Citation Nr: 21067402 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 16-48 322 DATE: November 4, 2021 REMANDED Entitlement to service connection for the cause of death is remanded. Entitlement to Dependency and Indemnity Compensation (DIC) under 38 U.S.C. § 1151 is remanded. REASONS FOR REMAND The Veteran had active duty in the U.S. Army from July 1968 to July 1970. The Veteran sadly passed away in April 2012. The appellant is the Veteran's surviving spouse. The issues are on appeal from an October 2012 rating decision. The appellant testified before the undersigned Veterans Law Judge in July 2019. A transcript of the hearing is associated with the record. In January and July 2021, the Board remanded the appeal. As detailed below, a remand is again required. Entitlement to service connection for the cause of death is remanded. The Board previously remanded service connection for the cause of death as such was found to be inextricably intertwined with ongoing review of the Veteran's record at the Agency of Original Jurisdiction (AOJ) pursuant to Nehmer v. U.S. Department of Veterans Affairs. A review of the record shows that the AOJ has not yet issued a decision. Therefore, service connection for the cause of death must be remanded again, pending the outcome of the AOJ's Nehmer review. Entitlement to Dependency and Indemnity Compensation (DIC) under 38 U.S.C. § 1151 is remanded. Per the Board's July 2021 remand, a VA addendum opinion was obtained regarding the appellant's contention that VA failed to properly treat the Veteran's diagnosed hepatitis C, and that such failure was the proximate cause of his death. Specifically, the representative alleges that the lack of treatment of the Veteran's hepatitis C during his lifetime led directly to the Veteran's development of cirrhosis of the liver, necessitating a liver transplant, which was rejected by his body, causing septic shock and eventual death. During the hearing, the appellant's representative specifically questioned the treatment protocol the Veteran received during his lifetime for his hepatitis C. Similar to the addendum opinions obtained in January 2021, the July 2021 examiner did not discuss the particulars of the Veteran's hepatitis C treatment during his lifetime, despite specific instructions to do so. Accordingly, an addendum opinion is again required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's hepatitis C. After reviewing the evidence of record, the examiner is asked to address the following: (a.) Is it at least as likely as not (i.e. 50 percent or greater) that VA treatment caused, contributed to, or hastened the Veteran's death from multiorgan dysfunction syndrome, liver failure, and septic shock, by failing to properly treat the Veteran's hepatitis C during his lifetime? Please explain why or why not, commenting specifically on the treatment protocol the Veteran received during his lifetime. (b.) If VA treatment caused, contributed to, or hastened the Veteran's death, what is the likelihood that there was carelessness, negligence, lack of proper skill, error in judgment, or similar instances of fault on VA's part in treating the Veteran's hepatitis C? Please explain why or why not. A rationale for any opinions expressed should be set forth. If an opinion cannot be provided without resorting to mere speculation, the examiner should explain why so (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 2. After completing the above, conduct any additional development necessary are readjudicate the appellant's appeal for DIC benefits under 38 U.S.C. § 1151. 3. After the Nehmer development has been completed, readjudicate the appellant's claim for service connection for the Veteran's cause of death. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.Z., 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.