Citation Nr: 21072236 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-03 537 DATE: December 2, 2021 REMANDED Entitlement to service connection for multiple myeloma, also claimed as myelodysplastic syndrome (MDS), is remanded. REASONS FOR REMAND Entitlement to service connection for multiple myeloma, also MDS is remanded. The Veteran asserts that he is entitled to service connection for the claimed disability because it is the result of herbicide agent exposure in service. Herbicide agent exposure has been acknowledged by the Agency of Original Jurisdiction. In an October 2017 VA examination, the examiner opined that the claimed disability was not the result of active service. The rationale provided was that the claimed disability was not a presumed service-connected disability from herbicide agent exposure and is unrelated to any other presumed conditions related to herbicide agent exposure. The Board acknowledges that multiple myeloma is not on the list of disabilities associated with herbicide agent exposure. However, direct service connection may still be established. With regard to disabilities a Veteran attributes to exposure to herbicide agents, for Veterans who served in the Republic of Vietnam, service connection may be presumed for certain enumerated diseases that become manifest within a presumptive period. Regardless of the applicability of the presumption, a claimant is not precluded from establishing service connection with proof of direct causation. The Veteran has not been provided a VA examination which addresses multiple myeloma or MDS and any relationship to active service or exposure to herbicide agents during service. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). Therefore, a VA examination on direct causation is necessary. The examiner should also address the September 2021 VA treatment record wherein a physician opined that environmental factors may have played a role in the development of the claimed disability. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the etiology of any multiple myeloma or myelodysplastic syndrome disability. The examiner must review the claim file and must note that review in the report. The examiner should diagnose any myeloma or myelodysplastic syndrome disability found on examination or on review of the medical records. The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that any multiple myeloma disability is related to active service, to include acknowledged herbicide agent exposure during service. The basis of the opinion cannot be that myeloma or myelodysplastic syndrome are not recognized presumptive disability for VA based on herbicide agent exposure. The examiner should review medical research to determine whether it is at least as likely as not, in this specific case, that either disability is related to the Veteran's service or exposure to herbicide agents during service. The examiner should discuss any known causative factors for myeloma and myelodysplastic syndrome and should eliminate any that are not present in the case in determining the probability of relationship to service or herbicide agent exposure. The examiner should provide a rationale for all opinions provided. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.