Citation Nr: 1002633 Decision Date: 01/15/10 Archive Date: 01/22/10 DOCKET NO. 04-11 927 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for the cause of the Veteran's death for the purpose of receiving burial benefits at the service-connected death allowance rate. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The Veteran served on active duty from July 1963 to September 1967. He died on December [redacted], 2003. The appellant is his surviving spouse. This case comes before the Board of Veterans' Appeals (Board) on appeal of January 2004 decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Board notes that, at the time of the aforementioned rating decision in January 2004, the RO granted Dependency and Indemnity Compensation Benefits under the provisions of 38 U.S.C.A. § 1318(b) (West 2002 and Supp. 2009). This case was previously before the Board in September 2007, at which time it was remanded for additional development. The case is now, once more, before the Board for appellate review. FINDINGS OF FACT 1. The Veteran died on December [redacted], 2003. According to the Certificate of Death, the immediate cause of the Veteran's death was acute myocardial infarction. 2. At the time of the Veteran's death, service connection was in effect for posttraumatic stress disorder, evaluated as 100 percent disabling, and tinea pedis, evaluated as noncompensably disabling. 3. With the resolution of all reasonable doubt in his favor, the medical evidence of record demonstrates that the Veteran's service-connected posttraumatic stress disorder contributed materially to the development of coronary artery (i.e., ischemic) heart disease, which ultimately lead to his death from a fatal myocardial infarction. CONCLUSION OF LAW Service connection for the cause of the Veteran's death is warranted. 38 U.S.C.A. §§ 1310, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.312 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION In reaching this determination, the Board wishes to make it clear that it has reviewed all the evidence in the Veteran's claims file, which includes: the appellant's multiple contentions, as well as service treatment records, and both VA and private treatment records and examination reports. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the appellant's claim, and what the evidence in the claims file shows, or fails to show, with respect to that claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The appellant (the widow of the Veteran) seeks entitlement to service-connected burial benefits. In pertinent part, it is contended that service-connected posttraumatic stress disorder (for which the Veteran was in receipt of a 100 percent schedular evaluation at the time of his death) caused or contributed substantially or materially to hypertension and heart disease leading to a fatal myocardial infarction. In that regard, in order to establish service connection for the cause of the Veteran's death, the evidence must show that a disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death. For a service-connected disability to be the cause of death, it must singly, or with some other condition, be the immediate or underlying cause, or be etiologically related. For a service-connected disability to constitute a contributory cause, 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 U.S.C.A. § 1310 (West 2002 & Supp. 2009); 38 C.F.R. § 3.312 (2009). There are primary causes of death, which, by their very nature, are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, but even in such cases, there is for consideration whether there may be a reasonable basis for holding that a service-connected condition was of such severity as to have had a material influence in accelerating death. In this situation, however, it would not generally be reasonable to hold that a service- connected condition accelerated death unless such condition affected a vital organ, and was of itself of a progressive or debilitating nature. 38 C.F.R. § 3.312(c)(4) (2009). In the present case, a review of the record discloses that the Veteran died on December [redacted], 2003. According to the Certificate of Death, the immediate cause of the Veteran's death was acute myocardial infarction. At the time of death, service connection was in effect for posttraumatic stress disorder, evaluated as 100 percent disabling, and tinea pedis, evaluated as noncompensably disabling. Service treatment records, it should be noted, are negative for history, complaints, or abnormal findings indicative of the presence of cardiovascular disease, including coronary artery disease and hypertension. In point of fact, the earliest clinical indication of the presence of hypertension is revealed by a VA record of hospitalization dated in December 1984/January 1985, more than 17 years following the Veteran's discharge from service, at which time there was noted the presence of mild essential hypertension. Coronary artery disease/myocardial infarction was similarly first noted many years following the Veteran's discharge from service, as evidenced by treatment for a myocardial infarction in 1993. Significantly, the Veteran apparently suffered a second myocardial infarction in 2001, at which time he underwent the surgical implantation of a pacemaker/defibrillator. The Board acknowledges that, as noted above, the first evidence of coronary artery disease and/or myocardial infarction is at a point in time many years following the Veteran's discharge from service. Nonetheless, following a review of the Veteran's entire claims folder in September 2009, a VA staff physician offered his opinion that, notwithstanding the contributory factors of gender, inheritance, hypertension, tobacco and ethanol abuse, and dyslipidemia, "the Veteran's posttraumatic stress disorder as likely as not contributed (though to a lesser extent) to his fatal acute myocardial infarction." Moreover, a VA cardiologist, following an indepth review of the Veteran's medical chart and medical records in October 2009, offered his opinion that, notwithstanding the Veteran's "multiple serious risk factors" (including hypertension, tobacco use, hyperlipidemia, gender, depression, and medical noncompliance), his "cardiac complications (were) as likely as not related to his posttraumatic stress disorder, even though (that) contribution might be less than 50 percent." Based on the aforementioned, and with the resolution of all reasonable doubt in the Veteran's favor, the Board is of the opinion that the Veteran's service-connected posttraumatic stress disorder at least to some extent contributed his coronary artery disease and fatal myocardial infarction. That is, it aided or lent assistance to the production of the Veteran's demise. Accordingly, service connection for the cause of the Veteran's death for the purpose of receiving burial benefits at the service-connected death allowance rate is in order. In reaching this determination, the Board acknowledges that the Veterans Claims Assistance Act of 2000 (VCAA) imposes obligations on VA in terms of its duty to notify and assist claimants. However, in view of the favorable disposition in this case, the Board is of the opinion that any further discussion of the VCAA-imposed duties to notify and assist the appellant has been rendered moot. ORDER Service connection for the cause of the Veteran's death for the purpose of receiving burial benefits at the service- connected death allowance rate is granted. ____________________________________________ C. CRAWFORD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs