Citation Nr: 20053531 Decision Date: 08/12/20 Archive Date: 08/12/20 DOCKET NO. 14-12 417 DATE: August 12, 2020 REMANDED Entitlement to service connection for polycythemia vera (PV) (myelofibrosis), to include as due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1968. The Veteran died in February 2019. The appellant is his widow and is the substituted claimant. In a February 2018 decision, the Board denied claims of service connection for chronic lymphocytic leukemia (CLL) and myelofibrosis. The Veteran subsequently appealed that decision to the United States Court of Appeals for Veterans Claims (Court). During the pendency of the appeal, the Veteran died and the appellant was formally substituted in the claim. In an October 2019 order, the Court granted a Joint Motion for Partial Remand (JMPR), which vacated the part of Board’s decision on the myelofibrosis claim. Pursuant to a Stipulated Agreement by the parties to the JMPR, service connection for CLL was granted. See October 2019 rating decision. Entitlement to service connection for myelofibrosis, to include as due to herbicide exposure is remanded. The Board is unable to make an informed decision on the claim without further development. The Veteran meets the criteria for presumptive exposure to herbicides, however, myelofibrosis is not among those diseases considered a presumptive disease under 38 C.F.R. § 3.309(e). The record includes a May 2016 opinion from the Veteran’s hematologist that opined that the Veteran’s diagnosed conditions of CLL and myelofibrosis are likely related to his exposure to herbicides in Vietnam. However, the rationale considered both conditions, without discussion as to myelofibrosis alone. The opinion provider also noted the combination of CLL and myeloproliferative disorders are uncommon and “interactions between the [Veteran’s] stay in Vietnam and the development of these hematological disorders seem plausible.” The reference to “plausible,” without other rationale, makes the opinion to speculative to provide the degree of certainty required for medical nexus evidence. See Hood v. Shinseki, 23 Vet. App. 295 (2009). The claim is remanded for a medical opinion. The matters are REMANDED for the following action: Obtain a medical opinion from a hematologist, if available, or if not another appropriate VA examiner, to determine the nature and etiology for the Veteran’s myelofibrosis. Copies of all pertinent records must be made available to the examiner. After reviewing the claims file, the examiner is asked to answer the following: Is it at least as likely as not (50 percent probability) that the Veteran’s myelofibrosis is related to the Veteran’s service, to specifically include exposure to herbicides and/or his service-connected chronic lymphocytic leukemia? The Veteran’s exposure to herbicides is conceded. The examiner must specifically comment on the May 2016 private hematology opinion that the Veteran’s myelofibrosis was caused by chemical exposure, to include herbicides. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state why that is and what, if any, information is needed in order to provide an opinion. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.