Citation Nr: 20046735 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 16-41 981 DATE: July 13, 2020 REMANDED Entitlement to service connection for a stomach disability is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1969 to September 1971. The Veteran passed away in June 2014 and at the time of his death, had a pending appeal for claims for the above-mentioned issues. The Appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa. In a June 2016 determination, the RO granted the Appellant's February 2016 request for substitution (via Application for DIC, Death Pension, and/or Accrued Benefits). See 38 C.F.R. § 3.1010(c)(2) (2017). As the Appellant has been properly substituted as the claimant in this case, the Veteran's appeal is continued. See 38 U.S.C. § 5121A (West 2014). This matter was previously before the Board in September 2019, wherein the Board remanded the case to obtain an addendum medical opinion. The case has returned to the Board for adjudication. 1. Entitlement to service connection for a stomach disability The Veteran asserted that he has a stomach disability that is due to his military service, or in the alternative, related to his exposure to Agent Orange from his service in the Republic of Vietnam. Prior to his death, the Veteran was afforded a VA examination in July 2013. He was diagnosed with pancreatitis and gastrojejunoscopy due to duodenal stricture. The VA examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. He stated that there was one note in the STRs in September 1970 showing that he was treated for stomach cramps, vomiting and signed as gastroenteritis. There was no mention of any GI problems on the exit physical and he was discharged with a one profile. The Veteran also related to the examiner that he had no similar symptoms while in service, to those symptoms after he was out of service. However, the VA examiner indicated that a repeat UGI was ordered and was to be done on July 2013, but due to a problem with equipment in the radiology department, the UGI was cancelled by the department and due to time involved, the report was being sent without a repeat UGI evaluation. Upon review of the VA treatment records, in September 2013, the x-ray report of the upper GI was completed and found to be abnormal. The impression showed thickening of the gastric rugal folds, possible small sliding hiatal hernia, trace of spontaneous reflux, and left epigastric punctate radiodensities, possibly adrenal or renal calcifications. The report noted that due to cancellation of the first scheduled x-rays due to equipment problems, this last report was completed too late to be included in the last C&P examination. See September 2013 VA treatment record. Furthermore, a May 2014 CT scan of the chest, abdomen, and pelvis shows that the Veteran had a very aggressive tumor in the fundus of the stomach. See May 2014 VA treatment record. The September 2019 Board decision remanded the issue as there was no medical opinion addressing whether the stomach disability was causally related to his exposure to herbicide agents. To this end, an addendum medical opinion was obtained in November 2019. The VA examiner found that it is not at least as likely as not that the stomach disability is causally related to the Veteran’s active service, to include herbicide agent exposure. The VA examiner concluded that scientific validation of an etiological or causative association between pancreatitis and stricture and Agent Orange herbicide related to or based on epidemiological or scientific studies, on environmental exposures, or on occupational exposures during deployment in this Veteran cannot be established. The November 2019 medical opinion is unclear as to whether the VA examiner considered the September 2013 x-ray report of the upper GI and the May 2014 CT scan as he only addressed diagnoses of the pancreatitis and duodenal stricture. Accordingly, the Board finds that the matter must be remanded again for an addendum medical opinion before a decision on the merits may be made. 2. Entitlement to a TDIU With respect to the claim for TDIU, because the resolution of the claim being remanded could impact the adjudication of this claim, the claim for TDIU must be deferred at this time. Harris v Derwinski, 1 Vet. App. 80 (1991). The matters are REMANDED for the following action: 1. Arrange for a medical opinion from the VA provider who issued the November 2019 medical opinion to address the claim for a stomach condition (or if no longer available, an appropriate replacement). The Veteran's record, to include a copy of this remand, should be made available to and reviewed by the examiner, and an opinion as follows is requested: a) Identify each diagnosis associated with the stomach/gastrointestinal tract during the appeal period. b) For each diagnosis, provide an opinion for the following: Is it at least as likely as not (a 50 percent or greater probability) that such disability had an onset or is related to service, to include as due to herbicide agents/Agent Orange exposure? The examiner must not discount the herbicide agents exposure or amount of exposure as it is presumed under VA law as it is confirmed that he had Vietnam Service from May 12, 1970, to March 12, 1971. The examiner must comment on whether there is a level of exposure to herbicide agents that would as likely as not cause the stomach disorders in this Veteran’s case, and based upon his unique history. The examiner must address the September 2013 upper GI x-ray report and the May 2014 CT scan in the medical opinion. The examiner is also requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Kim, 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.