Citation Nr: 21074107 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-31 498 DATE: December 14, 2021 REMANDED Entitlement to service connection for monoclonal gammopathy of undetermined significance (MGUS) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1968 and from November 1990 to April 1991. This case comes to the Board of Veteran's Appeals (Board) on appeal from a July 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran disagreed with this rating decision. In October 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. Entitlement to service connection for MGUS is remanded. In a February 2017 statement, the Veteran included undated treatment records that showed that he has been diagnosed with MGUS since 2014. He stated that his MGUS is related to his herbicide exposure in Vietnam. In his October 2021 hearing, the Veteran testified that he had symptoms of tingling, numbness, kidney disease state 3, prostate cancer, and osteoarthritis. The Board notes that while MGUS could progress to become multiple myeloma eventually, it is unclear whether the Veteran's current diagnosis is sufficient to be considered multiple myeloma. There is at least some evidence that herbicide agents may be connected to MGUS. See, e.g., "Agent Orange Exposure and Monoclonal Gammopathy of Undetermined Significance: An Operation Ranch Hand Veteran Cohort Study" JAMA Oncol. 2015 Nov;1(8):1061-8. doi: 10.1001/jamaoncol.2015.2938, abstract available at https://www.ncbi.nlm.nih.gov/pubmed/26335650. The Board further notes that the Veteran has never had a VA examination and it does not appear that he has been diagnosed with multiple myeloma. Additionally, VA recently issued a final rule revising 38 C.F.R. § 4.117, the portion of the Rating Schedule which addresses disabilities of the hematological and lymphatic systems. 83 Fed. Reg. 54, 240, 54, 253 (October 29, 2018). The new rule added Diagnostic Code (DC) 7712 (multiple myeloma). Note (1) to DC 7712 indicates that "Current validated biomarker of symptomatic multiple myeloma and asymptomatic multiple myeloma, shouldering, or monoclonal gammopathy of undetermined significance (MGUS) are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma working group." Because of this, and because the Veteran has never had a VA examination, a remand is necessary to determine whether the Veteran is diagnosed with a condition that qualifies as multiple myeloma, and if not, whether his MGUS is directly related to active service, to include as due to herbicide exposure. The matters are REMANDED for the following actions: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), contact the Veteran for additional information about treatment for his condition and make efforts to obtain all VA and private treatment records concerning this claim. 2. Schedule the Veteran for a VA examination to determine the identity and cause of any diagnosed MGUS or multiple myeloma. Prior to the examination, the claims folder and a copy of this remand must be made available to the examiner for review of the case. A notation to the effect that this record review took place should be included in the report. The VA examiner should clarify whether the Veteran's diagnosis of MGUS is a form of multiple myeloma or a precursor to multiple myeloma. The examiner should also consider the applicability of the revised regulations under 38 C.F.R. § 4.117, Diagnostic Code 7712. The examiner should address whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed condition, to include MGUS, is causally related to active service, or represents the initial manifestations of the Veteran's current disability, to include as due to herbicide exposure. In reaching any conclusion, the examiner's attention is directed to the latest research of "Agent Orange Exposure and Monoclonal Gammopathy of Undetermined Significance: An Operation Ranch Hand Veteran Cohort Study" JAMA Oncol. 2015 Nov;1(8): 1061-8. Doi: 10/1001/jamaoncol.2015.2938, abstract available at https://www.ncbi.nlm.nih.gov/pubmed/26335650. (Continued on next page) 3. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.