Citation Nr: A19002099 Decision Date: 10/22/19 Archive Date: 10/21/19 DOCKET NO. 190506-8535 DATE: October 22, 2019 REMANDED Entitlement to service connection for a myelofibrosis blood/bone marrow cancer precursor to leukemia to include as secondary to inservice herbicide exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1967 to April 1969 to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an April 2019 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran selected the Direct Review lane without a Board hearing when he opted in to the Appeals Modernization Act (AMA) review system by submitting a VA Form 10182 (Decision Review Request: Board (Notice of Disagreement)). Accordingly, the Board’s current review is limited to the evidence of record at the time of the Agency of Original Jurisdiction’s (AOJ’s) April 2019 rating decision. The Veteran contends that he has a blood/bone marrow disorder to include myelofibrosis due to herbicide exposure in Vietnam. Medical records indicate that the Veteran was diagnosed with myelofibrosis based on blood work and a bone marrow biopsy in August 2017. Prior to that diagnosis, he had been suffering from essential thrombocytosis for approximately fifteen years. While the Veteran is presumed to have been exposed to herbicide agents during service in the Republic of Vietnam, none of the Veteran’s current diagnoses, including myelofibrosis are diseases presumed associated with herbicide exposure by VA. 38 U.S.C. § 1116; 38 C.F.R. § 3.307, 3.309. The Veteran has supplied private medical opinions and clinical studies to argue that the soft tissue disorders included on the C.F.R. 3.309 (e) list such as Hodgkin’s Disease, B-Cell leukemias, multiple myeloma and soft-tissue sarcoma’s all share a pathological footprint or genesis with the claimed disability. Additionally, medical evidence supplied by the Veteran indicates that myelofibrosis is a pre-cursor to leukemia. Despite the substantial medical evidence that has been assembled in an attempt to support the Veteran’s claim, he has not been afforded a VA examination to assimilate this data into a cogent medical opinion on the existence of any nexus that might exist between the blood and bone marrow condition and exposure to herbicide agents while in service. This constitutes a pre-decisional error in failing to fulfill the duty to assist. McClendon v. Nicholson, 20 Vet.App. 79 (2006) Accordingly, a VA examination and associated further development is warranted. The matter is REMANDED for the following action: 1. In light of Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (VA records are constructively of record) obtain all VA treatment records pertaining to care for myelofibrosis dating since October 2017 that are not already of record from the VA Medical Center in Denver, Colorado and its satellite facilities in that area.   2. 3. Thereafter, in light of the pre-decisional failure to fulfill the duty to assist, schedule the Veteran for a VA examination with an oncologist to address the nature and etiology of any current blood or bone marrow cancer, to include myelofibrosis. The VA examiner must be provided access to the appellant’s VBMS and Virtual VA/Legacy files, and note that review in the report. As a Veteran who served in the Republic of Vietnam, he is presumed to have been exposed to herbicides. For each diagnosed blood/bone marrow cancer, the examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the disorder had its onset during the Veteran's active duty service? If not, is it at least as likely as not related to any event or injury incurred during active duty service, including exposure to herbicides while on active duty? The examiner must consider and address the February 2019 private opinion. All submitted journal articles, studies and treatises should be reviewed. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical   science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Allen M. Kerpan, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.