Citation Nr: 21040099 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 14-32 218A DATE: July 2, 2021 REMANDED Entitlement to service connection for deep vein thrombosis (DVT), claimed as due to exposure to herbicide agents, is remanded. Entitlement to service connection for a pulmonary embolism, claimed as due to exposure to herbicide agents and/or secondary to DVT, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1964 to July 1967, to include service in the Republic of Vietnam from September 1965 to September 1966. This matter comes before the Board of Veterans Appeals (Board) on appeal from a rating decision issued in April 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In November 2019, the Board remanded the case and it now returns for further appellate review. 1. Entitlement to service connection for DVT, claimed as due to exposure to herbicide agents. 2. Entitlement to service connection for a pulmonary embolism, claimed as due to exposure to herbicide agents and/or secondary to DVT. In November 2019, the Board remanded the above captioned issues in order to obtain a VA opinion addressing whether the Veteran's DVT and resulting pulmonary embolism was related to his acknowledged in-service exposure to herbicide agents coincident with his service in the Republic of Vietnam. Thereafter, in July 2020, a VA examiner opined that such disorders were less likely than not related to the Veteran's acknowledged exposure to herbicides in Southeast Asia from 1966 to 1967. In offering such opinion, he reported that DVTs and pulmonary emboli had not been shown to be caused by exposure to herbicides in the medical literature, and such disorders most commonly occurred at random with no etiology and a lack of risk factors. However, without an analysis specific to the Veteran's case, such statements are conclusory. Furthermore, despite being requested to do so, the examiner did not address the February 2011 and July 2019 medical opinions from Dr. R.H. indicating that the Veteran's exposure to chemical agents used in Vietnam such as Agent Orange is as likely as not a contributing factor in his clotting disorder. Thus, the Board finds that remand is necessary to obtain an addendum opinion addressing the etiology of the Veteran's DVT and resulting pulmonary embolism. The matters are REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate clinician other than the July 2020 VA examiner, if possible, to obtain an addendum opinion addressing the etiology of the Veteran's DVT and resulting pulmonary embolism. Following a review of the record, the examiner should offer an opinion as to whether the Veteran's DVT and/or pulmonary embolism is at least as likely as not (i.e., a 50 percent or greater probability) related to his acknowledged in-service exposure to herbicide agents. In offering such opinion, the examiner is asked to consider and comment on the clinical significance of the Veteran's lack of risk factors for developing DVT, including the negative results of blood serology and genetic testing looking for such indicators (namely the August 2010 testing for plasma homocysteine levels, which were normal, and Factor V Leiden mutation, which was negative), as well as the February 2011 and July 2019 medical opinions from Dr. R.H. indicating that the Veteran's exposure to chemical agents used in Vietnam such as Agent Orange, is as likely as not a contributing factor in his clotting disorder. The examiner is advised that his/her rationale cannot be based solely on the fact that VA has not included DVT and pulmonary embolism on the list of diseases acknowledged to be presumptive related to herbicide agents. Further, if the examiner relies upon studies, articles, and/or medical literature in offering the opinion, he or she should discuss the significance of such in light of the Veteran's specific case. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Koria B. Stanton, 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.