Citation Nr: 22067076 Decision Date: 12/02/22 Archive Date: 12/02/22 DOCKET NO. 18-11 207 DATE: December 2, 2022 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Marine Corps from March 1960 to September 1962. The Veteran died in November 2016. The appellant is the Veteran's surviving spouse. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In April 2019, the Board remanded the issues for further development. That development was completed, and the case has since been returned to the Board for appellate review. 1. Entitlement to service connection for the Veteran's cause of death is remanded. While the Board regrets further delay on this issue, after a review of the evidence of record, the Board finds that further development is necessary prior to adjudicating this claim. The Veteran's November 2016 Death Certificate noted that the immediate cause was metastatic transitional cell carcinoma of the bladder. In the October 2017 notice of disagreement, the appellant alleged the Veteran's bladder cancer was related to herbicide agent exposure while transporting herbicides. In the April 2019 Board remand, the Board directed the AOJ to undertake development to determine whether the Veteran had service in Vietnam, to include in the territorial waters, and was therefore presumed to be exposed to herbicide agents. In a January 2022 Records Research Response, the Veterans Benefits Administration, Office of Field Operations Service, Military Records Research Center, noted that the Veteran's asserted herbicide exposure could not be verified through service records, to include ship and deck logs. Specifically, the response noted that A professional researcher from the Veterans Benefits Administration, Office of Field Operations Service, Military Records Research Center, has completed comprehensive research on the Veteran's claimed exposure claiming that while assigned to USNS GENERAL DANIEL I SULTAN from April 8, 1962, to April 25, 1962, the Veteran was exposed to herbicides. The following primary sources located in or obtained from the Naval History and Heritage Command website were reviewed in an attempt to substantiate the Veteran's claimed exposure incident: the Dictionary of American Naval Fighting Ships (DANFS) ship history of the USS GENERAL DANIEL I. SULTAN. We also requested records from Naval History and Heritage Command (NHHC), the custodian of Naval command history records for 1962. NHHC was unable to locate the 1962 Command History, Ship History, and Aviation Historical Summary for USS GENERAL DANIEL I. SULTAN. In conclusion, no evidence was located to support documentation of the claimed incident. Additionally, the Veteran's DD214 indicates five months and five days of overseas service, but not indicate any awards or decorations associated with service in the Republic of Vietnam. Therefore, the Board finds that herbicide exposure cannot be conceded. However, the unavailability of presumptive service connection for a disability based on herbicide agent exposure does not preclude a veteran from establishing service connection with proof of direct causation, i.e., showing that he was in fact exposed to herbicide agents during service and that such exposure caused his bladder cancer. Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994) (when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis); see also 38 U.S.C. § 1110; 38 C.F.R. § 3.303(d). In this regard, the Veteran had also asserted that his disability had been a result of exposure to herbicides and to aviation and other fuels as a bulk fuel handler in service. In a July 2021 private opinion, the Veteran's treating urologist opined that He had significant exposure to Agent Orange while serving in Vietnam. He also had significant exposure to bulk fuels, since he was a deliverer and driver. He handled the bulk fuel continuously. This bulk fuel exposure along with Agent Orange exposure in my opinion was a likely cause for this very aggressive cancer. While noting possible exposure, the private urologist did not provide a sufficient rationale for his opinion that this exposure caused the Veteran's sarcoidosis, nor did he provide medical literature or other evidence to support this conclusion. Therefore, the opinion is inadequate to adjudicate the issue on appeal. However, the July 2021 private opinion does provide a sufficient basis to warrant obtaining a VA expert opinion on the matter. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the appellant's claim must be remanded for an addendum medical opinion. The matters are REMANDED for the following action: 1. Obtain an expert opinion, from a qualified expert, on the nature and etiology of the late Veteran's sarcoidosis. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record, the examiner should respond to the following: (a.) Determine whether it is at least as likely as not that the Veteran's sarcoidosis had its onset in or is related to service, to include presumed exposure to herbicide agents? In considering whether herbicide agent exposure caused the Veteran's sarcoidosis, please keep in mind that the mere fact that VA has not included a certain diagnosis on a list of presumptive conditions is not, in and of itself, a sufficient rationale for finding that the condition is not related to service. In other words, the Board needs an opinion as to the likelihood that the Veteran's sarcoidosis, without regard to the conditions VA recognizes as being due to herbicide exposure, was nevertheless at least as likely as not related to his exposure to herbicides in Vietnam. (b). Determine whether it is at least as likely as not that the Veteran's sarcoidosis had its onset in or is related to service, to include presumed exposure to bulk fuel and other chemicals? The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.J. O'Connor, 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.