Citation Nr: 21027291 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 16-31 309 DATE: May 5, 2021 REMANDED Entitlement to service connection for glioblastoma multiforme for accrued benefits purposes is remanded. Entitlement to service connection for the cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1983 to February 2001. He died in October 2013 and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In October 2018, the appeal was remanded for additional development and it now returns for further appellate consideration. 1. Entitlement to service connection for glioblastoma multiforme for accrued benefits purposes. 2. Entitlement to service connection for the cause of death. Pursuant to the October 2018 remand, in November 2020, a memorandum from the Director, Post-9/11 Era Environmental Health Program was obtained. The health physicist determined that the Veteran's assigned lifetime total radiation dose was 0.5 rem and that since such did not exceed 100 millisievert (10 rem) above natural background, it was their opinion that it was unlikely that glioblastoma multiforme was caused by exposure to ionizing radiation during military service. Later that same month, the Director of Compensation Service also concluded that based on the scientific evidence referenced in the memorandum from the VA Under Secretary for Health and their review of the evidence in its entirely, it was their opinion that there was no reasonable possibility that the Veteran's glioblastoma multiforme could be attributed to ionizing radiation exposure during military service. Nonetheless, a VA opinion was provided in December 2020, the examiner opining that it was less likely than not that the Veteran's brain cancer was incurred in or was caused by the claimed in-service injury, event, or illness. In support thereof, the examiner based his opinion on the fact that the Veteran did not meet the criteria for in-service radiation exposure and that burn pit exposure had not been associated with the development of any long-term health benefits. However, the Board notes that a fact sheet noted that the Department of Defense (DoD) performed air sampling at Joint Base Balad, Iraq and Camp Lemonier, Djibouti and that most of the air samples had not shown individual chemicals that exceeded military exposure guidelines. Nonetheless, the DoD further concluded that the confidence level in their risk estimates was low to medium due to lack of specific exposure information, other routes/sources of environmental hazards not identified, and uncertainty regarding the synergistic impact of multiple chemicals present, particularly those affecting the same body organs/systems. Additionally, in February 2021, the appellant submitted a study on cancer and Gulf War veterans, which indicated that such veterans may be at an increased risk for developing brain cancer and that such risk may be related to exposure to oil well fire smoke, nerve gases like sarin and cyclosarin, drugs used to protect against nerve gas, and pesticides to name a few. It also noted that studies reviewed in the report showed that Gulf War veterans who were most exposed to the release of nerve gas by the destruction of the Khamisiyah Iraqi arms depot had significantly elevated rates of death due to brain cancer and that veterans exposed to the highest level of contaminants from oil well fires also had increased rates of brain cancer deaths. Thus, the Board finds that a remand is necessary to obtain an addendum opinion that addresses such concerns. The matters are REMANDED for the following action: Forward the claims file to the VA examiner who rendered the opinion addressing the etiology of the Veteran's glioblastoma multiforme in December 2020. If he is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. After a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's glioblastoma multiforme is related to his acknowledged in-service exposure to burn pit toxins and/or other chemicals during his active duty service. Why or why not? (Continued on the next page) In this regard, the examiner should consider and discuss the DoD study that indicated that burn pit toxins affected the central nervous system and the study the appellant submitted in February 2021 indicating that Gulf War veterans have an increased risk for developing brain cancer. A rationale for any opinion offered should be provided. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Clark, 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.