Citation Nr: 0702144 Decision Date: 01/24/07 Archive Date: 01/31/07 DOCKET NO. 02-19 759 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUE Entitlement to service connection for the cause of the veteran's death, including as due to undiagnosed illness. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant and veteran's mother ATTORNEY FOR THE BOARD T. S. Kelly, Counsel INTRODUCTION The veteran served on active duty from December 1990 to April 1991 and had an additional five months and 23 days of prior unverified service. He served in support of Operation Desert Storm while stationed in the Persian Gulf Area. He died in May 1998 and his surviving spouse is the appellant. This matter comes before the Board of Veterans' Appeals (Board0 on appeal from a September 1999 rating determination of the Winston-Salem, North Carolina, Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in October 2005, at which time it was remanded for further development. FINDINGS OF FACT 1. The veteran died in May 1998; the immediate cause of death was disseminated intravascular coagulopathy due to or as a consequence of sepsis with shock due to or as a consequence of cardiac arrest. Other significant conditions contributing to death include hepatitis and alcoholism, left ventricular hypertrophy was also reported. 2. Service connection was not in effect for any disability during the veteran's lifetime. 4. The weight of the evidence is against a link between any of the conditions that caused or contributed to the veteran's death and a disease or injury in service. CONCLUSION OF LAW A service-connected disability was not a principal or contributory cause of death. 38 U.S.C.A. §§ 1110, 1117, 1310 (West 2002); 38 C.F.R. §§ 3.303, 3.317 (2006). REASONS AND BASES FOR FINDINGS AND CONCLUSION Veterans Claims Assistance Act of 2000 The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2006); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2006). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim. 38 U.S.C.A. § 5103(a) (West 2002); C.F.R. § 3.159(b)(1) (2006). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The June 2001 and May 2006 VCAA letters informed the appellant of the information and evidence necessary to substantiate the claim. The VCAA letter also told the appellant what types of evidence VA would undertake to obtain and what evidence the appellant was responsible for obtaining. The May 2006 letter notified the appellant of the need to submit any pertinent medical or service medical records in her possession. The United States Court of Appeals for Veterans Claims (Court) has also held, that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) veteran status; 2) existence of a disability; 3) a connection between the veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The appellant was provided with this notice in the May 2006 letter. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here some of the notice was provided after the initial denial, but the deficiency in the timing of the notice was remedied by readjudication of the claim after provision of the notice. Mayfield v. Nicholson, 444 F.3d 1328 (2006). Furthermore, the Board finds that there has been compliance with the assistance provisions set forth in the new law and regulation. All available service medical, VA, and private treatment records have been obtained. No other relevant records have been identified. A medical opinion was also obtained. Under these circumstances, no further action is necessary to assist the claimant with the claim. Service Connection The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The service-connected disability is considered the principal cause of death when such disability, either singly or jointly with another condition, was the immediate or underlying cause of death or was etiologically related to the cause of death. To be a contributory cause of death, it must be shown that the service-connected disability contributed substantially or materially to cause death, that it combined to cause death, or that it aided or lent assistance to the production of death. It is not sufficient 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. Generally, minor service-connected disabilities, particularly those of a static nature or not materially affecting a vital organ, would not be held to have contributed to death primarily due to unrelated disability. Service-connected diseases or injuries affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other diseases or injury primarily causing death. Where the service-connected condition affects vital organs as distinguished from muscular or skeletal functions and is evaluated as 100 percent disabling, debilitation may be assumed. 38 C.F.R. § 3.312(c)(3). The criteria for establishing entitlement to compensation for the cause of death are those governing the establishment of service connection under 38 U.S.C.A, Chapter 11 (West 2002 & Supp. 2006). 38 U.S.C.A. § 1310(a). Service connection will be granted if it is shown that the veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In order to establish service connection under 38 U.S.C.A. § 1117; and 38 C.F.R. § 3.317, a claimant must present evidence that the veteran was a Persian Gulf veteran who had a chronic qualifying disability. A chronic qualifying disability is a) an undiagnosed illness; b) a chronic multisystem illness defined by a cluster of signs or symptoms, namely chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome; or c) and diagnosed illness that VA determines by regulation warrants a presumption of service connection. To establish service connection on the basis of an undiagnosed illness, the evidence must show (1) objective indications; (2) of a chronic disability such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2009; and (4) such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C.A. § 1117; Gutierez v. Principi, 19 Vet. App. 1 (2004); 38 C.F.R. § 3.317(a); 71 Fed. Reg. 75,669-72 (Dec. 18, 2006). A Persian Gulf Veteran is one who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(d). The veteran's military records document that he served in Southwest Asia during the applicable time period. At the time of the veteran's death, service connection was in not in effect for any disability. The death certificate listed the immediate cause of death as disseminated intravascular coagulopathy due to or as a consequence of sepsis with shock due to or as a consequence of cardiac arrest. Other significant conditions listed included hepatitis and alcoholism. The veteran's final hospitalization records reveal that he was hospitalized on May [redacted], 1998, for lightheadedness, weakness, and being unable to walk to the bathroom. The veteran was noted to have a history of alcoholism (last drunk on Friday). At the time of admission, the veteran denied any abdominal pain. He also did not report any jaundice. The veteran reported having heavy breathing. The examiner noted that according to the chart, the veteran had had one positive hand on his hepatitis-C and was due to have a Hep-C viral load drawn to clarify whether or not this was positive. The results were not available at the time of admission. A past medical history of "?positive Hepatitis C;" alcohol abuse; and tension headaches was reported. The veteran indicated that he was an alcoholic and that he had not been drinking for about a month but had had a fifth and a half in the past week due to stress and personal reasons. An abdominal ultrasound revealed an enlarged liver, enlarged spleen, no ascites, no common bile duct dilatation, and gallbladder wall thickening with fluid surrounding the gall bladder. The assessment was that the veteran was an alcoholic with recent heavy Tylenol use presenting with symptoms of shock and hepatic failure, and decreased white cell count with left shift. The hepatic failure was noted as "infection versus Tylenol versus alcoholic." The veteran was placed on detox protocol. The coagulopathy was noted to probably be secondary to the hepatic process. The veteran died on May [redacted], 1998. An autopsy was performed on the same day. Final diagnoses following the autopsy were sepsis with bacteremia (stentotrophomonas xanthomonas) maltophilia (pseudomonas maltophilia); organizing bronchopneumonia, with abscess formation, bilateral; left ventricular myocardial hypertrophy; massive steatosis of the liver; congestive splenomegaly; petechiae, pericardial; and cerebral edema. In her March 2000 notice of disagreement, the appellant related that the veteran had received Anthrax and other vaccinations in service. She also contended that he was most likely exposed to toxic chemicals during his service in the Gulf War, and that there were several occasions when the veteran was not able to put on his chemical suit when the alarms sounded. She further reported that the veteran was exposed to clouds from burning oil. In May 2002, VA requested that the veteran's claims folder be forwarded to a VA examiner to discuss the cause of the veteran's death. In a May 2002 report, the examiner opined that the veteran died of multi-organ failure brought on by a disseminated intravascular coagulopathy (DIC) brought on by his acute on chronic hepatic failure and sepsis. The examiner noted that the cause of sepsis was listed by the pathologist from the autopsy as pseudomonas maltophilis. The examiner also noted that the veteran had a positive hepatitis C band and a positive hepatitis C RNA. He noted that the liver examination conducted during the autopsy revealed no evidence of chronic disease suggesting that this was rather more acute in its onset. He stated that there was no way to determine when the veteran developed the hepatitis C without resort to speculation. As to the question of how alcoholism was acquired, the examiner commented that the only note in the file was that the veteran had a long history of alcoholism. He noted that on one evaluation the veteran had reportedly had a third DWI in the past eight years. He observed that the note was dated in 1996, suggesting that the veteran had problems with alcohol before the Gulf War, as far back as 1988. He noted that there were a number of statements in the C-file indicating that the veteran had been an alcoholic for some time, and had been hospitalized at least twice for therapy for this, but was continuing to abuse alcohol. He further reported that there was a statement indicating that the veteran had abused cocaine and cannabis in the past. Along with her October 2002 substantive appeal, the appellant submitted a letter from a Rear Admiral of the Civil Engineer Corps, Naval Reserve, which demonstrated that the veteran had been given a Navy Achievement Medal. In the letter, it was noted that he had been recalled to duty and deployed to Saudi Arabia in support of Operation Desert Storm and Shield. He was assigned to the operation of a Field Truck responsible for the field maintenance of over 250 pieces of Civil Engineer Support equipment. His efforts were directly attributed to the successful and timely completion of crucial projects to the war effort, such as the construction of an airfield at Tanijar which was used to evacuate wounded and bring in supplies to the forward troops, and construction of an air strip at Mishap which was built to mount a major air attack and provide direct support to the City of Kuwait. It was noted that the veteran's maturity, dedication, and professional knowledge consistently exceeded normal expectations especially in hostile conditions encountered during the war. At the appellant's June 2003 hearing, the veteran's mother testified that the veteran told her that he had an odor of chlorine near him all the time in the Persian Gulf, as he worked near a chemical factory. His mother testified that the veteran told her that he was outside most of the time under terrible conditions. He noted that they went into Kuwait with the1st Marines to repair runways. She reported that he had various aches and pains, difficulty concentrating, and that he had troubling sleeping when he came home. She related that he was an outstanding athlete prior to being deployed, that the veteran was activated during his senior year of college; and that he was the best soccer player on the team at that time. The veteran's mother testified that he was a social drinker in college. The veteran finished college in 1993 and became an independent cable contractor. She noted that she had sought an opinion from a Dr. Craig Bash who was an Associate Professor of Radiology and Nuclear Medicine at the Uniformed Services University. She indicated that she had forwarded all available medical records to Dr. Bash and that it was his conclusion that the veteran's death was related to his Saudi Arabia deployment. She noted that in Dr. Bash's opinion her son's liver problems were not a result of alcohol abuse. The veteran's wife testified that he had had respiratory problems all winter prior to his death. She noted that he veteran was a very strong and determined individual. In a report received at the hearing and dated in April 2003, Craig Bash, M.D., reported that he had reviewed the veteran's service medical records, post service medical records, other medical opinions, and medical literature. Dr. Bash noted that the veteran had a blood pressure reading of 140/68 on April 29, 1988. He also reported that the veteran had a pain in the epigastrium, right lower quadrant, on July 4, 1996. and that on January 27, 1997, the veteran was noted to be detoxified without complications. He also noted that his blood pressure had been found to be mildly elevated on several occasions. Dr. Bash observed that on May [redacted], 1998, the veteran had hepatic failure: infection versus Tylenol versus alcoholic. He noted the causes of death listed on the death certificate. He observed that on the autopsy report, the veteran had left ventricular myocardial hypertrophy, massive steatosis of the liver, that there were extensive fatty alteration among hepatic parenchymal cells with large and small globules, that there was no evidence of necrosis or inflammation, and no evidence of fibrosis. Dr. Bash also noted the lab results reported in the May 1998 hospitalization report. Dr. Bash noted that the veteran served honorably in the Gulf War and added that there where known supplies of chemical/biological weapons stored and destroyed in the region; therefore, giving the veteran the benefit of the doubt, it was reasonable to assume that he was likely exposed to the full range of these possible toxins. He found that the record contained information that the veteran was hypertensive during service time, as evidenced by a blood pressure of 140/68. He observed that longstanding hypertension was a well known cause of cardiac disease and that this disease could be asymptomatic for the first 15-20 years as it damaged the cardiovascular system. He concluded that the veteran's cardiomegalia and cardiac failure (as documented on autopsy) were all "very likely" secondary to his longstanding untreated service induced hypertension. He observed that the veteran's hypertension following service was documented in 1997. He further found that the veteran's demise was due to cardiac arrest and electromechanical dissociation (EMD), which was due to long-standing untreated service-induced hypertension and left ventricular myocardial hypertrophy. His opinion was that had the veteran been diagnosed in service and treated appropriately over the years from when he left service until his demise, that he would likely not have had his ventricular hypertrophy and he would not have had EMD and cardiac arrest as significant contributors to his demise. Concerning the veteran's exposure to chemical/biological agents, it was well known, according to Dr. Bash, that these agents which were present in "the Desert Storm action region," and that they could cause "significant liver damage/fatty infiltration due to their effects on the liver Glutathione system/free radical attack on lipid membranes- macromolecules." He observed that the veteran had a fatty liver on imaging and pathologic studies during his final admission, which was a sign of both acute and chronic hepatocyte damage. The veteran, according to his mother's statement, had digestive problems following his return from the Gulf War. Dr. Bash also acknowledged that it was clear that the veteran had Hepatitis C and alcohol usage problems. He stated that it was known that chemical/biological agents, alcohol, and hepatitis C all caused damage to liver cells. Therefore, giving the veteran the benefit of the doubt, it was Dr. Bash's opinion that the veteran's likely exposure to chemical and/or biological agents during service in Desert Storm likely contributed significantly to his fatty liver and ultimate demise due to hepatitis. In July 2003, VA again requested that the claims folder be reviewed by a VA physician and that he be requested to give an opinion as to whether the veteran's fatty liver was related to the veteran's likely exposure to chemical and or biological agents during his period of service. In an August 2003 opinion, a VA examiner indicated that he had reviewed the veteran's claims folder. He noted that the veteran had a long history of alcoholism referred to in the medical records and was thought to have been drinking alcohol during the month prior to his admission for his final illness. On admission, the veteran had an acute and chronic liver failure (marked increase in hepatic enzymes and other tests indicating acute liver injury and liver failure). He had other acute problems, pneumonia, pulmonary abscess, pseudomonas, sepsis, and disc syndrome. He stated that it was well known and accepted that alcohol was a main cause of fatty liver and could lead to acute and chronic disease and liver failure. It was the examiner's opinion that more likely than not the veteran's acute fatty liver and liver failure were secondary to alcoholic liver disease compounded by an acute multisystem illness defined by a cluster of signs and symptoms. He indicated that it was "not at least as likely as not" that the severe fatty liver and other problems with his final illness were secondary to possible remote exposure (approximately eight years prior) to chemical or biological agents during service in the Gulf War. In response to an inquiry about the command history of Naval Mobile Construction Battalion 234 for the period December 1990 to April 1991, USACRUR indicated that during their deployment, the unit was based in Al Jubayl, Saudi Arabia, at Camp Rohrbach, while various elements of the Battalion were dispersed over a 250 square mile area with the northernmost detachment being at Camp Smith, Al Khanjar, on the Kuwait/Saudi Arabia border. USACRUR noted that while the command history contained a great deal of detail about the accomplishments of the Battalion, it did not clearly identify any incidents of exposure to chemical or biological agents. It did state that there were no deaths or permanent injuries to the Battalion. The command history also noted that the Battalion's main emphasis prior to deployment was on preparation, particularly chemical, biological, and radiological defense. In a June 2004 report, Dr. Bash indicated that he had re- reviewed the record, and paid close attention to the recent statement of the VA examiner. He added that the case was well within his area of expertise as he had performed and interpreted plain X-rays, CT scans, ultrasounds, nuclear medicine scans, and MRI scans "on thousands of patients with hepatic disorders" and had correlated his findings with the clinical record. He noted that the veteran had had several of these imaging studies. Dr. Bash disagreed with the concept that the veteran was not exposed to chemicals. Using the worst case scenario concept (which Dr. Bash asserted was the standard for Agent Orange cases), the veteran was likely exposed to toxic chemicals while in the Gulf War because of his location. He was unable to find any other medical opinion in the record that stated that it was not likely that the veteran was exposed to toxic chemicals. Dr. Bash indicated that he discounted the VA examiner's opinion as he did not comment on the previous opinion that Dr. Bash had set forth, which meant that he may not have had the entire file for review. He also noted that the VA examiner did not comment on the type of chemicals that the veteran was likely exposed to within the 250 mile patrol area. He further observed that the VA examiner did not comment on the toxicity of the war related chemicals or their effect on the liver. He also indicated that the VA examiner did not comment on the synergistic effect of alcohol and war type toxic chemicals. Dr. Bash further noted that the VA examiner did not provide any literature to support his opinion and that he did not comment on the veteran's longstanding hypertension as a cause of his demise. The VA examiner also did not comment on did not comment on the veteran's mother's lay statements. He further observed that the VA examiner did not comment on the legal concepts of "lent assistance" or "contributed to" which were important concepts to evaluate because they gave the veteran the benefit of the doubt during wartime when the medical situation was chaotic at best. Dr. Bash again acknowledged that alcohol could cause liver failure, but he did not see anything in the opinion of the VA examiner that would make him change his previous opinion that the veteran's likely exposure to chemical and or biological agents during service in Desert Storm likely contributed significantly to his fatty liver and ultimate demise due to hepatitis. Dr. Bash stated that it was his opinion that the veteran was likely exposed to toxic chemicals while in the Gulf War and that this exposure likely contributed significantly to his fatty liver and ultimate demise to hepatitis. He noted that had the veteran been diagnosed in service and treated appropriately over the ensuing years from when he left service until his demise, that he likely would not have had his ventricular hypertrophy and therefore would not have had EMD and cardiac arrest as significant contributors to his demise. In October 2005, the Board remanded this matter for further development, to include obtaining additional records and again referring the matter to the examiner who reviewed the file in August 2003, to see if there had been a change in his opinion based upon evidence received since that time. Treatment records obtained in conjunction with the October 2005 remand reveal that the veteran received treatment for alcoholism on numerous occasions following his release from service, including a VA hospitalization for alcohol dependence in March 1995. In the March 1995 discharge report, the veteran was noted to have completed a substance abuse program at the same facility in 1993. In June 2006, the VA physician who had prepared the August 2003 opinion again addressed the cause of the veteran's death. The examiner noted that the veteran's death in 1998 was from consequences of septic shock, disseminated intravascular coagulopathy, and cardiac arrest. Contributing to this was alcoholism and severe liver disease with fatty infiltration of the liver and evidence of liver failure. The examiner noted that there was some question as to the cause of the liver disease and its significant role in the veteran's demise. He noted that he had reviewed the service medical records at length and the opinion from Dr. Bash. He observed that Dr. Bash felt that the veteran's illness was related in a strong way to his exposure to chemical and/or biological agents while in the Persian Gulf in 1991. The examiner noted that he had personally rendered an opinion that the veteran's liver disease was primarily due to chronic alcoholism. The examiner stated that on reviewing the record, the veteran's alcoholism was "very impressive." There were multiple entries into the record from 1992 to 1995 regarding alcoholism. On at least two occasions, the veteran was hospitalized for alcohol withdrawal. There was also mention of at least two DWI's, employment problems, and alcohol withdrawal problems. The examiner indicated that he did not find a great body of evidence to support exposure to chemical or biological weapons in the veteran's service medical records. He noted that one entry stated that a command history of the veteran's unit did not identify any incidents of exposure to chemical or biological agents. He also noted that the record stated that exposure of veterans to low levels of chemical weapons was a concern. He stated that the problem of exposure to chemical weapons appeared to not have been settled yet. He observed that the effect of such exposure that he may have had, which was speculative, did not appear to have any acute effect on the veteran at the time of said exposure, and there was no apparent long term toxicity that could be substantiated. The examiner noted that the veteran did have longstanding alcohol abuse. He stated that alcohol was a known toxin to the liver. He reported that this could not be discounted and it was an accepted factor in the development of fatty liver that could lead to alcoholic hepatitis and cirrhosis. He stated that this was factual and could be substantiated by decades of clinical experience. He noted that in the veteran's case, his liver failure was related to severe fatty liver, and this in itself was known to have multiple effects on the body which could lead to the clinical syndrome that caused his demise. He stated that the effect of alcohol on the liver was not arguable. The examiner reported that the effect of toxic chemicals and/or biological weapons, even in low concentrations, was speculative and under investigation. He noted that the veteran had major alcohol abuse problems from 1992 to the time of his death. The record also indicated that he was abusing alcohol just prior to his death. In that there was no question about the effect of alcohol on the liver, and there was substantial evidence in the record to indicate that he was having toxic effects of alcohol on the liver even prior to his death, it appeared to the examiner that alcohol played the major role in the development of the fatty liver which led to liver failure and subsequently sepsis and death. The examiner stated that to discount the role of alcoholism in this clinical syndrome and on the other hand incriminate the possible involvement of chemical or biological agents as the main cause of the fatty liver, would not hold up under peer review. The examiner indicated that his previous opinion that alcohol more likely than not was the primary cause of the extreme fatty liver and subsequent liver failure, sepsis, and death, stood. He stated that the role of any chemical or biological agent was conjectural. Analysis For service connection for the cause of death of a veteran, the first requirement for service connection, evidence of a current disability, will always have been met (the current disability being the condition that caused the veteran to die). However, the last two requirements must be supported by evidence of record. Ruiz v. Gober, 10 Vet. App. 352, 356 (1997); Ramey v. Brown, 9 Vet. App. 40, 46 (1996). There is conflicting evidence as the relationship between the causes of death and service. The Board has espoused the theory that the veteran was hypertensive during service, with a blood pressure of 140/68 being reported, that longstanding hypertension was a well known cause of cardiac disease and that cardiomegaly and cardiac failure (as documented on autopsy) were all very likely secondary to his longstanding untreated service incurred hypertension. With regard to Dr. Bash's contention that the veteran had hypertension in service, the Board notes that the blood pressure finding of 140/68 which Dr. Bash made reference to occurred in April 1988, at which time the veteran was not on active duty, but rather enlisting in the reserves. At the time of a January 1989 visit, the veteran's blood pressure was noted to be 110/70. At the time of a December 1990 outpatient visit, the veteran's blood pressure was noted to be 130/80. There were no findings of hypertension or elevated blood pressure during the veteran's period of active service. At the time of a December 1992 hospitalization for alcohol dependence, the veteran's blood pressure was noted to be 132/82. The Board observes that at the time of the veteran's January 1994 reserve annual physical, he was noted to have blood pressure readings of 148/85 in the sitting position, 140/81 in the recumbent position, and 143/95 in the standing position; however, these readings were more than 3 years following his release from active duty. Thus, the premise that the veteran had hypertension which began during a period of active service or within one year following his release from active service is not supported by the record, and it cannot be relied upon as a basis for granting service connection for the cause of the veteran's death. The Board further notes that there have been several theories raised as to the cause of the damage to the veteran's liver, which has been found by all examiners/physicians to have contributed substantially to the cause of the veteran's death. Dr. Bash has asserted that chemical exposure caused or contributed to the liver disease, but he has never been able to specify the chemicals that purportedly contributed to the veteran's death. He has never provided a reason for his conclusion that these chemicals, rather than the well documented history of alcohol abuse, played a significant role in the liver disease. It is difficult to fathom how Dr. Bash could conclude that "chemicals" contributed to the liver disease without specifying those chemicals. It is also difficult to give much probative weight to his conclusion that these chemicals contributed to the liver disease, absent any rationale for that conclusion. Dr. Bash merely asserted that unspecified chemicals contributed to the veteran's liver disease notwithstanding that he had a long well documented history of alcohol abuse. Records from the veteran's terminal hospitalization and autopsy show that chemical exposure, other than overuse of Tylenol, was not suspected of playing any role in the liver disease. The VA opinions, particularly the most recent opinion, took into account Dr. Bash's statements, and the entire record. They specifically responded to Dr. Bash's argument, and discussed the entire evidence of record, including evidence not discussed by Dr. Bash (including the extensive treatment for alcohol abuse). As such, the Board is placing greater emphasis on the VA examiner's opinion. The testimony of the veteran's mother could be read as contending that the veteran's alcoholism began in service. The fact that the veteran received a DWI prior to service, belies such a conclusion; however, even if alcoholism were incurred in service, compensation cannot be paid for disability resulting from the abuse of alcohol. 38 U.S.C.A. § 1110 (West 2002). It is also clear that the veteran did not have a "qualifying chronic disability" as defined in 38 U.S.C.A. § 1117; 38 C.F.R. § 3.317. The conditions that caused or contributed to his death were diagnosed disorders, and he did not have any recognized chronic multi-system illnesses. Further VA has not recognized any diagnosed disorders as being subject to presumptive service connection under 38 C.F.R. § 3.317. The preponderance of the evidence is against the claim; there is not doubt to be resolved; and the claim is denied. 38 U.S.C.A. § 5107(b) (West 2002). ORDER Service connection for the cause of the veteran's death is denied. ____________________________________________ Mark D. Hindin Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs