Citation Nr: 21075177 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-17 845 DATE: December 17, 2021 REMANDED Entitlement to service connection for anemia, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 1968 to January 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified at a virtual hearing conference before the undersigned. A transcript of the hearing is associated with the claims file. 1. Entitlement to service connection for anemia, to include as secondary to a service-connected disability, is remanded. The Veteran contends that his anemia is due to his service, or, in the alternative, due to monoclonal gammopathy of uncertain significance (MGUS) caused by exposure to Agent Orange. See Hearing Transcript, pp. 8-9. The Board notes that VA conceded exposure to herbicides based on the Veteran's duty or visitation in the Republic of Vietnam. See Jul. 2021 VA Memo. In August 2021, the Veteran submitted a statement from a VA physician, Dr. S.A. The provider stated, "I believe that Agent Orange is as likely as not is possible because of his plasma cell disorder." See Aug. 2021 Medical Treatment Record Government Facility, p. 1. The Board notes that the "plasma cell disorder" to which Dr. S.A. referred appears to be the Veteran's MGUS diagnosis. In the Veteran's VA medical records, MGUS is noted on his problem list, along with a comment that the condition transformed to smoldering myeloma with 50 percent plasma cells. Id. at 4. Further, the nexus opinion by Dr. S.A. is found under the assessment and plan regarding the Veteran's history of monoclonal paraproteinemia. Id. at 2. The Board notes that the connection between the Veteran's MGUS and his conceded herbicide exposure may serve as an "intermediate step" for service connection for anemia. See Walsh v. Wilkie, 32 Vet. App. 300 (2020). However, the Veteran has not been afforded a VA opinion as to whether there is a connection between his current disabilities of MGUS and anemia. While the Board notes that the Veteran was previously afforded a VA opinion as to his claim for anemia in April 2018, the examiner was not in possession of the favorable opinion by Dr. S.A. outlined above. Therefore, the Board finds that the matter must be remanded in order to afford the Veteran an examination and opinion to determine whether his MGUS causes or aggravates his anemia. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (stating that the probative value of medical opinion evidence, among other factors, is based on whether a clinician was "informed of the relevant facts" and medical history in rendering a medical opinion). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his anemia. Any indicated evaluations, studies, or tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner must address the following: (a.) Determine whether it is at least likely as not (a 50 percent probability or greater) that the Veteran's anemia is related to the Veteran's active duty service, to include exposure to herbicides. In so opining, the examiner must address the Veteran's theory that herbicide agent exposure led to his MGUS disability which led to anemia, and the August 2021 physician's opinion that the Veteran's plasma-cell disorder was related to Agent Orange. The examiner is advised that VA has conceded exposure to herbicide agents. See July 2021 VA Memo. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries and that his reports must be taken into account in formulating the requested opinions. (Continued on the next page) The examiner must provide rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Watkins, Associate 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.