Citation Nr: 18159322 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 15-03 860 DATE: December 19, 2018 REMANDED Entitlement to dependency and indemnity compensation (DIC) based on 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 August 1954 to July 1962. He died in November 2010. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The appellant filed a timely Notice of Disagreement (NOD), received in September 2014. A Statement of the Case (SOC) was issued in December 2014. A timely substantive appeal was received in January 2015. The Veteran’s death certificate states that the cause of his death was multiple myeloma on relapse, due to (a) suspected myocardial infarction due to severe anemia, and (b) sepsis due to immunocompromised. At the time of his death, service connection was in effect for duodenal ulcer disease with anemia, rated as 20 percent disabling since July 1, 1975. A VA medical opinion was obtained in May 2013. The Veteran’s VA medical records were reviewed. The VA physician opined that it was less likely than not that the Veteran’s service-connected duodenal ulcer disease with anemia was a contributing cause of his death. It was explained that anemia was possibly related to multiple myeloma. The VA physician explained that cancerous cells crowd out normal blood cells, while multiple myeloma can also cause anemia and other blood problems. There was no other evidence, such as endoscopy study or gastroenterology notes, to support the contention that duodenal ulcer bleeding was the cause of the Veteran’s anemia. The Board finds that the May 2013 VA medical opinion is inadequate. It is speculative with respect to the cause of the anemia, which contributed to the Veteran’s death per the death certificate; and it does not consider whether the Veteran’s fatal multiple myeloma on relapse, suspected myocardial infarction due to severe anemia, and/or sepsis due to immunocompromised were incurred in or are otherwise causally related to his active service. Indeed, it does not appear that the VA examiner reviewed the Veteran’s service treatment records, but rather simply reviewed his VA treatment records. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Thus, the Board finds that a new medical opinion regarding the cause of the Veteran’s death should be obtained upon remand, which also discusses the significance, if any, of the May 1961 notation of abnormal heart examination due to “syst [sic] m at apex with radiation to Erb’s point,” and the May 1962 separation examination report which indicates that examination of the heart was normal. The matter is REMANDED for the following action: Obtain an opinion from an appropriate VA clinician addressing the etiology of the cause of the Veteran’s death. Following a review of the claims file, the reviewing clinician should provide an opinion, with supporting rationale, as to whether it is at least as likely as not (50 percent greater probability) that a service-connected disability, to include the service-connected duodenal ulcer disease with anemia, caused or contributed substantially or materially to the Veteran’s death. In providing the rationale, the examiner should comment on the relevant evidence of record, to include the Veteran’s November 2010 death certificate which notes that the cause of the Veteran’s November 2010 death was multiple myeloma on relapse, due to (a) suspected myocardial infarction due to severe anemia, and (b) sepsis due to immunocompromised. The Board is particularly interested in the significance of the notation of anemia on the death certificate, as anemia was part of the Veteran’s service-connected duodenal ulcer disease. The examiner is also asked to comment on the significance, if any, of the May 1961 service treatment records which contains a notation of abnormal heart examination due to “syst [sic] m at apex with radiation to Erb’s point,” and the May 1962 separation examination report which indicates that examination of the heart was normal. The examiner is asked to provide an opinion as to whether it is at least as likely as not that the Veteran’s fatal suspected myocardial infarction was causally related to the in-service notation of an abnormal heart. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Behlen, Associate Counsel