that the Veteran’s service-connected colitis caused the development of pancreatic cancer.  The appellant also states that the Veteran’s pancreatic cancer had been present since active service, based on literature finding that pancreatic cancer can begin as early as twenty years prior to its discovery.  
The Veteran’s death certificate shows the immediate cause of death is recorded as pancreatic cancer.  No other immediate causes, and no significant conditions contributing to death, are recorded.
In a June 2016 VA examination report, the examiner opined, in pertinent part, that it was less likely than not that the Veteran’s pancreatic cancer first developed in active service.  The examiner did not provide an explanation for this conclusion.    
In a July 2016 statement, the appellant asserts that if the Veteran would have been seen upon separation from service, his pancreatic cancer would have been detected even though he was symptom free at the time except for the colitis.  In July 2016 email correspondence with W.P. from the Microscopic Colitis Foundation, the appellant was informed that it was likely that the Veteran developed pancreatic cancer prior to separation from service.  Medical articles were submitted in support of this assertion.  
In light of the above, the Board finds that a new opinion is necessary.
The matter is REMANDED for the following action:
Obtain a new medical opinion regarding service connection for the cause of the Veteran’s death, as specified below.  The opinion should be provided by an oncologist, or other available medical doctor with appropriate expertise if an oncologist is not available.  If not an oncologist, the doctor should explain the basis for his or her expertise regarding the questions asked. 
The examiner is asked to provide opinions on the following:
1.	Whether the Veteran’s service-connected collagenous colitis at least as likely as not (50 percent probability or greater) caused his pancreatic cancer?  The examiner should consider the articles submitted by the appellant finding that inflammatory bowel disease, and especially ulcerative colitis, increases the risk for developing pancreatic cancer.  
2.	Whether it at least as likely as not that the Veteran’s pancreatic cancer, although apparently not diagnosed until January 2012, first developed in service, even if not detected at the time. In this regard, the appellant has submitted evidence that pancreatic cancer is a slow-growing cancer that typically takes over 20 years to progress, a timeline that would indicate an onset during the Veteran’s service. 
 
J. Rutkin
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. D. Cross, Associate Counsel