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I've pruned them out lots to retain them for awhile longer, the odd one seems to do ok. Your pics look kinda bad though and if it's declining fast I bet it's a goner.

On a birch I'm fairly certain that sapsucker is going after borers, not sap. It's the secondary, in doing it's thing it's creating the perfect habitat for the borers to multiply.

It's feeding on the borer and around here that tree would be doomed. BBB dies from the top down as you described. Cut back to live wood/lateral if your customer is wanting to retain it. But as I said before up here it would be a multi-part removal if they want to keep it around.

Up here it's BBB bronze birch borer and the bird is looking for the larvae as well as creating the perfect habitat for the bug. Pretty much a removal or a multi-part removal if the people want to retain it for a few years. In these parts anyways.