Citation Nr: 22011925 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 16-49 938 DATE: March 2, 2022 REMANDED Service connection for the cause of death is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1969 to December 1970. The Veteran died July 1996, and his widow is the Appellant. This matter comes before the Board of Veterans' Appeal (Board) on appeal from a January 2016 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In September 2019, the Board denied the Veteran's appeal for service connection for the cause of the Veteran's death. However, in a December 2020 Order, the United States Court of Appeals for Veterans Claims (the Court) granted the December 2020 Joint Motion for Partial Remand (JMPR) and remanded the appeal for additional development consistent with their decision. Subsequently, the appeal was previously remanded by the Board in October 2021 for additional development as directed by the JMPR. According to the JMPR, it was noted that September 2019 Board decision determined that the Veteran's lung cancer had metastasized from his liver and liver cancer was not subject to presumptive service connection. The Board then cited to the July 1996 VA imaging study where the impression was an "appearance compatible with wide spread pulmonary metastasis from liver carcinoma." It further stated there was "possible" malignancy and a follow-up was needed. Therefore, the Board failed to address the equivocal language of this treatment record finding. In October 2021, the Board remanded this appeal for a VA etiological opinion. The remand instruction requested that the VA examiner consider the July 1996 VA radiology report where Veteran was diagnosed with metastatic lung disease and noted that it "was probably from the Veteran's liver cancer." A new VA opinion was obtained in November 2021 where the VA examiner addressed the July 1996 VA radiology report. The VA examiner stated this record, "describ[ing] lung metastasis from liver cancer was also noted. Metastasis is spread of a primary cancer to other parts of the body which happens when the primary cancer is advanced." Based on the provided conclusion, it is unclear to the Board whether the VA examiner fully considered the July 1996 VA radiology report's finding of an "appearance compatible [emphasis added] with wide spread pulmonary metastasis from liver carcinoma" and "possible [emphasis added] malignancy, follow-up needed." Therefore, the Board finds an addendum opinion is warranted for clarification prior to readjudication. The matter is REMANDED for the following action: Obtain an addendum opinion from the November 2021 VA examiner (or an equally qualified examiner if the November 2021 VA examiner is unavailable) regarding whether the Veteran's cause of death is related to service. The VA examiner should provide the following opinions: a. Identify whether any of the Veteran's causes of death, including cardio-respiratory failure and adenocarcinoma of the liver, were incurred in service, or caused by an in-service injury, event, or illness to include conceded exposure to herbicide agents. Why or why not? b. Whether the Veteran's cardio-respiratory failure could have preceded his adenocarcinoma of the liver. Why or why not? Specifically, in responding to this question, the VA examiner must consider and address the July 1996 VA radiology report noting that the Veteran was diagnosed with metastatic lung disease. Notably, and as argued in the December 2020 JMPR, this treatment record noted the metastatic lung disease was probably from the Veteran's liver cancer. If the VA examiner determines that this report demonstrates that the Veteran's lung cancer metastasized from his liver cancer, a thorough explanation is requested with supporting medical evidence and reasoning. For further clarity, the examiner should review the December 2020 CAVC JMPR. Carole R. Kammel Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.