Citation Nr: 21062814 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-35 308 DATE: October 12, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Preliminary Matters The Veteran had honorable active duty service with the United States Army from November 1965 to November 1967, to include service in the Republic of Vietnam. The Veteran passed away in November 2016. The Appellant in the present appeal is his surviving spouse. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2020, the Board remanded the issue on appeal for further development. The issue has returned to the Board. The Board notes that the Appellant presented testimony before a Veterans Law Judge (VLJ) in January 2020. The VLJ who conducted the hearing is no longer employed by the Board. In an August 2021 letter, the Appellant was notified that the VLJ who conducted the hearing was no longer employed at the Board. Pursuant to 38 U.S.C. § 7101(c), she was offered an opportunity to testify at a hearing before a VLJ who could participate in making a final determination on her claim. The Appellant was provided 30 days from the date of the letter to make her election. Absent any indication from the Appellant, the Board will proceed with adjudicating the claim. The Appellant did not respond. As such, the Board finds that VA has fulfilled its duty in providing the Appellant an opportunity for another hearing. Thus, the Board will proceed with adjudicating the Appellant's claim. REASONS FOR REMAND The Appellant seeks entitlement to service connection for the cause of the Veteran's death. Regrettably, as discussed below, a remand is required to obtain an additional VA medical opinion. Entitlement to service connection for the cause of the Veteran's death is remanded. At the time of his death, the Veteran was not service connected for any disability. The Veteran's death certificate states that he passed away due to cardiac arrythmia, tobacco abuse, and hyperlipidemia. The Appellant contends that the Veteran's death was caused by exposure to herbicides during his service in Vietnam. Specifically, she contends that the Veteran's hyperlipidemia was related to the Veteran's exposure to herbicide agents while in service, which ultimately resulted in a heart condition. In accordance with the April 2020 Board remand directives, a VA medical opinion was obtained in July 2020. The examiner opined that it is less likely than not that the Veteran's hyperlipidemia was caused by his exposure to herbicide agents while in the Republic of Vietnam. The examiner indicated that review of medical literature finds that common causes of hyperlipidemia include genetics/family history, diet, and alcohol. The examiner addressed the Korean study obtained by the Appellant from the National Institutes of Health website that states, "the prevalence of hypertension and hyperlipidemia, which are well-known risk factors for cardiovascular disease, was significantly higher in the patients who had been exposed to TCDD than in those who had not." The examiner explained that this study was designed to examine the correlation between exposure to TCDD and acute coronary syndrome, not hyperlipidemia. Additionally, the July 2020 VA examiner noted that the Veteran's medical treatment records contain no diagnostic tests to establish a cardiac/heart condition, including coronary artery disease. The Board notes that private treatment records submitted prior to the July 2020 VA opinion show that in January 2016 and March 2016, the Veteran complained of chest pain. A January 2016 private treatment record shows that the Veteran presented with chest pain. Symptoms included chest pain and cough. The pain was located in the left anterior chest and left lateral chest. The Veteran described the pain as sharp and the onset was days ago. A March 2016 private treatment record shows that the Veteran reported that he still experienced an occasional anterior chest wall pain with some cough on the left. The July 2020 VA examiner did not address these relevant treatment records. Thus, the Board finds the medical opinion inadequate, as the examiner did not address whether these episodes of chest pain were related to a heart condition or other causes. As such, the Board cannot make a fully-informed decision on the issue of service connection for the cause of the Veteran's death because, currently, there are no adequate medical opinions of record addressing the etiology of the cause of the Veteran's death. Accordingly, on remand, the RO must obtain an additional medical opinion to clarify the etiology of the cause of the Veteran's death. The matter is REMANDED for the following action: 1. Forward the Veteran's claims folder to an appropriate clinician for review and for an opinion on the cause of the Veteran's death. Based on a review of the record, and with consideration of the Appellant's statements, the examiner must state whether the Veteran had a heart condition that was related to events during his military service or any incident therein, to include herbicide exposure. The Veteran's death certificate includes cardiac arrythmia and hyperlipidemia as the cause of death. In addressing this question, the examiner must state whether the Veteran's complaints of chest pain in January and March 2016 are related to any heart condition, including coronary artery disease. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 2. After completing all indicated development, the Appellant's claim should be readjudicated based on the entirety of the evidence. If the benefit sought on appeal is not granted, the Appellant and her representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. MacDonald, 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.