Citation Nr: 21012936 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-17 488 DATE: March 8, 2021 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served in the United States Army from January 1966 to November 1968, and from January 1975 to January 1993. Unfortunately, the Veteran died in March 2012. The Appellant is his surviving spouse. 38 U.S.C. § 101(3). This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). The matter was most recently before the Board of Veterans’ Appeals (Board) in May 2018, at which time it was remanded to the agency of original jurisdiction (AOJ) for further development, to include obtaining the Veteran’s service personnel records and obtaining an etiological opinion concerning the Veteran’s cause of death. Personnel records were obtained in December 2018, and opinions from an oncologist were obtained in October 2020 and December 2020. As such, . opinion regarding the etiology of the Veteran’s fatal cancer. As such, the directives have been substantially complied with and the appeal is again properly before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for the cause of the Veteran’s death. The Appellant seeks service connection for the cause of the Veteran’s death. The certificate of death lists the immediate cause of death as metastatic cholangiocarcinoma, and also lists biliary obstruction as a significant condition contributing to death. The Appellant asserts that exposure to chemical or environmental factors contributed to the development of the Veteran’s cause of death. In accordance with the May 2018 Board remand, VA obtained an opinion from an oncologist in October 2020. The oncologist stated that it was less likely than not that the Veteran’s noted cause of death was related to service, to include any exposures therein. In support of this the examiner provided a list of risk factors for cholangiocarcinoma and then stated that there was no evidence that the Veteran had ever been treated for liver flukes, which was included as a risk factor on the list. However, the opinion in no way provided any rationale supporting the implied conclusion that the cholangiocarcinoma was not related to the Veteran’s presumed exposure to herbicide agents in service. Instead, the supporting rationale at most directly addressed only the contention concerning liver flukes. VA requested an addendum opinion in December 2020, asking that the oncologist address herbicide agents specifically as a potential cause of the Veteran’s cholangiocarcinoma. The examiner responded by simply stating that he previously provided a literature review which did not show an association between herbicide agents and cholangiocarcinoma. However, the only citation provided in the original opinion was a list of risk factors for cholangiocarcinoma provided by the Mayo Clinic, which does not clearly rule out herbicide agent exposure as a potential cause of cholangiocarcinoma. Further simple citations to medical literature, without application of the principles contained in the literature to the facts of the case, are insufficient to support an opinion. See Bailey v. O’Rourke, 30 Vet. App. 54, 59–61 (2018). As both the October 2020 opinion and the December 2020 addendum are inadequate, a remand is necessary for a new opinion concerning the etiology of the Veteran’s cause of death. The matter is REMANDED for the following action: 1. Obtain an opinion concerning the etiology of the Veteran’s metastatic cholangiocarcinoma, preferably from a medical professional other than the author of the October 2020 and December 2020 opinions. The examiner should address the following question: Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s metastatic cholangiocarcinoma is related to his active duty, to include his in-service herbicide agent exposure? A clearly-stated rationale for any opinion offered should be provided, and must be based on consideration of all pertinent lay and medical evidence. 2. Thereafter, and after any further development deemed necessary, the issue on appeal should be readjudicated. CHRISTOPHER A. WENDELL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Fulmer, 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.