Citation Nr: 21007827 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 15-28 443 DATE: February 10, 2021 REMANDED Entitlement to service connection for esophageal cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from February to November 1970. The Board is grateful for his service. Unfortunately, the Veteran passed away in January 2014. His surviving spouse is the appellant. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The matter was previously before the Board in July 2018, at which time it was remanded for development. It has been returned to the Board for appellate review. 1. Entitlement to service connection for esophageal cancer is remanded. Although it regrets the additional delay, the Board finds that a remand is necessary in order to obtain clarity with respect to the etiology of the Veteran’s esophageal cancer, particularly in light of evidence demonstrating a possible link between the Veteran’s service-connected type II diabetes and his cancer, which link has not as yet squarely been addressed by a VA examiner. Critically, the appellant has maintained that the Veteran’s esophageal cancer, which ultimately constituted the underlying cause of his death, was caused or aggravated beyond its normal course of progression by his service-connected diabetes. In support of this theory of entitlement, she furnished a July 2018 submission outlining a systematic review and meta-analysis of scientific studies tending to demonstrate an etiological link between cancer, including adenocarcinoma of the esophagus, and diabetes mellitus, type II. The VA examiner who reviewed the medical file in this case and submitted a July 2019 opinion, merely indicated that “the association between [diabetes mellitus] and [esophageal cancer] remains in dispute, adding that “a well-designed prospective study on the correlation” between the conditions is “still to be warranted,” without offering direct comment on the evidence submitted by the appellant and summarized above. The Board regards this opinion as inadequate in its failure squarely to address this evidence. Moreover, the acknowledgment that the etiological link between diabetes and esophageal cancer “remains in dispute” is inadequate as regards the VA examiner’s charge in this particular case, where he has been requested to furnish a specific opinion in consideration of this particular Veteran’s disease, and his opinion does not reveal any apparent consideration of this case’s particulars; for instance, other risk factors for cancer, including family history, lifestyle factors, age of onset, possible side effects of medication, including medication prescribed for treatment of diabetes, or other factors. Thus, in sum, a remand is necessary in order to afford the appellant an adequate VA examination of the claims file and opinion as to etiology that is responsive to her proposed theories of entitlement, and that duly considers all evidence of record, including that showing a potential link between diabetes mellitus and esophageal cancer. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, obtain any outstanding VA and private treatment records relevant to the claim. 2. Then, forward the claims file to a VA examiner to explore the etiology of the Veteran’s esophageal cancer. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.         The examiner is requested to opine as to whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the Veteran’s esophageal cancer is directly related to active duty service, to include by virtue of exposure to tactical herbicides therein. If direct service connection is not found, the examiner should state whether, on an at least as likely as not basis, esophageal cancer was caused or aggravated beyond its normal course of progression by the Veteran’s diabetes mellitus, type II, or any aspect of its treatment. In considering whether any etiological connection between these conditions exists, the examiner is directed to consider and comment on the evidence submitted by the appellant, including a July 2018 submission relating to a systematic review and meta-analysis of a number of scientific studies suggesting an etiological link between diabetes and cancer in general, and esophageal cancer in particular. 3. Review the opinion to ensure that it is in complete compliance with the directives of this remand. If the opinion or report is deficient in any manner, the AOJ must implement corrective procedures.  4. Then, readjudicate the claim. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.