Citation Nr: 21076186 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 19-28 918 DATE: December 22, 2021 ORDER Service connection for the cause of the Veteran's death is granted. FINDINGS OF FACT 1. The Veteran died in February 2015. His death certificate lists cholangiocarcinoma as the immediate cause of death. 2. The evidence is at least in equipoise that the Veteran's cholangiocarcinoma was etiologically related to his active service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have been met. 38 U.S.C. §§ 1110, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1964 to October 1966, including service in the Republic of Vietnam. The Veteran died in February 2015. The Appellant is his spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a June 2018 Agency of Original Jurisdiction (AOJ) rating decision issued by the Department of Veterans Affairs (VA). The Appellant and Dr. C.H., the Veteran's treating oncologist, testified before the undersigned in December 2021. The Appellant filed a claim for entitlement to service connection for the cause of the Veteran's death. 38 C.F.R. § 3.312 (a) (the death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death). The Veteran's death certificate shows cholangiocarcinoma (bile duct cancer) as the immediate cause of his February 2015 death, with no other medical conditions listed as a significant condition contributing to death. Generally, the Appellant asserts that the Veteran's metastatic cholangiocarcinoma is related to exposure to liver fluke parasites during his service in Vietnam. The Appellant reports that the Veteran told her that he ate almost all meals at local restaurants while in country; she contends that this exposure to liver flukes through undercooked fish led to the development of his cholangiocarcinoma. See December 2017 Statement in Support of Claim; December 2021 Correspondence. During his lifetime, the Veteran was not service connected for any disease or injury. This case turns on whether cholangiocarcinoma was related to an in-service injury or event or manifested to a compensable degree within one year of the Veteran's discharge from service. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Initially, the Board notes that cholangiocarcinoma is not listed as a disease associated with exposure to certain herbicide agents to warrant presumptive service connection on that basis. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Further, the preponderance of the evidence weighs against a conclusion that cholangiocarcinoma may be presumptively service connected as a chronic disease. 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (listing malignant tumors as a chronic disease). The Appellant has not contended, nor does the record indicate, that the malignant bile duct carcinoma manifested within one year of the Veteran's 1966 discharge. His service treatment records (STRs) reflect no findings or treatment for malignant tumors. See September 1966 separation examination. Moreover, the record does not document any treatment for, or findings of, cholangiocarcinoma prior to 2014. Rather, the Board concludes that the Veteran's cholangiocarcinoma was etiologically related to his active service. Shedden, 381 F.3d at 1166-67. Here, private medical opinions found cholangiocarcinoma was due to exposure to liver flukes in service. See, e.g., October 2017 medical opinion from Dr. F.B. The Veteran's treating oncologist, Dr. C.H., submitted multiple medical opinions and testified at the December 2021 Board hearing that the Veteran's exposure to the endemic parasite was presumed due to the frequency of his consumption of food prepared by local cooks in the Republic of Vietnam. Dr. C.H. also found the Veteran's cholangiocarcinoma was at least as likely as not related to the exposure due to the rarity of cholangiocarcinoma in the United States compared to the rate of occurrence in Southeast Asia and the medical literature in support of the long latency period between liver fluke infection and onset of malignancy. See, e.g., November 2019 medical opinion. In support of these opinions, the Appellant also provided articles and medical literature discussing liver fluke infections that may be transmitted through consumption of undercooked fish in Southeast Asia and the development of cholangiocarcinoma. The Board notes that an April 2018 VA opinion found cholangiocarcinoma was unrelated to the Veteran's active service because there was no mention of eating raw or undercooked fish in his service records and the Veteran's January 2015 diagnostic records did not show elevated Eosinophil counts indicative of a parasitic liver fluke infection. This opinion did not address the Appellant's reports that the Veteran described consistently eating meals during his deployment at local Vietnamese restaurants. The Appellant is competent to testify to facts she personally observed, including recall of what the Veteran told her regarding his service in Vietnam. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds the statements credible and notes they are supported by other evidence of record, such as a copy of a Vietnamese translator's business card that provided directions to a restaurant and letters from the Veteran describing how he ate most meals at local restaurants. Moreover, Dr. C.H. testified that the immediate symptomatology after ingestion of a fluke worm would be gastrointestinal upset and the record reflects a June 1967 STR indicating the Veteran was treated for ulcerous stomach after his return from Vietnam. As such, the Board affords little probative weight to the April 2018 medical opinion because it does not account for all relevant evidence of record. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) (noting that the credibility and weight of the opinions are within the province of the adjudicator); see also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion.). The Board finds the probative evidence of record places the evidence for and against the Appellant's claim at least in relative equipoise. Resolving all reasonable doubt in favor of the Appellant, service connection for the cause of the Veteran's death is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Odya-Weis 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.