Citation Nr: 20011925 Decision Date: 02/13/20 Archive Date: 02/12/20 DOCKET NO. 17-46 730 DATE: February 13, 2020 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served in the Army from August 1945 to October 1948 and from August 1950 to January 1976, to include service during World War II and in the Republic of Vietnam and Korea. Sadly, the Veteran passed in February 1986. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin, proposing severance of service connection for cause of death. The appellant filed a timely notice of disagreement (NOD) in September 2016, and in July 2017, the RO issued rating decision severing service connection for cause of death, effective May 1, 2016. The RO then issued a statement of the case (SOC) in August 2017. In September 2017, the appellant perfected her substantive appeal and requested a video conference before a Veterans Law Judge (VLJ). In January 2020, the appellant testified at a videoconference hearing before the undersigned VLJ. A transcript of that proceeding is associated with the record. The appellant’s appeal has been advanced on the docket. 38 U.S.C. § 7107(a)(2) (2012); 38 C.F.R. § 20.900(c) (2019). 1. Entitlement to service connection for cause of death. The appellant is seeking service connection for the cause of the Veteran’s death. Specifically, she contends that the Veteran’s death from pneumonia due to myeloid metaplasia/myelofibrosis was a direct result of exposure to herbicides during active service. Specifically, she contends that one of the exposure chemicals associated with myelofibrosis is “Benzene,” which is part of the chemical makeup of Agent Orange. See January 2020 Hearing Tr.; November 2017 Statement of Representative (citing to “Merk Manual, ch. 130, sec. II” with regards to the chemical benzene). Alternatively, the appellant contends that the Veteran’s death was due to his service-connected heart disability as it aggravated the Veteran’s myeloid metaplasia. See January 2011 Statement in Support of Claim; January 2010 Statement in Support of Claim. The Board finds that additional development is needed before the issues on appeal can be decided. As a preliminary matter, the Veteran served in Vietnam and is therefore presumed to have been exposed to herbicides. At the time of the Veteran’s death, he was serviced-connected for arteriosclerotic heart disease; ankylosis of the right fourth and fifth fingers; high frequency hearing loss; paraesophageal hiatal hernia; and degenerative joint disease of the spine, right hand, and bilateral knees. The Veteran’s cause of death is listed as necrotizing pneumonia due to myeloid metaplasia and myelofibrosis. In April 2012 the DRO requested a medical opinion from a Dr. D. See April 2012 Third Party Correspondence. A handwritten note with an illegible signature and date subsequently states, “The Veteran’s myeloid metaplasia complicated by septic shock and death is as likely as not a variant of leukemia that is presumptively related to agent orange exposure.” September 2012 Report of Contact. In a subsequent January 2016 VA medical opinion, a staff physician Dr. G.K., contrastingly opined that it is less likely as not that the Veteran had B-cell leukemia. He explained that myeloid metaplasia with myelofibrosis is known to transform to acute myelogenous leukemia if it transforms to leukemia. This is not a B-cell leukemia. The physician also opined that the Veteran’s myeloid metaplasia /myelofibrosis was less likely as not related to his exposure to herbicidal agents during his military service. He reasoned that in reviewing the medical record, there did not appear to be significantly decreased cardiac function due to his cardiac disease. The focus in treatment during the last year of the Veteran’s life was in treating the myeloid metaplasia/myelofibrosis and related complications such as infections. The medical records do not demonstrate a decrease in heart function or use of medications that would cause him to be less able to resist the ultimate cause of death. Regarding direct service connection, the January 2016 VA examiner, asserted that the veteran’s STRs did not reveal any diagnosis which would have at least as likely as not contributed to the veteran’s death. He reasoned that the Veteran had several medical issues documented in the record over a long military career. None of these conditions are known to cause the myeloid metaplasia /myelofibrosis. The Board finds the provided medical opinions inadequate for adjudicative purposes. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The September 2012 Report of Contact does not contain any information as to the credentials of the examiner and the examiner does not provide any reasons or bases for his opinion. Likewise, the January 2016 VA physician failed to provide an opinion as to whether the Veteran’s death from pneumonia due to myeloid metaplasia was as a direct result of exposure to herbicides during active service or whether the Veteran’s service-connected heart disability aggravated his cause of death. In light of the above, the Board finds a remand for a new VA medical opinion is warranted. On remand, the AOJ should arrange to obtain a medical opinion based on claims file review from an appropriate physician—preferably an oncologist. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate physician, preferably an oncologist, regarding the Veteran’s cause of death. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. The VA examiner/clinician should address the following: (A) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s cause of death was incurred in or caused by his military service, to include conceded herbicide exposure. In doing so, the examiner should consider the Veteran’s STRs, the September 2012 Report of Contact, the January 2017 VA medical Opinion, the November 2017 Statement of Representative, and the January 2020 Hearing Tr. (B) If not, whether the Veteran’s cause of death was at least as likely as not (50 percent probability or more) caused by or aggravated by his service-connected disabilities. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the appellant’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remain denied, furnish the appellant and her representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.