Citation Nr: 20007640 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 16-44 006 DATE: January 29, 2020 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND 1. Entitlement to service connection for the cause of the Veteran’s death is remanded. The Veteran served on active duty in the United States Marine Corps from December 1970 to December 1974, including in the Republic of Vietnam, with additional service in the Reserves. He was awarded the Vietnam Service Medal, the Republic of Vietnam Campaign Medal, and the Combat Action Ribbon, among other decorations. He passed away in May 2013. The appellant is his surviving spouse. The Board thanks the Veteran’s family for his honorable service to the United States during wartime. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The appellant and her attorney appeared before the undersigned during a hearing in November 2019. A transcript of the hearing is associated with the claims file. The Veteran’s death certificate lists the cause of death as cardiopulmonary arrest, due to pneumonia, due to coma, due to glioblastoma multiformis of the brain. The certificate also includes malignant brain cancer and dysphagia as contributing conditions. The Veteran was not service-connected for any conditions at the time of his death. However, the appellant contends that the Veteran’s service in Vietnam and at Camp Lejeune exposed him to herbicide agents and environmental toxins, including vinyl chloride, which caused his brain cancer. Neither brain cancer nor glioblastoma multiformis are on the list of conditions that may be presumptively service-connected based on exposure to herbicide agents or contaminated water at Camp Lejeune. See 38 C.F.R. §§ 3.307, 3.309 (e)-(f). However, a veteran may still be eligible for service connection on a direct basis for cause of death, if the evidence demonstrates an etiological link between an event in military service and condition causing or contributing to a veteran’s death. See 38 C.F.R. § 3.312; Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The Board notes that VA has not yet procured a medical opinion in the matter at issue. VA must obtain a medical opinion when the evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. See McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). Accordingly, the Board finds that a VA medical opinion is necessary to consider the evidence and arguments submitted by the appellant. The Board is aware that the appellant submitted an opinion from J.W., Ph.D., who stated that it is at least as likely as not that the Veteran developed glioblastoma as a result of his exposure to vinyl chloride, trichloroethylene (TCE), and perchloroethylene (PCE) at Camp Lejeune. The appellant also submitted scientific articles purporting to show a link between brain cancer and exposure to vinyl chloride. However, J.W. is not a medical doctor, and it is unclear to the Board whether he has the specialized medical knowledge required to opine as to the etiology of glioblastoma multiformis or to state that the medical history of this Veteran is consistent with the development of glioblastoma multiformis due to environmental exposures during military service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (noting that a layperson is not competent to diagnose a form of cancer). Moreover, J.W. did not address the appellant’s theory that exposure to herbicide agents may have caused the Veteran’s brain cancer. Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008). Regardless, J.W. did not provide a medical rationale in that he did not address how the Veteran’s medical history supports the conclusion; did not address why cited studies are persuasive or unpersuasive and/or whether the Veteran had other risk factors for developing brain cancer and/or whether brain cancer manifested in an unusual manner. As such, a VA medical opinion is necessary to appropriately consider the appellant’s contentions, the scientific articles, and J.W.’s etiology opinion. The Board further notes that the Veteran’s complete military personnel records have not been associated with the claims file. As such records are potentially relevant to the matter at issue, the agency of original jurisdiction (AOJ) must attempt to obtain them on remand. 38 U.S.C. § 5103A (c). The matter is REMANDED for the following actions: 1. Please obtain the Veteran’s complete service personnel records. 2. Obtain a VA medical opinion regarding the nature and etiology of the deceased Veteran’s glioblastoma multiformis (brain cancer). The claims file must be reviewed by the examiner, who is asked to opine on the following: (a) Is it at least as likely as not that the Veteran’s glioblastoma multiformis is etiologically related to exposure to herbicide agents during military service? The examiner is asked to consider and discuss as necessary all relevant evidence, to specifically include the scientific articles submitted by the appellant in October 2019, and the etiology opinion of J.W., Ph.D., when rendering his or her opinion. (b) Is it at least as likely as not that the Veteran’s glioblastoma multiformis is etiologically related to exposure to environmental contaminants in the water supply at Camp Lejeune? (c) Is it at least as likely as not that the Veteran’s glioblastoma multiformis had its onset during or is otherwise etiologically related to military service? A complete rationale should be provided for all opinions, meaning that the provider should cite to medical authority and/or address how the Veteran’s medical history supports the conclusion. The clinician can discuss why cited studies are persuasive or unpersuasive and/or whether the Veteran had other risk factors for developing brain cancer and/or whether brain cancer manifested in an unusual manner. The examiner is encouraged to provide citations to medical literature and/or scientific evidence to support his or her opinion. The examiner is advised that the absence of brain cancer from the list of conditions which are presumed to be the result of exposure to herbicides in Vietnam and/or contaminants at Camp LeJeune is not, by itself, a sufficient explanation for a negative opinion. The examiner is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.