Citation Nr: 20028834 Decision Date: 04/24/20 Archive Date: 04/24/20 DOCKET NO. 17-61 138 DATE: April 24, 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 September 1947 to September 1951 and from December 1955 to November 1977. The Veteran died in August 2016. The Appellant is the surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO)in Philadelphia, Pennsylvania. The Appellant seeks service connection for the cause of the Veteran’s death. The Appellant believes that the Veteran died due to his service-connected disabilities, his prostate cancer in specific. She stated that Dr. Gilles told her that her husband was full of cancer. See Form 9. The immediate cause of the Veteran’s death was a brain tumor with no other contributory causes listed. See August 2016 Death Certificate. At the time of his death the Veteran was service connected for prostate cancer, hiatal hernia with recurrent esophageal stricture, lumbosacral strain with degenerative disc and joint disease, postoperative internal derangement of the left knee, sinusitis with hay fever and headaches, hypertension with history of first degree AV block, lichen planus involving the entire body, bilateral hearing loss and erectile dysfunction. A medical opinion on the cause of death of the Veteran was not obtained because of the medical statement by Dr. B.K.O. of the Mountain Home VA Medical Center. See March 2018 Supplemental Statement of the Case (SSOC). Dr. B.K.O. had stated that it is always at least possible that the Veteran’s cause of death can be linked to his service-connected disability but without known pathology of the brain mass, no definite determination can be made on whether the brain mass was a primary mass that was not related to military service or if it had metastasized from the Veteran’s service connected prostate cancer. The physician’s opinion appears to reflect a belief that a definitive causation standard is required in order to establish a causal relationship between the Veteran’s service-connected disabilities and his subsequent development of a brain tumor. The applicable standard, however, is “an at least as likely as not” proposition. The matter is REMANDED for the following actions: 1. Update the record for any VA or private treatment records. Specifically, contact the appellant and ask that she identify the provider(s) of any additional treatment or evaluation the Veteran received, records of which are not already associated with the claim files, and to provide any releases necessary for VA to secure such records of treatment or evaluation. 2. Forward the Veteran’s claims file to an appropriate clinician for an opinion regarding the nature and etiology   of the Veteran’s cause of death. The VA examiner should review the claims file (including this remand), and consider all pertinent evidence of record to include, but not limited to, the Veteran’s service treatment records, VA and private treatment records, and Certificate of Death. After reviewing the relevant evidence, the examiner must opine: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cause of death had its onset during or causally related to his service. (b) Whether it is at least as likely as not 50 percent or greater probability) that the Veteran’s cause of death is proximately due to his service-connected disabilities, to specifically include his service-connected prostate cancer. The examiner must consider the combined effects of the service connected disabilities as well as each individual disability. (c) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cause of death was the result of herbicide exposure in service. The examiner should provide reasons for all opinions. If an opinion cannot be made without resort to speculation, he or she should state whether the inability is due to the limits of medical knowledge in general, the limits of the   examiner’s medical knowledge, or there is additional evidence, which if obtained, would permit the opinion to be provided. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kelsey Love, 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.