Citation Nr: 21071172 Decision Date: 11/30/21 Archive Date: 11/29/21 DOCKET NO. 18-43 993 DATE: November 30, 2021 REMANDED Entitlement to service connection for cholangiocarcinoma, to include as due to exposure to parasites, for the purposes of accrued benefits, is remanded. REASONS FOR REMAND The Veteran served in the United States Air Force, on active duty from January 1968 to June 1969, with additional unconfirmed service in the Air National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died in May 2017. The appellant, his surviving spouse, filed an application for substitution in July 2017; VA issued a decision dated January 2018, accepting her request for substitution. See 38 C.F.R. § 3.1010. In September 2021, the appellant testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Entitlement to service connection for cholangiocarcinoma, to include as exposure to parasite, for the purposes of accrued benefits, is remanded. The appellant asserts that the Veteran's diagnosed cholangiocarcinoma, a rare bile duct tumor, is related to service. Specifically, that the Veteran developed cholangiocarcinoma due to being exposed to liver fluke parasites on active duty while serving in the Republic of Korea. The Board concludes that a remand is warranted, as the appellant has not been afforded a VA opinion with respect to this claim. A VA examination must be provided when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or current symptoms of a disability may be associated with the Veteran's service or with another service connected disability, but (4) there is insufficient competent evidence of record to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The appellant has submitted numerous medical treatises and articles that show a causal relationship between liver fluke infections and cholangiocarcinoma. Moreover, one article states that cholangiocarcinomas may develop decades after a liver fluke infection. Based on the evidence referenced above, the appellant has provided competent evidence suggesting a relationship between his type of carcinoma and active service. Accordingly, there is a possibility of a nexus between his current disability and active service. As the McLendon elements have been met, a remand is necessary in order to obtain an addendum opinion to determine the nature and etiology of the Veteran's claimed cholangiocarcinoma. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran's cholangiocarcinoma. The examiner should be qualified to assess the etiology of cancer. The examiner must be provided with the claims file and a copy of this remand order. The examiner should consider and address the medical articles of record submitted by the appellant regarding liver flukes in Asia and their relation to cholangiocarcinoma. The examiner should opine on whether the Veteran's cholangiocarcinoma is at least as likely as not (at least 50 percent) related to an in-service injury, event, or disease, including exposure to Southeast Asian parasitic worms (liver flukes). The examiner should address the appellant's contention that the Veteran was exposed to liver flukes during service and that this exposure resulted in bile duct cancer. The examiner should set forth a complete rationale for any conclusion reached, citing to medical literature and/or evidence in the Veteran's claim file as necessary. If an opinion cannot be reached without resorting to mere speculation, the examiner should fully explain why this is so. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald