Citation Nr: 21065341 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 15-02 579 DATE: October 25, 2021 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1968 to February 1971, with service in Vietnam. He died in June 2011. The appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision by the Department of Veterans Affairs (VA). This case was remanded in October 2018 and April 2021 for further development. In October 2017, the appellant testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record. Entitlement to service connection for cause of death. The Veteran's cause of death was esophageal cancer. See death certificate. An April 2021 VA examiner clarified that the Veteran's esophageal cancer was adenocarcinoma. As discussed in the Board's last remand, there are numerous theories of entitlement for this matter: (i) the Veteran's cause of death is due to herbicide agent exposure in Vietnam; (ii) the Veteran had atherosclerotic heart disease, or coronary artery disease, that contributed to his death; (iii) the Veteran's service-connected diabetes contributed to his death, and (iv) the Veteran's prostate cancer, which was non-service-connected but is presumably related to herbicide exposure in Vietnam, contributed to his death. There is also a new theory of entitlement raised by the record: whether the Veteran's hypertension, which was non-service-connected but possibly related to herbicide agent exposure in Vietnam or possibly incurred during service, contributed to his death. See August 2021 written brief presentation. An April 2021 examiner provided several medical opinions related to most of the numerous theories of entitlement discussed above. However, two of these opinions are inadequate and require addendum opinions. First, the examiner opined it was less likely than not that the Veteran's cause of deathhis esophagal cancerwas related to herbicide agent exposure in Vietnam. After, the appellant's representative submitted a medical article which it purports to show a significant association between herbicide agents and adenocarcinoma esophageal cancer. See August 2021 written brief presentation. Because the April 2021 VA examiner did not consider that article, remand for an addendum opinion is necessary. Second, the Board's directives in April 2021 stated that the examiner had to discuss June 2011 private treatment records discussing diabetes management was at least a concern during the Veteran's treatment prior to his death. When the April 2021 VA examiner opined it was less likely than not that the Veteran's diabetes was a principal or contributory cause of death, the examiner did not discuss these treatment records. As a result, the opinion is inadequate, and an addendum opinion is necessary. Finally, there is no opinion whether the Veteran's hypertension was a principal or contributory cause of his death. As a result, remand for an opinion is necessary. The matter is REMANDED for the following action: 1. The AOJ should obtain VA medical addendum opinions by the April 2021 VA examiner, if available; if the April 2021 VA examiner is not available, the AOJ should obtain opinions from another provider, such as an oncologist, if available. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please provide an addendum opinion to the April 2021 VA examiner's opinion that answered the question of whether the Veteran's cause of death was related to exposure to herbicide agents in Vietnam. Specifically, the examiner must discuss the medical article cited by the Veteran's representative in the August 2021 written brief presentation that purportedly stated there was a significant association between herbicide agent exposure and esophageal adenocarcinoma. (b.) Please provide an addendum opinion to the April 2021 VA examiner's opinion that answered the question of whether the Veteran's diabetes was a principal or contributory cause of death, specifically by impeding the Veteran's treatment for his esophageal cancer. Specifically, the examiner must discuss the June 2011 private treatment records discussing diabetes management and may not rely on the absence of evidence in medical records. A conclusory opinion will not be deemed adequate. (c.) Is it at least as likely as not (50% or greater probability) that the Veteran's hypertension was a principal or contributory cause of death? Please explain why. A conclusory opinion or an opinion that relies solely on the absence of evidence in medical records will not be deemed adequate. 2. If upon completion of the above action the issue remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Sandler, 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.