Citation Nr: 21075582 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 18-05 686 DATE: December 20, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran had active service from March 1969 to October 1971. He died in January 2016. The Appellant is the Veteran's surviving spouse. The Appellant was afforded a hearing before the undersigned in August 2021. A copy of the transcript is of record. The Board notes that the Appellant appointed George R. Buck, a family friend, as her representative pursuant to the exception provided in 38 C.F.R. § 14.630. Under this provision, an unaccredited individual may represent an appellant one time only so long as a VA Form 21-22a along with a statement signed by the representative and the appellant that no compensation shall be paid to the representative is submitted. A review of the VA Form 21-22a submitted in August 2017 shows that the box for an "individual providing representation under section 14.630 was checked." Additionally, no fee agreement ever was submitted, and George R. Buck has never requested the payment of fees from VA, further evidencing the intention to provide representation under section 14.630. In light of the foregoing, the Board finds that George R. Buck is a valid representative for this appeal but will not be permitted to represent the appellant for any other claim in the future absent an applicable exception. Prior to death, the Veteran was not service connected for any disabilities. The Death Certificate recorded the Veteran's primary cause of death as a pulmonary embolism due to deep vein thrombosis. The Appellant argues that the Veteran's pulmonary embolism was caused by his Sjogren's Syndrome. In particular, she asserts that he was wheelchair-bound due to Sjogren's Syndrome, and that such was caused by his in-service Agent Orange exposure. The Board notes that the record reflects that the Veteran served in Vietnam, such that his Agent Orange exposure is conceded. Additionally, medical records show that the Veteran made use of a wheelchair, and had a diagnosis of Sjogren's Syndrome, that was suspected to be affecting his peripheral nervous system. In support of her appeal, the Appellant submitted an opinion from the Veteran's treating physician, Dr. G.C., linking the Veteran's pulmonary embolism to his Sjogren's Syndrome, and finding that it was "probable" that his Sjogren's Syndrome was caused by his Agent Orange exposure. However, this opinion does not include a full rationale, nor does it use the appropriate legal standard, such that the Board is unable to rely upon this opinion. She also submitted an article entitled "Increased Risks of Deep Vein Thrombosis and Pulmonary Embolism in Sjogren's Syndrome: A Nationwide Cohort Study," as well as former Board decisions, which are non-binding, granting service connection for Sjogren's Syndrome as due to Agent Orange exposure. The Appellant also asserts that Sjogren's Syndrome should have been listed on the Veteran's death certificate as a contributing cause. To this point, the Appellant's representative testified that the Veteran's death certificate was filled out by a doctor working in the emergency room who was unfamiliar with the Veteran's entire medical history. His wife, N.B., a hospice nurse, was also present at the hearing and offered her opinion that it would have been appropriate to include Sjogren's Syndrome on the Veteran's death certificate as the condition which precipitated his pulmonary embolism and deep vein thrombosis. Based on the above, the Board finds that a medical opinion to determine whether the Veteran is entitled to service connection for cause of death is warranted. Additionally, the record indicates that there may be outstanding VA treatment records. In this regard, the record includes VA treatment records submitted by the Appellant only. Any additional VA treatment records should be obtained on remand. The matter is REMANDED for the following action: 1. Obtain the Veteran's VA treatment records. 2. Obtain a VA medical opinion addressing the cause of the Veteran's death. Following a review of the claims file, the examiner should address whether it is as least as likely as not (50 percent or greater probability) that the Veteran's pulmonary embolism and deep vein thrombosis are related to his Sjogren's Syndrome. If so, the examiner should then opine as to whether it is as least as likely as not (50 percent or greater probability) that the Veteran's Sjogren's Syndrome is related to his in-service Agent Orange exposure. In rendering an opinion, the examiner should comment on the relevant medical evidence of record, to include the January 2018 private opinion from Dr. G.C., as well as the article entitled "Increased Risks of Deep Vein Thrombosis and Pulmonary Embolism in Sjogren's Syndrome: A Nationwide Cohort Study." A complete rationale should be given for all opinions and conclusions expressed. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.Z., 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.