Citation Nr: 21000486 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 15-20 806 DATE: January 5, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Entitlement to accrued benefits is remanded. REASONS FOR REMAND The Veteran had active service from March 1968 to March 1972. He died in March 2011. The appellant is the Veteran’s widow, who has been substituted in the appeal for accrued benefits. In November 2018, the appellant testified at a hearing in Washington, D.C. before the undersigned Veterans Law Judge, and a transcript of the hearing is of record. In May 2020 and August 2020, these claims were remanded for additional development. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. 2. Entitlement to accrued benefits is remanded. The appellant contends that the adenocarcinoma of the sinus, which was the Veteran’s cause of death, is related to his exposure to Agent Orange during service in Vietnam. In the August 2020 remand, the Board found that the basis of the June 2020 medical opinion was unclear. The Board remanded the case for a new medical opinion with respect to whether the Veteran’s sinonasal adenocarcinoma was at least as likely as not related to the Veteran’s presumed Agent Orange exposure. The examiner was advised that the absence of sinonasal cancer on the list of presumptive disabilities for Agent Orange is not, by itself, a sufficient basis for a negative nexus. In September 2020, a VA examiner gave a negative nexus opinion. The examiner’s rationale was that the medical literature does not support an association between cancers of the oral cavity, nose, or pharynx with herbicides sprayed in Vietnam. The examiner noted that the National Academy of Sciences has performed an extensive literature search and has not found an association between Agent Orange/ herbicides and the Veteran’s cancer. The examiner did not provide any analysis of the relationship of herbicide exposure and nasal cancer, other than citing the fact that the NAS has not found an association between Agent Orange and nasal cancer. The September 2020 opinion noted that nasal cancers are associated with occupational exposures including leather, textiles, wood dust, and formaldehyde. The examiner opined that the Veteran’s occupational exposure to adhesives was a documented risk factor but did not address the Veteran’s occupational exposures as an aircraft mechanic during service. The Board finds that a new medical opinion is necessary. The September 2020 opinion did not include a detailed rationale about the relationship of Agent Orange and sinonasal adenocarcinoma. As there is evidence indicating that occupational exposures are a risk factor, the opinion should address the Veteran’s occupational exposures as an airplane mechanic during service. The matters are REMANDED for the following action: 1. Forward the record to an appropriate medical professional to obtain a VA medical opinion regarding the nature and etiology of the Veteran's sinonasal adenocarcinoma. If possible, the opinion should be provided by an examiner who has not previously given an opinion in this case. (a) The examiner should opine whether it is as at least as likely as not that the Veteran’s sinonasal adenocarcinoma was related to his Agent Orange exposure in Vietnam. The examiner is advised that the absence of sinonasal adenocarcinoma from the list of conditions which are presumed to be the result of exposure to herbicides in Vietnam is not, by itself, a sufficient explanation for a negative opinion. The examiner must specifically address the relationship between Agent Orange exposure and sinonasal adenocarcinoma. (b) The examiner should opine whether it is at least as likely as not that sinonasal adenocarcinoma was related to the Veteran’s occupational exposures as a jet mechanic, including his exposures to fuel, oil, and other chemicals used in engine maintenance. The examiner must explain the rationale for all opinions. The examiner should discuss the pertinent supporting clinical data and medical/scientific data upon which the opinion is based. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge in general or, there is evidence that, if obtained, would permit the opinion to be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Catherine Cykowski 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.