Citation Nr: 19109369 Decision Date: 02/06/19 Archive Date: 02/06/19 DOCKET NO. 16-24 684A DATE: February 6, 2019 ORDER Entitlement to service connection for the cause of the Veteran’s death is granted. FINDING OF FACT 1. The Veteran passed away in March 2014, and his death certificate shows that the immediate cause of death was glioblastoma. 2. The Veteran’s glioblastoma is related to his exposure to herbicide agents during his military service in Vietnam. CONCLUSION OF LAW The criteria for entitlement to service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1967 to July 1970. The Veteran passed away in March 2014, and the appellant is his surviving spouse. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision. Entitlement to service connection for the cause of the Veteran’s death. The appellant contends that the Veteran’s death was caused by his exposure to herbicide agents in service. To establish service connection for the cause of the Veteran’s death, the evidence must show that a service-connected disability was either the principal or a contributory cause of death. For a service-connected disability to be the principal (primary) cause of death, it must singly or with some other condition be the immediate or underlying cause of death or be etiologically related. For a service-connected disability to constitute a contributory cause it must contribute substantially or materially; 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 U.S.C. § 1310; 38 C.F.R. § 3.312. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to direct service connection requires evidence of three elements: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran’s death certificate reflects that he died in March 2014 as a result of brain cancer (glioblastoma). At the time of the Veteran’s death, he was service-connected for posttraumatic stress disorder evaluated as 100 percent disabling and burn scars rated as 40 percent disabling. There is no evidence that the Veteran’s service-connected disabilities contributed substantially or materially to his death, and the appellant has not alleged that the Veteran’s service-connected disabilities caused his death. The Veteran served in the Republic of Vietnam from January 1968 to January 1969, as shown in his Form DD 214. The Veteran is therefore presumed to have been exposed to herbicide agents while in service. 38 C.F.R. § 3.307(a)(6). However, the Veteran’s glioblastoma is not presumed to have been caused by such exposure, as glioblastoma is not listed as an enumerated disease under 38 C.F.R. § 3.309. The appellant must therefore establish service connection directly under the provisions articulated above by showing a nexus between his glioblastoma and his presumed exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). In a December 2018 private medical opinion, the doctor opined that it was more likely than not that the Veteran’s exposure to herbicide agents caused or substantially contributed to his cause of death. The doctor reviewed epidemiological studies and considered their findings. The doctor noted that gliomas are relatively rare and that there is unlikely to be high-quality epidemiologic evidence directly linking herbicide agent exposure to gliomas. He noted, however, that there are a limited number of studies linking herbicide agents to gliomas in non-military settings. The doctor also addressed the Veteran’s other risk factors, which included his brother’s history with brain cancer and his history of cigarette smoking. The doctor reviewed medical literature that addressed potential associations between these risk factors and glioblastoma and found that these studies did not support a link to these nonservice-related risks. The doctor also addressed the gap in time between the Veteran’s diagnosis and his separation from service, finding that cancers rarely manifest within a short time frame of exposure. The Board assigns a moderate to high degree of probative value to this opinion, given the doctor’s thorough review of the Veteran’s medical history and extensive supporting medical literature. The record does not contain any opinion to the contrary. In light of the evidence discussed above, the Board finds that entitlement to service connection for cause of the Veteran’s death is warranted, and the claim is granted. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. H. White, Associate Counsel