Citation Nr: 20008077 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 19-17 041 DATE: January 30, 2020 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1971 to February 1996. He died in July 2017. The appellant is his surviving spouse. The Board finds that further development of the evidence is required prior to adjudicating the appellant’s service connection claim for the cause of the Veteran’s death. The Veteran’s death certificate lists the immediate cause of death as astrocytoma of the brain, and significant conditions contributing to death were hypertension, memory loss, seizure disorder, and sleep apnea. At the time of his death, he was service connected for fibromyalgia, tinnitus, bilateral foot hallux valgus, and back scars. The appellant contends that the Veteran’s cause of death (astrocytoma of the brain, hypertension, memory loss, seizure disorder, and sleep apnea) was due to or made worse by his exposure to burn pits in the Southwest Asia Theater of Operations (Gulf War). She additionally provided articles in support of her contention. A February 2018 VA examiner determined that the Veteran’s brain tumor was less likely than not incurred in or caused by service. The examiner reasoned that, according to UpToDate, “most primary brain tumors in adults are sporadic, with no identifiable risk factors. Aside from relatively rare genetic syndromes such as neurofibromatosis and cancer predisposition syndromes, such as Li-Fraumeni, the only established risk factor for primary brain tumors is exposure to ionizing radiation.” The examiner went on to opine that, with current medical available evidence and knowledge, it is less likely as not that the Veteran’s astrocytoma was caused by or the result of his exposure to burn pits during service in the Gulf War. She indicated that the Veteran did have neurofibromas but the examiner did not find a diagnosis of neurofibromatosis. The examiner provided no rationale for this conclusion. In addition, as the VA examiner’s opinion did not provide an opinion regarding the other conditions contributing to the Veteran’s death. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Once VA has provided an examination, it is required to provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (noting that once VA provides an examination, VA has a duty to ensure that the examination is adequate for evaluation purposes). The Board finds that the February 2018 opinion is inadequate and additional medical opinion is necessary to determine if there is any relationship between the Veteran’s military service and his death. The matter is REMANDED for the following action: Arrange to obtain an addendum medical opinion addressing any relationship between the Veteran’s death and his service. The claims file must be provided to and reviewed by the examiner. Following a review of the claims file, the examiner is requested to furnish an opinion with respect to the following questions: (a.) Is it at least as likely as not (a probability of 50 percent or greater) that any of the conditions listed on the Veteran’s death certificate (astrocytoma of the brain, hypertension, memory loss, seizure disorder, sleep apnea) had its onset during service or are otherwise causally related to the Veteran’s active service, to include his service in Southwest Asia and conceded exposure to burn pits? (b.) Is it at least as likely as not (a probability of 50 percent or greater) that any of the Veteran’s disabilities (to include his service-connected disabilities of fibromyalgia, tinnitus, bilateral foot hallux valgus, back scars) diagnosed before the Veteran’s death, alone or in combination, caused or contributed substantially or materially to his death? Please consider this question for all disabilities noted upon review of the Veteran’s medical treatment records. (Continued on the next page)   A complete and detailed rationale must be given for each opinion and conclusion expressed. JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. Warren 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.