Citation Nr: 20039919 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 12-09 198 DATE: June 11, 2020 REMANDED Service connection for metastatic salivary duct carcinoma, to include as secondary to service-connected diabetes mellitus, on a substituted claim basis, is remanded. Service connection for periodontal disease, claimed as bone loss due to dry mouth syndrome, to include as due to nonservice-connected metastatic salivary duct carcinoma, on a substituted claim basis, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1965 to September 1967 in the U.S. Army. The Veteran died in January 2016. The Appellant is his surviving spouse, who has been properly substituted. 38 C.F.R. § 3.1010. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. Most recently, this matter was before the Board in November 2019, at which time the Board remanded the issues on appeal for additional development. This case has now been returned to the Board for further appellate action. While the Board regrets additional delay, further development is necessary. Metastatic salivary duct carcinoma The Appellant contends that the Veteran’s metastatic salivary duct carcinoma was caused by his diabetes mellitus. Alternatively, the Appellant contends that the Veteran’s metastatic salivary duct carcinoma was caused by in-service exposure to herbicide agents. A VA opinion was obtained in January 2020. The examiner opined that it is less likely than not that the Veteran’s claimed condition was proximately due to or the result of the Veteran’s service-connected diabetes mellitus. The examiner’s rationale stated that the Veteran’s genetic predisposition has significantly increased his risk for development of salivary gland carcinoma and at the time of his diagnosis, medical records show that the Veteran’s diabetes mellitus without mention of complication. The examiner also stated that there is no pathophysiological link between salivary duct carcinoma and diabetes mellitus, or peripheral neuropathy in this context and that both conditions are separate and independent as their clinical etiology and nature are unrelated. The Board finds the January 2020 opinion inadequate for adjudication purposes. While the examiner stated that the Veteran had diabetes mellitus without complications, the evidence of record shows that he had peripheral neuropathy and erectile dysfunction secondary to his diabetes mellitus. Additionally, in March 2013, the Veteran submitted a medical article about the relationship between salivary gland cancer and diabetes, however it is unclear if the examiner considered it. Furthermore, the examiner did not provide an opinion regarding aggravation. Therefore, the Board finds that remand is necessary to obtain an addendum opinion. The Board also notes that no examiner has opined whether the Veteran’s metastatic salivary duct carcinoma is related to his in-service exposure to herbicide agents. As such, remand is necessary to obtain an addendum opinion.   Periodontal disease, claimed as bone loss due to dry mouth syndrome The Board finds that the issue of service connection for periodontal disease, claimed as bone loss due to dry mouth syndrome, is inextricably intertwined with the claim for entitlement to service connection for metastatic salivary duct carcinoma. Accordingly, remand is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the nature and etiology of the Veteran’s metastatic salivary duct carcinoma. The claims file, including a copy of this remand, must be made available to the examiner and review must be noted. The examiner is asked to provide an opinion to each of the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s metastatic salivary duct carcinoma is related to an in-service injury, event, or disease, to include exposure to herbicide agents. (b.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s metastatic salivary duct carcinoma is (1) proximately due to or the result of any of the Veteran’s service-connected disabilities, to include diabetes mellitus, or (2) aggravated by any of the Veteran’s service connected disabilities, to include diabetes mellitus. The examiner must consider the lay evidence of record and the medical article submitted by the Veteran in March 2013. A complete rationale must be provided for all opinions offered. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kernen, 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.