Citation Nr: 20004447 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 16-24 708 DATE: January 21, 2020 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran had active service from March 1967 to April 1969, including service in the Republic of Vietnam. He died in July 2006. The appellant is his widow. The appellant contends that the Veteran’s death was caused by the Veteran’s service-connected diabetes mellitus or was due to ischemic heart caused by herbicide agent exposure. In September 2018, the Board remanded this issue in order to obtain a VA medical opinion addressing the cause of the Veteran’s death. In addition to requesting that the examiner discuss whether diabetes mellitus and coronary artery disease contributed to his death, the examiner was asked to discuss whether it was at least as likely as not that the Veteran’s renal disease arose in service or was otherwise related to service, to include conceded exposure to Agent Orange. The examiner was instructed to explain why or why not. A VA medical opinion was issued in August 2019. The cardiologist stated that it was less likely as not that the Veteran’s renal disease arose in service or was otherwise related to military service including exposure to Agent Orange. He discussed the course of the Veteran’s final illness and the diagnoses that led to his death, and he provided rationale regarding why diabetes and coronary artery disease did not contribute to his death, but he did not provide any rationale regarding his conclusion that renal disease was not related to service or herbicide agents. Most of the probative value of an opinion comes from the discussion of its underlying reasoning or rationale, so a medical opinion should contain a conclusion and a reference to supporting data with a reasoned medical explanation connecting the two. Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The examiner was specifically asked to provide a medical opinion about the relationship of the Veteran’s final illnesses, including renal disease, to service and to herbicide agent exposure, but he failed to provide any rationale for this opinion as instructed. The Board finds this to be a failure to comply with the prior remand orders, and the case is remanded. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Return the claims file to the examiner who completed the August 2019 medical opinion and ask him to provide an addendum medical opinion regarding the etiology of the Veteran’s final illnesses. If that examiner is no longer available, forward to the claims file to a similarly qualified physician for a medical opinion. The examiner should discuss whether the Veteran’s renal disease, end stage liver disease, nonalcoholic steatohepatitis, anemia, urosepsis, oliguria, hypotension, or respiratory failure were caused by or otherwise related to any disease or injury in service, including his presumed exposure to herbicide agents in the Republic of Vietnam. The Board notes that it is insufficient to state that these disorders are not on the presumptive list of diseases associated with herbicide exposure; the examiner must provide rationale explaining why the Veteran’s end of life illness were or were not related to this herbicide agent exposure. A complete rationale must be provided for all opinions rendered. Mary E. Rude Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Anthony L. Hines Associate Attorney The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and it does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.