Citation Nr: 18151439 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 16-10 188 DATE: November 20, 2018 ORDER Entitlement to service connection for the cause of death is granted. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era. 2. The Veteran’s immediate cause of death was esophageal cancer status post-surgery; colon cancer stage IIIB with metastatic disease, and failure to thrive secondary to underlying cancers. 3. The Veteran’s esophageal cancer status post-surgery and colon cancer stage IIIB with metastatic disease were caused by in-service Agent Orange exposure. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 1310, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.312 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1976 to July 1971 and from October 1971 to April 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Veteran passed away March 2015. The Appellant is his surviving spouse. 1. Entitlement to service connection for the cause of death Service connection for the cause of the Veteran’s death may be granted if a disability incurred in or aggravated by service was either the principle, or a contributory, cause of the Veteran’s death. 38 C.F.R. § 3.312(a). For a service-connected disability to be the principle cause of death it must singly or with some other condition be the immediate or underlying cause, or be etiologically related. 38 C.F.R. § 3.312 (b). For a service-connected disability to be a contributory cause of death, it must have contributed substantially or materially, and combined to cause death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (c)(1). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312 (c). Medical evidence is required to establish a causal connection between service or a disability of service origin and the Veteran’s death. Van Slack v. Brown, 5 Vet. App. 499, 502 (1993). Here, the Veteran’s death certificate shows he died in March 2015 due to esophageal cancer status post-surgery; colon cancer stage IIIB with metastatic disease, and failure to thrive secondary to underlying cancers. See March 2015 Death Certificate. At the time of his death, service connection was in effect for posttraumatic stress disorder and a right arm shrapnel wound scar. See March 2009 Rating Code sheet (noting the Veteran’s service connected disabilities). The Appellant asserts that the Veteran’s fatal esophageal cancer and colon cancer were caused as a result of his exposure to Agent Orange. See generally, September 2015 Appellant Treaties. The Veteran’s DD 214 shows his MOS to be that of a rifleman. See DD 214. In addition, the Veteran was presented with a Vietnam Campaign Medal, Vietnam Service Medal, and Republic of Vietnam Gallantry Cross. Id. The Veteran was also awarded the Navy Achievement Medal for distinguishing himself in a combat environment. See US Marine Corps Navy Achievement Medal. Accordingly, the Board concedes that the Veteran was in the Republic of Vietnam and is presumed to have been exposed to Agent Orange. Prior to his death, the Veteran’s private medical physician, Dr. Coker, submitted a medical opinion regarding the Veteran’s condition. See September 2014 Doctor’s Opinion. He stated that the Veteran’s health record does not reflect the use of smoking or alcohol consumption. The Veteran also did not have a family history indicating a familial disorder. The doctor opined that given the circumstances of two primary unrelated malignancies, it is more likely than not that the Veteran’s diseases were a result of the exposures he encountered during service. After the Veteran’s passing, Dr. Coker submitted another medical opinion. He noted that he was the Veteran’s primary oncologist and the Veteran had been under his care since July 1, 2014. He also stated that there is ample current medical literature supporting the association between Agent Orange and increased malignancies. He determined that given the Veteran’s lack of family history to exposure to other risk factors for these diseases, it is more likely than not that the cancers were a result of Agent Orange exposure. The Board finds the medical opinions of Dr. Coker to be competent and credible. As noted by the doctor, he reviewed the Veteran’s medical file and provided a determination that accounted for the Veteran’s familial history, medical history, military exposure, as well as the nature of his diseases. See D’Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination must be based on consideration of the claimant’s medical history and must describe the disability in sufficient detail so that the Board’s evaluation of the disability will be a fully informed one); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion depends upon whether it is factually accurate, fully articulated, and contains sound reasoning for the conclusion); Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) (citing Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that “[e]xamination reports are adequate when, as a whole, they sufficiently inform the Board of a medical expert’s judgment on a medical question and the essential rationale for that opinion” even when the rationale does not explicitly “lay out the examiner’s journey from the facts to a conclusion”). See also 38 C.F.R. §§ 3.159(c)(4), 3.326(a) (2017). Here, the medical evidence of record links the Veteran’s esophageal cancer and colon cancer to his in-service exposure to herbicides. Moreover, there is no etiological opinion to the contrary and no other evidence that the Veteran’s cancers may have a different cause. The Board thus finds that the Veteran’s esophageal cancer and colon cancer were caused by Agent Orange exposure. (Continued on the next page)   As the medical evidence reflects that the Veteran died as the result of esophageal cancer and colon cancer, and these diseases were incurred in active service by exposure to herbicides, it follows that service connection is warranted for the Veteran’s cause of death. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel