Citation Nr: 19106984 Decision Date: 01/29/19 Archive Date: 01/29/19 DOCKET NO. 15-25 093 DATE: January 29, 2019 REMANDED Entitlement to service connection for adenocarcinoma is remanded. Entitlement to service connection for ischemic heart disease is remanded. Entitlement to service connection for thrombocytopenia is remanded. Entitlement to service connection for gout is remanded. Entitlement to service connection for actinic keratosis is remanded. Entitlement to service connection for thyroid nodule is remanded. Request to reopen claim for service connection for psoriasis is remanded. Entitlement to non-service connected pension is remanded. Entitlement to special monthly compensation is remanded. Entitlement to service connection for the cause of death is remanded.   REASONS FOR REMAND The Veteran had active service from August 1967 to August 1969, including service in the Republic of Vietnam. The Veteran died in June 2013 and the appellant is his surviving spouse. His surviving spouse has been substituted as the appellant. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois, which denied service connection for cause of death. The RO also administratively denied entitlement to accrued benefits in this decision. In March 2016, the appellant testified at a Board hearing. A transcript is not of record due to technical difficulties. In August 2016 the appellant indicated that she did not wish to appear at a second hearing. 1. Entitlement to service connection for adenocarcinoma is remanded. 2. Entitlement to service connection for ischemic heart disease is remanded. 3. Entitlement to service connection for thrombocytopenia is remanded. 4. Entitlement to service connection for gout is remanded. 5. Entitlement to service connection for actinic keratosis is remanded. 6. Entitlement to service connection for thyroid nodule is remanded. 7. Request to reopen claim for service connection for psoriasis is remanded. 8. Entitlement to nonservice-connected pension is remanded. 9. Entitlement to special monthly compensation is remanded. In October 2013, the RO administratively denied issues 1-9 on an accrued basis. The appellant was properly substituted in this appeal in January 2019. There is an important distinction between the law governing a claim for accrued benefits upon the death of a beneficiary and claims regarding substitution of claimants in the case of death of a claimant. 38 U.S.C. §§ 5121, 5121A. When adjudicating the accrued benefits claims, only the evidence of record at the time of death may be considered as the basis for a determination on the merits of the claim, as noted. See 38 U.S.C. § 5121; 38 C.F.R. § 3.1000; Hayes v. Brown, 4 Vet. App. 353, 360-61 (1993) (holding that service department and certain VA medical records are considered as being constructively of record at the date of death although they may not physically be in the file until after that date). However, when a properly qualified substitute claimant continues the pending claim in the footsteps of the Veteran after death, additional development of the record may be undertaken if deemed appropriate or necessary to adequately adjudicate the merits of the claim. The RO must readjudicate the aforementioned claims as substitution claims. The appeal is also remanded to obtain outstanding treatment records. The Veteran previously reported that he received treatment for his claimed disabilities from Jesse Brown VA Medical Center (VAMC) since June 2000. The appellant has also submitted evidence showing the Veteran received emergency medical care from Jesse Brown VAMC; these records mention additional hospice care. On remand, the RO should ensure that all records from the Jesse Brown VAMC are associated with the file. The RO should also contact the appellant for assistance in obtaining any and all hospice records. With respect the claim for adenocarcinoma, a medical opinion would be helpful to the Board. 38 U.S.C. § 5103A(a)(1). The Veteran’s death certificate shows his cause of death to be malignant neoplasm of unknown origin. The Veteran is presumed to have been exposed to herbicide agents, including Agent Orange, during his service in the Republic of Vietnam. In a March 2016 letter, Dr. K., a private clinician, opined that the Veteran’s exposure to Agent Orange caused the development of carcinoma of the liver, which led to a service-related cause of death. In a July 2016 addendum, Dr. K. indicated the Veteran died of metastatic pancreatobiliary adenocarcinoma and suggested that this was due to his exposure to Agent Orange; therefore, his underlying cause of death was a consequence of his Agent Orange exposure. Based on the medical evidence of record, an opinion is warranted to determine whether the Veteran’s fatal adenocarcinoma is related to his exposure to herbicide agents in service (and thus whether his cause of death is related to his military service). 10. Entitlement to service connection for the cause of death is remanded. The outcome of the service connection claim for adenocarcinoma may impact the claim for cause of death. Thus, these issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the Board must defer adjudication of the cause of death claim for now. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from Jesse Brown VAMC and any other identified VA facilities, for the period from June 2000 to June 2013. 2. Ask the appellant to complete a VA Form 21-4142 for any physicians or facilities that treated the Veteran for his claimed disabilities, to include any hospice care received. Make two requests for the authorized records from identified physicians or facilities unless it is clear after the first request that a second request would be futile. 2. Obtain a medical opinion by an appropriate VA clinician to determine the nature and etiology of the Veteran’s adenocarcinoma. The physician must review the entire claims file, including any newly associated medical records. The clinician is asked to identify the likely origin of the Veteran’s fatal malignant neoplasm identified on the death certificate. Following review of the record, the clinician should provide an opinion as to whether it is at least as likely as not (at least a 50 percent or greater probability) that the Veteran’s adenocarcinoma and/or fatal malignant neoplasm was: a) incurred during service; b) is otherwise related to the Veteran’s service, to include as a result of his presumed exposure to herbicide agents; or, c) first manifested within one year of separation from service. A fully-explained rationale for these opinions must be provided. In doing so, the VA clinician should consider and discuss the March 2016 and July 2016 opinions provided by Dr. K. If the clinician is unable to render an opinion without resorting to speculation, he or she must provide a rationale as to why this is so (e.g. state whether there is additional evidence that would permit an opinion to be rendered or whether the limits of medical knowledge have been exhausted regarding the etiology of the disability at issue or because of some other reason). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Lauritzen, Associate Counsel