Citation Nr: 21039970 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 19-29 706 DATE: July 1, 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 Marine Corps from March 1966 to July 1986, including service in the Republic of Vietnam; and then from July 1986 to June 1989. The Veteran died on January [REDACTED], 2017. The Appellant is the surviving spouse of the Veteran. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the October 2019 substantive appeal (VA Form 9), the Appellant requested a live videoconference hearing with a Veterans Law Judge. The Appellant subsequently requested to cancel the hearing and that the appeal proceed with the evidence on record. In March 2021, the Board remanded the issues on appeal for additional development. The Board finds that the Regional Office (RO) substantially complied with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). Regrettably, more development is still necessary for the Appellant's claim of entitlement to service connection for cause of death. The Appellant seeks service connection for the cause of the Veteran's death. She contends that the Veteran's exposure to herbicide agents while in service in the Republic of Vietnam, during the Vietnam Era, led to the development of coronary artery disease which then led to and contributed to the Veteran's chronic obstructive pulmonary disease (COPD), his ultimate cause of death. The record establishes that the Veteran served in Vietnam and VA has conceded the Veteran's herbicide exposure. Additionally, the Veteran had confirmed diagnoses for coronary artery disease and COPD before he passed away in January 2017.The Veteran's death certificate lists COPD as the immediate cause of death. In April 2021 VA secured a medical opinion regarding the Veteran's cause of death. The examiner opined that the Veteran's exposure to exposure to dioxin or other herbicides was less likely than not (less than 50 percent probability) the cause of the Veteran's death. As to the rationale, the examiner explained, Per Treatment record dated 9/5/2013 the veteran has COPD that was secondary to long history of smoking. Per Treatment record 8/2/13 it was noted that he had a 45 pack history of smoking. Death Certificate Feb [REDACTED] 2017 states COPD was cause of death. In the setting of heavy tobacco use with no STR of risk related pulmonary exposure the claimed COPD which lead to veteran's death was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner also explained that there is no medical literature that suggests that Agent Orange leads to COPD. However, the examiner failed to explain why the research materials the Appellant submitted are not evidence of a nexus. In addition, the Appellant has submitted more research that needs to be evaluated. Thus, a remand is necessary to secure an addendum opinion that addressed the Appellant's contention that the Veteran's exposure to dioxin or other herbicides agents lead to or caused the Veteran's COPD. The matter is REMANDED for the following action: 1. If possible, return the Veteran's complete record, to include a copy of this remand, and the claims folder to the examiner who reviewed the file and provided the April 2021 medical opinion hereinafter "examiner," for an addendum opinion. If it is not possible to obtain clarification from the examiner, then forward the Veteran's claim file to another appropriate medical professional who has the requisite experience to render the requested medical opinions. The examiner must review the expanded record and address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's COPD had its onset or is related to active service, particularly to exposure to dioxin or other herbicides agents in the Republic of Vietnam? (b.) In addition to addressing a nexus between herbicide agent exposure and COPD, the examiner should also address etiology on a direct basis, i.e. a nexus between COPD and the Veteran's military service in general. The examiner must note and discuss the treatise materials (articles) submitted by the Appellant which she contends show a link between dioxin exposure and COPD. 2. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing the above, and conducting any further development deemed necessary, readjudicate the claim. If the benefits sought on appeal are not granted to the Appellant's satisfaction, the Appellant and her representative must be provided a Supplemental Statement of the Case and be given an adequate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist 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.