Citation Nr: 21025231 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-49 524 DATE: April 27, 2021 REMANDED Entitlement to service connection for chronic lymphocytic leukemia (CLL) to include as due to asbestos exposure or as secondary to service-connected pleural plaques (diagnosed as asbestosis), is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1952 to September 1956. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died in June 2014. The Appellant, his surviving spouse, has been substituted for the Veteran in the claims pending at the time of his death. 1. Entitlement to service connection for CLL, to include as secondary to asbestosis pleural plaques, as an accrued benefit. The Appellant contends that the Veteran’s CLL was incurred in service as due to asbestos exposure, or as secondary to the Veteran’s service-connected pleural plaques, diagnosed as asbestosis. In a September 2020 Board decision, the matter was remanded to obtain a VA medical opinion addressing the Appellant’s theory of entitlement of secondary service connection. In October 2020, a VA medical opinion was obtained. In providing a negative nexus opinion, the examiner reviewed medical evidence from the Veteran’s Service Treatment Records (STR), VA treatment records (CAPRI), private treatment records, a private opinion, and lay statements from the Veteran as well as the Appellant. See October 2020 VA addendum examination, pgs. 1-6. The examiner opined that the Veteran’s CLL is less likely than not due to or aggravated by his service-connected asbestosis because asbestosis has not been implicated in the pathogenesis of acute leukemias. See id. at pg. 8. The examiner explained that while the carcinogenicity of asbestosis has been established in malignant mesotheliomas and lung cancers and has recently been suspected in other types of cancer, current medical evidence does not establish a link to leukemia. Id. In November 2020, the Appellant submitted medical records from Tijuana, Mexico indicating a possible relationship between asbestos exposure and CLL. In January 2021, further opinion was obtained. This opinion considered medical evidence submitted from Tijuana, Mexico. The VA examiner reviewed the conflicting medical evidence and opined that the Veteran’s CLL was less likely than not caused or aggravated by the Veteran’s service-connected pleural plaques because no records have been found that indicates a causal relationship between asbestos and CLL. See January 2021 VA Addendum Opinion, pg. 7. The Board notes that the examiner did not clearly opine as to the relationship of pleural plaques and CLL. Moreover, the examiner did not opine as to whether pleural plaques cause or aggravate CLL. The examiner elaborated on asbestosis but did not clearly provide a causation or aggravation opinion regarding pleural plaques. Therefore, remand is necessary to clearly address whether CLL is due to or aggravated by pleural plaques.   The matters are REMANDED for the following action: 1. Obtain a VA addendum from the January 2021 VA examiner, or another appropriate clinician, addressing the nature and etiology of the Veteran’s CLL. The examiner is asked to opine on the following: a) Is at least as likely as not (50 percent probability or greater) that the Veteran’s CLL was caused by his service-connected pleural plaques? b) Is it as least as likely as not (50 percent probability or greater) that the Veteran’s CLL was aggravated by his service-connected pleural plaques? All findings, along with the complete rationale for all opinions expressed, must be set forth in the report. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McKenzie, 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.