Citation Nr: 20008201 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 16-24 824 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 from November 1969 to July 1972. He died in July 2012. The appellant is his surviving spouse. She appeals a November 2013 decision denying entitlement to dependency and indemnity compensation (DIC). See November 2013 notification letter. The Veteran’s death certificate confirms he died in July 2012. The sole cause of death was listed as metastatic hepatocellular cancer (liver cancer). The Veteran was not service connected for any disability at the time of his death. The appellant argues that the Veteran’s type II diabetes mellitus and associated fatty liver disease were attributable to herbicide exposure in service and subsequently contributed to his fatal liver cancer. Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). Diabetes mellitus, type II, is associated with herbicide agent exposure for purposes of the presumption. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). M21-1 Adjudication Procedure Manual (M21-1) provides that if a veteran served in the Air Force in Thailand during the Vietnam era at Ubon Royal Thai Air Force Base (RTAFB), and served at or near the base perimeter, then the veteran may be presumed to have been exposed to herbicide agents. M21-1 Part IV, Subpart ii, Chapter 1, Section H, Paragraph 5.b. The Veteran has been diagnosed with diabetes. Military personnel records confirm the Veteran was stationed on Ubon Royal Thai Air Force Base (RTAFB) from November 1970 to November 1971. The appellant asserts the Veteran had direct contact with the base perimeter during his daily activities to include contact with washing equipment, waste water, and ground contact. The Board finds the appellant’s assertion that the Veteran regularly served on or near the perimeter of RTAFB Ubon to be credible. The Veteran is afforded the benefit of the doubt and the Board finds the Veteran was exposed to herbicide agents in service as a result of his service along the perimeter of RTAFB Ubon. The record does not contain a medical opinion assessing the possible link between the Veteran’s fatal liver cancer and his diabetes or any other condition in the Veteran’s medical records which may be attributable to exposure to herbicide agents in service. As there is an indication that the condition which caused the Veteran’s death may be related to service and there is insufficient medical evidence to make a decision on the claim, remand for a medical opinion is necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician regarding the cause of the Veteran’s death. The claim’s file, including a copy of this remand, must be made available to the reviewing clinician. The reviewing clinician is asked to provide an opinion in response to the following inquiries: Is it as least as likely as not that the Veteran’s diabetes mellitus, or its residuals, caused or aggravated his fatal metastatic hepatocellular cancer? If the reviewing clinician determines that the Veteran’s fatal metastatic hepatocellular cancer was not at least as likely as not caused or aggravated by his diabetes mellitus or its residuals, is it at least as likely as not that the Veteran’s fatal metastatic hepatocellular cancer was related to service, to include in-service exposure to herbicide agents? All opinions must be supported by rationale. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page)   After the above development, and any other development deemed necessary, has been completed, readjudicate the claim. If any benefit sought remains denied, provide the appellant and her representative with a Supplemental Statement of the Case (SSOC) and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, 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.