Citation Nr: 21066121 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 17-23 654 DATE: October 28, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The appellant is the surviving spouse of the Veteran who served on active duty from September 1955 to December 1961 and who died in June 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2021, the Appellant testified at a Board hearing before the undersigned Veterans Law Judge. Entitlement to service connection for the cause of the Veteran's death is remanded. The Board finds that additional development is needed prior to final adjudication of the issue on appeal. The Veteran's death certificate identifies metastatic carcinoma due to prostate cancer and chronic pneumonia. His treatment records include a diagnosis of bladder cancer, which is listed as a presumptive disease associated with exposure to contaminants in the water supply at Camp Lejeune. See 38 C.F.R. § 3.309(f). It is not clear from the Veteran's death certificate, however, whether metastatic carcinoma includes bladder cancer. Accordingly, remand for an opinion addressing this medical question is necessary. During the October 2021 Board hearing, the Appellant's representative stated that he would attempt to obtain a medical opinion from the Veteran's family physician addressing the likelihood that bladder cancer was a contributing factor in his death; he also stated that he had medical article addressing the coexistence of bladder and prostate cancer. The representative also asserted that the Veteran was exposed to contaminated water while stationed in Guam and at Parris Island in South Carolina. As this claim is being remanded anyway, the Appellant and representative will have an opportunity to submit any medical opinion supporting this claim and any evidence supporting the assertion of the coexistence of bladder and prostate cancer, as well as exposure to contaminated water at the mentioned locations. The representative also asserted that the Veteran was exposed to radiation during his tour in Guam based on downwind contamination from atomic bombs. VA should develop this theory as directed under 38 C.F.R. § 3.311. The RO obtained a medical opinion in November 2014, which addressed the evidence of record and concluded, after citing to multiple medical articles, that the Veteran's cause of death was less likely as not caused by or a result of exposure to his exposure to contaminated water at Camp Lejeune during service because there was no scientifically documented link between exposure to either tetrachloro-ethylene or trichloroethylene (contaminants found in the water) and the development of prostate cancer. Th examiner, however, did not address the Veteran's bladder cancer or explain what metastatic carcinoma encompassed on the Veteran's death certificate. The matters are REMANDED for the following action: 1. Invite the appellant to submit any medical opinions in support of her claim for service connection for the cause of the Veteran's death, as well as any medical articles or treatises addressing the coexistence of bladder and prostate cancer, as well as the existence of contaminated water in Guam and Parris Island, South Carolina. 2. Take all appropriate action to develop the assertion that the Veteran was exposed to radiation during his tour in Guam based on downwind contamination from atomic bombs. If more details are needed, contact the appellant to request the information. 3. Obtain, if possible, records of relevant private evaluations and treatment the Veteran received prior to his death. The appellant must assist in the matter by identifying the Veteran's private healthcare providers and by submitting releases for VA to obtain any private records identified. 4. After the development in #1-3 are complete, obtain a medical opinion addressing the cause of the Veteran's death. The opinion provider should review the claim file and provide a complete rationale for all opinions expressed. The opinion provider should specifically address the following: (a) Does the notation of metastatic cancer on the Veteran's death certificate include bladder cancer? In other words, did the Veteran's prostate cancer metastasize into the bladder? Or, alternatively, did the Veteran's bladder cancer metastasize into prostate and/or bone cancer? In answering this question, the opinion provider's attention is directed to a January 1999 private treatment record addressing a cytoscopy that showed the Veteran's bladder was being invaded by the prostate cancer on the right side with high grade adenocarcinoma of the prostate in the muscularis propria of the bladder. (b) If the answer to (a) is no, is it at least as likely as not (a 50 percent or higher degree of probability) that the Veteran's bladder cancer was a principal or contributory cause of his death? The opinion provider is reminded that a contributory cause of death is inherently not related to the principal cause of death. In determining whether the disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; or that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. (c) Is it at least as likely as not (a 50 percent or higher probability) that the Veteran's prostate and/or bone cancer was caused by his active duty service, to include exposure to contaminated water at Camp Lejeune (and Guam/Parris Island, South Carolina if confirmed) and/or any confirmed radiation exposure? In answering this question, please address the November 2014 medical opinion that cites to research articles addressing occupational exposure to solvents and explain why such is an adequate comparison to ingesting contaminated water. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 5. 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 T. Matta, 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.