Citation Nr: 21028691 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 12-33 349 DATE: May 11, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1950 to December 1954, with service in the Korean War. In August 2009 the Veteran died and the appellant is his surviving spouse. This appeal was last before the Board in April 2018 when it was remanded to obtain a medical opinion to address the appellant's assertions, as well as an article on mycobacterium avium complex submitted in October 2009. Although an opinion was obtained, it did not address the Board's remand directives, nor did it address the submitted article, and thus is insufficient for adjudication purposes. Stegall v. West 11 Vet. App. 268 (1998). 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The appellant and her representative assert that a contributory cause of the Veteran's death from chronic obstructive pulmonary disease (COPD) was his exposure to mycobacterium avium (MA) from chickens and their feces during the Veteran's service in Korea, as the Veteran stated he stayed in chicken houses while serving in the Korean war. 38 C.F.R. § 3.312 (entitlement to service connection for cause of death warranted when a disability related to service caused or contributed substantially or materially to the Veteran's death). The appellant indicated that a doctor told her that MAC remains in an encapsulated form for up to many years until the lungs are compromised. In this case, the appellant contends that when the Veteran contracted pneumonia, the encapsulated MAC contributed to destroying his lung tissue and exacerbated his chronic obstructive pulmonary disease (COPD) (endstage), which was the direct cause of the Veteran's death, as indicated in the August 2009 death certificate. In connection, a July 2002 private treatment record notes the Veteran had submassive hemoptysis with large cavity in the right lung, which was chronic due to a distant history of necrotizing pneumonia complicated by mycobacterium avium complex and treated with multiple drugs for eighteen months. The note, dated February 2000, also diagnosed the Veteran with mycobacterium avium-intracellulare, COPD, and noted a history of Korean hemorrhagic fever and tobacco usage. Here, the Board finds that the July 2018 opinion did not sufficiently address the above. Moreover, the opinion did not address the article submitted with medical records in October 2009 showing the symptoms of MAC disease, listed as fever, fatigue, and weight loss, as were seen in the Veteran. Accordingly, an opinion as to the Veteran's contraction of MAC and his cause of death is required to properly adjudicate this appeal. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate VA specialist, preferably a pulmonary physician, as to the etiology and contributing factors in the Veteran's death from End Stage COPD with regard to his diagnosis of mycobacterium avium-intracellulare, also called mycobacterium avium complex (MAC). A copy of this remand and the entire file must be provided to the specialist. The physician should indicate whether it is as least as likely as not (50 percent probability) that the Veteran's in-service exposure to chickens and their feces during combat operations in the Korean War, and his diagnosis of mycobacterium avium-intracellulare, also called mycobacterium avium complex (MAC), contributed substantially or materially to the Veteran's death from COPD. In addressing this question, the VA physician should specifically address the appellant's contention that the Veteran's exposure to chicken and its feces during service in Korea caused the Veteran to contract mycobacterium avium (MA) and that a doctor told her that MA remains in an encapsulated form for many years until the lungs are compromised. In this case, the appellant contends that when the Veteran contracted pneumonia, the encapsulated MAC contributed to destroying his lung tissue, and exacerbated his chronic obstructive pulmonary disease (COPD), which was the direct cause of the Veteran's death. In addressing the above, the physician should address the mycobacterium avium complex article, submitted in October 2009, listing the symptoms of MAC, which treatment records show the Veteran experienced, as well as the relevant medical records discussing this infection. A complete rationale should accompany any opinion provided. The physician is advised that the Veteran was, and the appellant is, competent to report symptoms and treatment, and that these reports must be taken into account in formulating the requested opinion. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Nelson 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.