Citation Nr: 21064729 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 14-32 853 DATE: October 21, 2021 REMANDED Issue of entitlement to service connection for a hematological disability, to include myelofibrosis and anemia, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1959 to February 1980. This appeal to the Board of Veterans' Appeals (Board) arose from a September 2012 rating decision issued by the Department of Veterans Affairs (VA). See October 2013 Notice of Disagreement (NOD); August 2014 Statement of the Case (SOC); September 2014 Substantive Appeal (VA Form 9). In January 2017, the Board remanded the claim for further development. January 2017 Board Decision. The agency of original jurisdiction (AOJ) developed the evidence and continued the denial of the Veteran's claim. See August 2021 Supplement Statement of the Case. The case is now back before the Board. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(a)(2). Issue of entitlement to service connection for a hematological disability, to include myelofibrosis and anemia is remanded. Unfortunately, the Board finds that another remand is required. The January 2017 Board decision remanded the claim for an opinion from a VA examiner as to whether there is a medical nexus between the Veteran's in service herbicide agent exposure and his myelofibrosis and iron deficiency anemia. January 2017 Board Decision. The January 2017 Board decision also directed that further development is needed for the Veteran's assertion that he had in-service exposure to radiation. Id. A January 2019 VA examination medical opinion was obtained in which the VA examiner opined that it is less likely than not that the Veteran's myelofibrosis and iron deficiency anemia were incurred in or caused by in-service exposure to herbicide agents. However, the VA examiner's rationale is only that neither condition is cited as presumptive conditions due to herbicide agent exposure. Id. As noted in the January 2017 Board decision, even if the Veteran's conditions are not entitled to presumptive service connection as a disease associated with herbicide agent exposure, a medical opinion as to whether the evidence supports that the conditions were incurred in or are otherwise due to service is needed. See January 2017 Board Decision; see also Combee v. Brown, 34F.3d 1039 (Fed. Cir. 1994). The Board, thus, finds that the January 2019 VA examiner's opinion is inadequate. In regards to the development of the Veteran's assertion that he had in-service exposure to radiation, the Regional Office (RO) requested records from the Defense Threat Reduction Agency (DTRA), including dosimetry information. January 2020 Correspondence; February 2020 Correspondence. The RO indicated that all efforts to obtain information from the DTRA have been exhausted and the records could not be obtained. August 2021 Final Attempt Letter. However, DTRA indicated that it needed a copy of the January 2017 Board Decision. April 2020 Third Party Correspondence. The DTRA later indicated it was researching the RO's request, which would take "three months or longer to complete." June 2020 Third Party Correspondence. It is unclear if the DTRA still needs a copy of the January 2017 Board Decision or if there is still evidence from the DTRA forthcoming. The Board finds that additional development with the DTRA is needed. The matters are REMANDED for the following action: 1. Clarify whether there is any forthcoming evidence from the Defense Threat Reduction Agency (DTRA) about the Veteran's radiation exposure per their June 2020 Third Party Correspondence, which indicates the DTRA was researching the Veteran's case. 2. After the above development has been completed, obtain an addendum opinion from a medical professional about the Veteran's hematological disabilities, including myelofibrosis and iron deficiency anemia. If possible, obtain the opinion from the same VA examiner who provided the July 2019 VA examination for hematologic and lymphatic conditions. If the medical professional determines that it is necessary, schedule the Veteran's for a medical examination. The medical professional is asked to respond to the following: (a) Is the Veteran's myelofibrosis or iron deficiency anemia at least as likely as not (a 50 percent or greater probability) related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the conditions not on the list of diseases that are presumptively associated with exposure to herbicide agents. In other words, even if the Veteran's hematological disabilities are not listed at 38 C.F.R. § 3.309(e) as a disease associated with herbicide agent exposure, is there otherwise evidence that the conditions were incurred in or caused by service? The examiner should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.