Citation Nr: 25009083 Decision Date: 07/11/25 Archive Date: 07/11/25 DOCKET NO. 20-01 905 DATE: July 11, 2025 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1965 to May 1969. The Veteran died in April 2008. The appellant is his surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The appellant testified before the Board in December 2022. A copy of the hearing transcript is associated with the claims file. In a November 2023 decision, the Board denied entitlement to service connection for cause of death. The appellant appealed the denial of benefits to the United States Court of Appeals for Veterans Claims (Court). In a July 2024 Order, the Court granted a Joint Motion for Remand (JMR) vacating the November 2023 decision denying entitlement to service connection for cause of death and remanding the matter for readjudication. The matter was previously before the Board and remanded for development consistent with the JMR in October 2024 and April 2025. This case has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for cause of death is remanded. The Board is not able to make a fully informed decision regarding the issue of entitlement to service connection for cause of death. Dependency and indemnity compensation (DIC) is payable to the surviving spouse of a Veteran if the Veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. In order for service connection for the cause of a Veteran's death to be granted, it must be shown that a service-connected disability was either the principal cause of death or was a contributory cause of death. 38 C.F.R. § 3.312(a). A service-connected disability is one which was incurred in or aggravated by active service, one which may be presumed to have been incurred during such service, or one which was proximately due to or the result of a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. The service-connected disability will be considered as the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312(b). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1); see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). The Veteran's death certificate lists metastatic rectal carcinoma as the immediate cause of death with no other conditions identified as the underlying cause of death. The Veteran was not service connected for any disability at the time of his death; therefore, entitlement to service connection may be considered for the purpose of establishing service connection for the cause of death. See 38 U.S.C. § 1310 (a). The appellant contends that exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot, caused colorectal cancer and resulted in the Veteran's death. In the alternative, the appellant testified that exposure to toxins during service caused the Veteran's melanoma, which in turn caused or contributed to the development of colorectal cancer and the Veteran's death. Personnel records show that the Veteran's served as a fireman and boilerman with duties in automatic combustion control. The appellant reported that prior to service and after service the Veteran worked as a meat cutter. It is conceded that the Veteran was exposed to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot during service. The question before the Board is whether there is a nexus between the Veteran's primary cause of death and his exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot. Additional medical opinions were obtained in May 2025 to determine whether melanoma was related to the Veteran's period of active service, to include exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot; and, if so, whether metastatic colorectal carcinoma caused or aggravated metastatic colorectal carcinoma. Unfortunately, the Board finds that the May 2025 medical opinion addressing whether melanoma was related to the Veteran's period of active service is not adequate and remand for an addendum opinion is warranted. The examiner opined that malignant melanoma is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that a nexus for service connection cannot be made at this time due to the missing elements of origin and chronicity of the claimed condition. According to the May 2025 examiner, a disability which began in service or was caused by some event in service must be considered "chronic" before a nexus for service connection can be established. The examiner determined that no permanent residual or chronic disability was shown by the service medical records or demonstrated by evidence immediately following discharge from the service. He concluded that it is not possible for the Veteran to have had melanoma in the service and the condition went untreated and undiagnosed until many years after separation; therefore, a nexus cannot be made. The Board finds that this opinion is inadequate because the examiner failed to consider whether the conceded exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot resulted in the development of melanoma. This consideration does not require melanoma to be shown during service or immediately following discharge from service. Accordingly, remand for an addendum opinion is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the cause of the Veteran's death. The examiner should review the claims file and address the following: (a.) The examiner is asked to opine whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal probability) that the Veteran's melanoma and/or other skin cancers were related to conceded exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot. (b.) If the examiner opines that melanoma and/or other skin cancers were related to conceded exposure to asbestos, crude oil (benzene), fire suppression foam (pre- and polyfluoroalkyl substances (PFAS), or other chemicals, such as soot, the examiner is asked to opine whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal probability) that melanoma and/or other skin cancers caused or aggravated a metastatic colorectal carcinoma. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B Jackson, M. 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.