Citation Nr: 21071623 Decision Date: 12/01/21 Archive Date: 11/30/21 DOCKET NO. 09-27 702 DATE: December 1, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Entitlement to a nonservice-connected burial allowance and plot allowance is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1958 to May 1980. He passed away in February 2006. The Appellant is the Veteran's surviving spouse. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2006 denial letter and a February 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The matters were remanded twice, in December 2013 and January 2017, for additional development. Although it appears that the January 2017 directives have been complied with, the Board finds that an additional remand is required as there are not adequate medical opinions of record. Stegall v. West, 11 Vet. App. 268. As acknowledged in the December 2016 remand, the Appellant withdrew her June 2009 request for a Board hearing. See May 2011 Statement in Support of Claim. Cause of death The December 2013 remand directives requested etiology opinions. Although, a VA Doctor of Occupational Medicine provided opinions in March 2016, a review of these opinions illustrate that the rationale provided is inadequate. The rationale is conclusory, relies only on negative evidence, uses vague language such as "I believe," and contained an unfortunate clerical error in the body of the opinion, stating "less likely a snott,.." Additionally, the examiner indicated that he may have not reviewed all of the relevant documentation as he was unable to confirm all of the Veteran's historical statements/diagnoses. Once VA undertakes the effort to provide an examination, or obtain an opinion, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The death certificate states that the cause of death was cardiorespiratory arrest; and the underlying causes were arrhythmia, acute myocardial infarction, congestive heart failure, prostate cancer with metastasis to the spine, and malnutrition. At the time of his death, service connection had not been established for any disability. The Board recognizes that the Agency of Original Jurisdiction (AOJ) has performed development in an effort to confirm whether the Veteran was exposed to herbicide agents during service, as prostate cancer is an enumerated disease under 38 C.F.R. § 3.309. The development performed as a result of the January 2017 remand directives illustrate that the Veteran was not exposed to Agent Orange during service. Notwithstanding, the claim must be reviewed on a direct theory of entitlement and as stated above there are no adequate medical opinions of record. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed.Cir.1994). Non-service-connected burial allowance and plot allowance As the determination regarding the claim for service connection for cause of death could affect the outcome of the claim for non-service-connected burial allowance and plot allowance, the issues are inextricably intertwined. It would be premature for the Board to adjudicate the claim for non- service-connected burial benefits and plot allowance until the claim for service connection for cause of death has been considered. Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, the issue of entitlement to service-connected burial allowance and plot allowance is remanded. The matters are REMANDED for the following action: 1. Invite the Appellant to submit any additional evidence she would like considered in connection with the service connection claim. Specifically, request that she provide a statement from any medical provider detailing the state of malnutrition the Veteran was in at the time of his death, and she is invited to provide any details she may have regarding the state of malnutrition he was in and what she observed. 2. Request an opinion from an appropriate clinician, preferably from a clinician other than the clinician who provided the March 2016 opinions. The electronic claims file must be sent to the clinician for review. After a thorough review of the file the examiner is asked to opine as to when the Veteran was first diagnosed with prostate cancer and opine as to what the state of malnutrition he was in near the time of his death. Following a thorough review of the file, to include the December 2013 and January 2017 remands, and this remand, the examiner should address the following questions: (a.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's cause of death, cardiorespiratory arrest, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. (b.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's underlying cause of death, arrhythmia, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. (c.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's underlying cause of death, acute myocardial infarction, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. (d.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's underlying cause of death, congestive heart failure, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. (e.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's underlying cause of death, prostate cancer with metastasis to the spine, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. (f.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's underlying cause of death, malnutrition, manifested during active service; or is otherwise related to an event, injury, or disease incurred during active service. A complete rationale for any medical opinion rendered must be providedincluding consideration of the chest pain, shortness of breath, and prostatitis the Veteran had in service. 3. The AOJ should ensure that the opinions conform with the remand directives. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Talamantes, 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.