Citation Nr: 21061551 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 18-35 961 DATE: October 4, 2021 REMANDED Entitlement to service connection for cholangiocarcinoma, to include as secondary to exposure to herbicide agents and liver flukes, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to July 1969, to include service in the Republic of Vietnam. The Veteran died in March 2020. The appellant is his surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran and the appellant testified at a videoconference hearing held before the undersigned Veterans Law Judge, and a transcript of that hearing has been associated with the electronic claims file. In May 2020, the Board dismissed the appeal of entitlement to service connection for metastatic cholangiocarcinoma on the basis that the Veteran had died and that there had not been any decision on record showing that the RO had made a formal substitution determination. In October 2020, a RO granted the appellant's request for substitution as the claimant for the issues on appeal. In March 2020, the Veteran submitted medical treatise evidence showing that his type of cancer is related to exposure to liver flukes from eating raw or poorly cooked freshwater fish in Vietnam. The United States Court of Appeals for Veterans Claims (the Court) has held that "[g]enerally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). The Court has, however, also held that medical treatise evidence "standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion." Wallin v. West, 11 Vet. App. 509, 514 (1998) (citing Sacks, 11 Vet. App. at 317). The United States Court of Appeals for Federal Circuit (the Federal Circuit) held that "[a] veteran with a competent medical diagnosis of a current disorder may invoke an accepted medical treatise in order to establish the required nexus; in an appropriate case it should not be necessary to obtain the services of medical personnel to show how the treatise applies to his [or her] case." Hensley v. West, 212 F.3d 1255, 1265 (2000). The April 2018 VA medical opinion addressed whether the cancer was related to exposure to herbicide agents. An addendum to the April 2018 VA medical opinion is necessary to address whether the Veteran's cancer was otherwise related to service in Vietnam, to include a possible in-service exposure to liver flukes from eating raw or undercooked freshwater fish. The Veteran was treated by a Dr. Schmidt. The RO obtain records from Dr. Schmidt. The matter is REMANDED for the following action: 1. Ask the appellant to identify all treatment for the Veteran's cholangiocarcinoma and obtain any identified records. Ask the appellant to complete a VA Form 21-4142 for Dr. Schmidt. Make two requests for the authorized records from Dr. Schmidt, unless it is clear after the first request that a second request would be futile. 2. After the development in 1 is completed, the RO should arrange for the Veteran's claims file to be reviewed by the VA doctor who rendered the medical opinion in April 2018 on whether the Veteran's cancer was related to exposure to herbicide agents for preparation of an addendum opinion. If that doctor is unavailable, arrange for the claims file to be reviewed by an appropriate clinician. The clinician must opine whether it is at least as likely as not that the Veteran had an in-service exposure to liver flukes from eating raw or undercooked freshwater fish while serving in the Republic of Vietnam. The clinician should be reminded or advised that a medical opinion was rendered in April 2018 on whether the Veteran's cholangiocarcinoma was related to exposure to herbicide agents. The clinician must opine whether it is at least as likely as not that the Veteran's cholangiocarcinoma was otherwise related to his service in the Republic of Vietnam, to include any an in-service exposure to liver flukes from eating raw or undercooked freshwater fish. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought in connection with the claim remains denied, the appellant and her representative should be provided with an appropriate Supplemental Statement of the Case (SSOC) and given the opportunity to respond. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Cherry, 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.