Citation Nr: 21040873 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-48 322 DATE: July 7, 2021 REMANDED Entitlement to service connection for the cause of death is remanded. Entitlement to Dependency and Indemnity Compensation (DIC) under 38 U.S.C. § 1151 is remanded. REASONS FOR REMAND The Veteran had active duty in the U.S. Army from July 1968 to July 1970. The Veteran sadly passed away in April 2012. The appellant is the Veteran's surviving spouse. The issues are on appeal from an October 2012 rating decision. The appellant testified before the undersigned Veterans Law Judge in July 2019. A transcript of the hearing is associated with the record. In January 2021, the Board remanded the appeal. As detailed below, a remand is again required. Entitlement to service connection for the cause of death is remanded. The Veteran's death certificate lists his immediate cause of death as multiorgan dysfunction syndrome, due to liver failure, due to septic shock. VA treatment records show that the Veteran had hepatitis C for many years before his death. The appellant has contended that the Veteran's hepatitis C was caused by Agent Orange exposure, and that is should be service-connected. She has specifically stated that, though his available records do not show it, he had service in Vietnam. Additionally, in her September 2019 VA Form 9, she stated that he had diabetes due to Agent Orange exposure, and appeared to suggest a relationship between his treatment for such and his eventual death. In a June 2021 letter, the appellant expressed her wish to connect her husband's medical conditions and death to his Agent Orange exposure in Vietnam. The Board notes that the Veteran's file is now under review pursuant to Nehmer v. U.S. Department of Veterans Affairs (VA) by the Agency of Original Jurisdiction (AOJ). Accordingly, the Board finds that a remand is required of the appellant's claim for service connection for cause of death, as such may be impacted by the ongoing Nehmer development. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). Entitlement to Dependency and Indemnity Compensation (DIC) under 38 U.S.C. § 1151 is remanded. The Board finds that an addendum opinion is required regarding the appellant's contention that VA failed to properly treat the Veteran's diagnosed hepatitis C, and that such failure was the proximate cause of his death. Specifically, the representative alleges that the lack of treatment of the Veteran's hepatitis C during his lifetime led directly to the Veteran's development of cirrhosis of the liver, necessitating a liver transplant, which was rejected by his body, causing septic shock and eventual death. During the hearing, the appellant's representative specifically questioned the treatment protocol the Veteran received during his lifetime for his hepatitis C. While addendum opinions were obtained in January 2021, further comment is required on the specifics of the Veteran's hepatis C treatment. In this regard, the January 2021 examiner did not discuss the particulars of the Veteran's treatment, and instead only stated that the "Veteran's record showed that he was noted with history of hepatitis C dating back in 2004. Based on literature, it was in 2014, the United States Food and Drug Administration (FDA) has approved a new wave of direct-acting antiviral (DAA) oral medications that has revolutionized the landscape for hepatitis C virus (HCV) treatment." The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's hepatitis C. After reviewing the evidence of record, the examiner is asked to address the following: (a.) Is it at least as likely as not (i.e. 50 percent or greater) that VA treatment caused, contributed to, or hastened the Veteran's death from multiorgan dysfunction syndrome, liver failure, and septic shock, by failing to properly treat the Veteran's hepatitis C during his lifetime? Please explain why or why not, commenting specifically on the treatment protocol the Veteran received during his lifetime. (b.) If VA treatment caused, contributed to, or hastened the Veteran's death, what is the likelihood that there was carelessness, negligence, lack of proper skill, error in judgment, or similar instances of fault on VA's part in treating the Veteran's hepatitis C? Please explain why or why not. A rationale for any opinions expressed should be set forth. If an opinion cannot be provided without resorting to mere speculation, the examiner should explain why so (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 2. After completing the above, conduct any additional development necessary are readjudicate the appellant's appeal for DIC benefits under 38 U.S.C. § 1151. 3. After the Nehmer development has been completed, readjudicate the appellant's claim for service connection for the Veteran's cause of death. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.Z., 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.