Citation Nr: 1007256 Decision Date: 02/26/10 Archive Date: 03/05/10 DOCKET NO. 07-10 633 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for the cause of the Veteran's death. 2. Entitlement to service connection for glioblastoma for accrued benefit purposes as a result of exposure to ionizing radiation. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL The appellant and J.C. ATTORNEY FOR THE BOARD L. Barstow, Associate Counsel INTRODUCTION The Veteran had active military service from September 1958 to September 1962. He died in June 2005. The appellant is the Veteran's surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a May 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The case was remanded by the Board in October 2008 to allow the appellant to have her requested hearing before a Veterans Law Judge. The appellant testified before a decision review officer at a hearing in October 2006 and before the undersigned Veterans Law Judge at a hearing in March 2009. Transcripts of the hearings are of record. At the March 2009 hearing, the appellant submitted new evidence in the form of a statement regarding the Veteran's cancer and his exposure to radiation, in addition to articles involving ionizing radiation and cancer. The appellant specifically waived her right to have the RO consider this evidence in the first instance. 38 C.F.R. § 20.1304(c) (2009). FINDINGS OF FACT 1. The Veteran died in June 2005. 2. The Veteran's death certificate lists the immediate cause of death as glioblastoma or brain tumor. 3. At the time of the Veteran's death, service connection had been established for residuals of pilonidal cyst, evaluated as noncompensably disabling; it was not a principal or contributory cause of death. 4. The Veteran was exposed to ionizing radiation. 5. The Veteran's glioblastoma was first manifested years after his military service, but is a radiogenic disease. 6. The competent evidence fails to demonstrate that the Veteran's glioblastoma was related to any in-service exposure to ionizing radiation, or otherwise to military service. CONCLUSIONS OF LAW 1. Service connection for the cause of the Veteran's death is not warranted. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 1310, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.312 (2009). 2. For purposes of accrued benefits, the Veteran did not have glioblastoma that was the result of disease or injury incurred in or aggravated during active military service, including as due to exposure to ionizing radiation. 38 U.S.C.A. §§ 1101, 1112, 1131, 1137, 5107, 5121 (West 2002 and Supp. 2009); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310, 3.311, 3.1000 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Merits of the Claims The appellant contends that the Veteran's glioblastoma was caused by his exposure to ionizing radiation in service. Specifically, the appellant contends that the Veteran was stationed in Lakehurst, New Jersey at the time a fire destroyed a nuclear warhead equipped missile at the Boeing Michigan Aeronautical Research Center (BOMARC) located at the base in Lakehurst, New Jersey in June 1960. She contends that the Veteran was the lead fire fighter in putting out the fire and then guarded the area afterwards. She also contends that the Veteran was exposed to ionizing radiation when he was stationed in Vieques Island. As a preliminary matter, the Board notes that the appellant could potentially be barred as a matter of law from receiving benefits. The evidence shows that the appellant turned 57 on January [redacted], 2005. Correspondence received in June 2006 indicates that the appellant had a different last name, and later correspondence reveals that she had remarried; the name used in June 2006 is the same as her current husband. However, the evidence does not indicate the exact date that the appellant remarried. Under 38 C.F.R. § 3.50, the definition of a surviving spouse includes one that has not remarried, except as provided in 3.55. 38 C.F.R. § 3.50 (2009). One of the exceptions under 38 C.F.R. § 3.55 is for a surviving spouse who remarries after age 57 on or after January 1, 2004. In this case, if the appellant remarried before she turned 58 on January [redacted], 2006, she would be barred from benefits from the date of marriage. However, if she remarried after January [redacted], 2006, there would be no bar to benefits between the claim date and remarriage date. Although the Board notes that there is a potential bar for benefits, for the reasons discussed below, the appellant's claims will be denied. Therefore, since the claims will be denied, further development to find out the date of the appellant's remarriage is unnecessary and would only cause undue delay. Cause of death 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 active service was the principal or contributory cause of death. 38 U.S.C.A. § 1310 (West 2002); 38 C.F.R. § 3.312(a) (2009). This question will be resolved by the use of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the Veteran, including, particularly, autopsy reports. Id. For a service-connected disability to be considered the principal or primary cause of death, it must singly, or with some other condition, be the immediate or underlying cause, or be etiologically related thereto. 38 C.F.R. § 3.312(b) (2009). In determining whether a 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) (2009). The standards and criteria for determining whether or not a disability from which a Veteran has died is service-connected are the same standards and criteria employed for determining whether a disability is service connected generally, i.e., while the Veteran is still alive. 38 U.S.C.A. § 1310 (West 2002). Issues involved in a claim for Dependency and Indemnity Compensation [DIC] are decided without regard to any prior disposition of those issues during the Veteran's lifetime. 38 C.F.R. § 20.1106 (2009). Service connection for conditions claimed to be due to exposure to ionizing radiation in service can be established in any of three different ways. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are diseases that are presumptively service connected in radiation-exposed Veterans under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d). Second, service connection can be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311, if the condition at issue is a radiogenic disease. Third, direct service connection can be established under 38 C.F.R. § 3.303(d) by showing that the disease was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). Under Combee, VA must determine whether the disability is otherwise the result of active service. In other words, the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation. If a claimant does not qualify as a "radiation-exposed Veteran" under 38 C.F.R. § 3.309(d)(3) and/or does not suffer from one of the presumptive conditions listed in 38 C.F.R. § 3.309(d)(2), the Veteran may still benefit from the special development procedures provided in 38 C.F.R. § 3.311 if the Veteran suffers from a radiogenic disease and claims exposure to ionizing radiation in service. Under 38 C.F.R. § 3.311, "radiogenic disease" means a disease that may be induced by ionizing radiation and includes tumors of the brain and central nervous system. See 38 C.F.R. § 3.311(b)(2). Under the special development procedures in § 3.311(a), dose data will be requested from the Department of Defense in claims based upon participation in atmospheric nuclear testing, and claims based upon participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946. 38 C.F.R. § 3.311(a)(2). In all other claims, 38 C.F.R. § 3.311(a) requires that a request be made for any available records concerning the Veteran's exposure to radiation. These records normally include but may not be limited to the Veteran's Record of Occupational Exposure to Ionizing Radiation (DD Form 1141), if maintained, service medical records, and other records which may contain information pertaining to the Veteran's radiation dose in service. All such records will be forwarded to the Under Secretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. 38 C.F.R. § 3.311(a)(2)(iii). Although the Veteran was diagnosed with a disease for which presumptive service connection for radiation exposed Veterans can be granted, the evidence does not show that the Veteran meets the definition of a "radiation-exposed" Veteran. See 38 U.S.C.A. § 1112(c)(2),(3); 38 C.F.R. § 3.309(d). However, tumors of the brain are considered radiogenic diseases under 38 C.F.R. § 3.311(b)(2) and service connection can be granted to Veterans who do not meet the definition of a "radiation- exposed" Veteran under special development procedures. The Veteran's personnel records show that he was stationed at Lakehurst from May 1961 to September 1962; as noted above, the fire occurred in June 1960. The appellant submitted a private analysis for radioactive components on the cremation remains of the Veteran dated in March 2006. The analysis shows that a small amount of plutonium-238 was found in the Veteran's ashes, and that the best guess for the source of the exposure was the BOMARC missile incident in June 1960. The analysis conclusion was that it did not appear that radioactive material ingested during the Veteran's service would have resulted in any significant increased risk of radiation injury. It was noted that using another set of assumptions another health physicist could come up with a much higher estimated dose to the Veteran, but that the most realistic set of assumptions was used there based on information provided by the appellant. A letter dated in March 2006 from the Department of the Navy indicates that there were no reports of occupational exposure to ionizing radiation from the Naval Air Engineering Station in Lakehurst, New Jersey in their files. The letter reveals that it was therefore unlikely that any potential sources of ionizing radiation were of sufficiently low intensity to preclude the need for individual monitoring. In a January 2007 memorandum, the Under Secretary for Health (Chief Public Health and Environmental Hazards Officer) indicated that it was estimated that the Veteran was exposed to an occupational radiation dose of 0.5 rem per year while stationed in New Jersey during 1961-1962. The memorandum reveals that radiation increased the incidence of both benign and malignant central nervous system neoplasms; however, the dose relationship was uncertain and many of the studies relate to exposure in utero or during childhood ((for authority, the VA Chief cited to Health Effects of Exposure to Low Levels of ionizing Radiation (BEIR V), 1990, pages 310-313). Most studies in adults showed no excess risk or a nonstatistically significant increased risk for brain tumors, especially when the dose is less than 10 rads (for authority, the VA Chief cited to Mettler and Upton, Medical Effects of Ionizing Radiation, 2nd edition, 1995, page 122). The memorandum further indicates that the Interactive Radioepidemiological Program (IREP) of the National Institute for Occupational Safety and Health (NIOSH) was utilized to estimate the likelihood that exposure to ionizing radiation was responsible for the brain cancer. The computer software calculated a 99th percentile value for the probability of causation of 0.77 percent and 0.69 percent, depending on whether the doses were entered as acute or chronic. It was consequently concluded that it was unlikely that the Veteran's glioblastoma multiforme could be attributed to exposure to ionizing radiation in service. In a subsequent advisory opinion in January 2007, VA's Under Secretary for Benefits (VA's Veterans Benefits Administration), following a review of the above-noted opinion and the evidence in its entirety, opined that there was no reasonable possibility that the Veteran's glioblastoma multiforme resulted from radiation exposure in service. With regards to the question of whether the Veteran's only service-connected disability of residuals of pilonidal cyst, evaluated as noncompensably disabling, was the principal or contributory cause of death, the Board finds that it was not, nor has the appellant contended that it was. The cause of death listed on the Veteran's death certificate was glioblastoma or brain tumor; no contributing causes were given. The appellant has not asserted that the Veteran's only service-connected disability was the principal or contributory cause of death, nor does the evidence suggest that the Veteran's death was in any way related to his residuals of pilonidal cyst. Turning to the question of whether the Veteran's glioblastoma was caused by his military service, the Board finds that it was not. The Board acknowledges that tumors of the brain are radiogenic diseases, and that the Veteran was exposed to ionizing radiation in service while stationed in Lakehurst, New Jersey. However, the evidence does not show that the Veteran's exposure to ionizing radiation caused his cancer. Here, as discussed above, all the opinions that have been obtained in this case show that the Veteran's glioblastoma was not caused by his in-service radiation exposure. The March 2006 private analysis concluded that it did not appear that radioactive material ingested during the Veteran's service would have resulted in any significant increased risk of radiation injury. In a January 2007 memorandum, the Under Secretary for Health concluded that it was unlikely that the Veteran's glioblastoma multiforme could be attributed to exposure to ionizing radiation in service. Additionally, in a subsequent advisory opinion in January 2007, VA's Under Secretary for Benefits opined that there was no reasonable possibility that the Veteran's glioblastoma multiforme resulted from radiation exposure in service. In light of the negative nexus opinions and with no opinion to the contrary, the Veteran's glioblastoma was not caused by his exposure to radiation in service. The Board also finds that the Veteran's glioblastoma has not been shown to be otherwise related to his military service. His STRs show no complaints related to his brain, and the tumor was manifested many years after his discharge from service in 1962. The appellant has not contended that the glioblastoma was caused by anything but radiation exposure, and the record does not show any in-service disease or injury that could have caused the glioblastoma. The Board acknowledges that the appellant has provided numerous articles related to the connection between radiation and brain tumors, but none of that information is specific to the Veteran; therefore, they are not probative evidence as to whether the Veteran's glioblastoma was caused by his military service. The Board acknowledges the appellant's belief that the Veteran's glioblastoma was caused by his exposure to ionizing radiation. In this instance, the appellant is competent to say that that her husband had a brain tumor and that he had told her that he was stationed in Lakehurst, New Jersey following the BOMARC incident. Additionally, the Board acknowledges that the appellant is a nurse, and as a medical professional, is therefore competent to say that her husband's glioblastoma was due to exposure to ionizing radiation. See Edenfield v. Brown, 8 Vet. App. 384, 388 (1995); Robinette v. Brown, 8 Vet. App. 69, 74 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). However, although the appellant is competent regarding providing an opinion regarding medical causation, the Board does not find her opinion as probative as those of the Under Secretary for Health (Chief Public Health and Environmental Hazards Officer) and the senior health physicist who provided the private opinion. In this case, the Board finds the opinions from the Under Secretary for Health and the private health physicist to be more probative as they both possess expertise that the appellant does not have. Although the appellant is a nurse, the evidence does not show her to have the same expertise that the Under Secretary for Health and the private health physicist have. Therefore, although the Board acknowledges the appellant's opinion regarding the etiology of the Veteran's brain cancer, the Board is more persuaded by the opinions providing a negative nexus to the Veteran's in-service radiation exposure. The opinions from the Under Secretary for Health and the private health physicist are more significant, and therefore more probative, in light of their specialized knowledge. For the reasons discussed above, the Board finds that the Veteran's glioblastoma was not related to his military service, and that his service-connected disability of residuals of pilonidal cyst did not cause his death. As the preponderance of the evidence is against the appellant's claim, the benefit-of-the-doubt rule does not apply, and the appellant's claim of entitlement to service connection for the cause of the Veteran's death is denied. See 38 U.S.C.A §5107 (West 2002 & Supp. 2009). Accrued benefits Accrued benefits are benefits to which a Veteran was entitled at his death, based on evidence on file at the date of death, and due and unpaid, to be paid to survivors as provided by law. 38 U.S.C.A. § 5121 (West 2002); 38 C.F.R. § 3.1000 (2009). For a claimant to prevail on an accrued benefits claim, the record must show that (i) the appellant has standing to file a claim for accrued benefits, (ii) the Veteran had a claim pending at the time of death, (iii) the Veteran would have prevailed on the claim if he had not died; and (iv) the claim for accrued benefits was filed within one year of the Veteran's death. 38 U.S.C.A. §§ 5121, 5101(a) (West 2002 and Supp 2009); 38 C.F.R. § 3.1000 (2009); Jones v. West, 136 F.3d 1299 (Fed. Cir. 1998). Only evidence of record at the time of the Veteran's death is considered in adjudicating a claim for accrued benefits. 38 C.F.R. § 3.1000. The Court has stated that certain documents may be deemed constructively of record in an accrued benefits claim even though physically absent from the record on the date of death. Hayes v. Brown, 4 Vet. App. 353, 360- 361 (1993). Specifically, the Hayes Court noted that the VA Adjudication Manual, M21-1, paragraph 5.25(b), permits certain government documents to be considered as being in the file at date of death even though actually put into the file after the date of death. The government documents consist of evidence in file at date of death. Evidence "in file," in turn, includes the following, even if such reports are not reduced to writing or are not physically placed in the Veteran's file until after death: (1) service department records; (2) reports of VA hospitalization; (3) reports of treatment of examinations in VA medical centers including those in outpatient treatment folders; (4) Reports of hospitalization, treatment or examinations authorized by VA; and (5) Reports of autopsy made by VA on the date of death. In addition, the Court noted that VA Manual, M21-1, paragraph 5.25(b) states, in relevant part, that "[t]he cited regulations [38 C.F.R. § 3.1000(d)(4) and § 3.327(b)(1) (1992)] also provide for the acceptance of evidence after death for verifying or corroborating evidence 'in file' at death." The Court also noted that, in accordance with a then-current VA regulation, any hospital report and any examination report from a military hospital or from a State, county, municipal or other government hospital or recognized private institution which contain descriptions, including diagnoses and clinical and laboratory findings, adequate for rating purposes, of the condition of the organs or body systems for which claim is made may be deemed to be included in the term "Department of Veterans Affairs examination." 38 C.F.R. § 3.327(b)(1) (1992). That holding, however, only applied to medical examinations related to rating claims, not to service connection claims. Id. See also 60 Fed. Reg. 27409 (May 24, 1995), which eliminated the requirement in 38 C.F.R. § 3.327(b)(1) that at least one VA examination be made in every case in which compensation benefits are awarded, and with it, the exceptions deemed to be included in the term "Department of Veterans Affairs examination." Thus, the Court found that, taken together, these provisions from the VA Adjudication Manual and the Code of Federal Regulations may require that such reports, even though submitted after death, nevertheless, be considered. As will be shown below, some of the evidence received after the Veteran's death can be considered to have been "in file" at the time of the Veteran's death. The record shows that, as the surviving spouse of the Veteran, the appellant has standing to file a claim for accrued benefits and that she did so in a timely fashion. The record also shows that at the time of the Veteran's death he had a claim pending for service connection for brain cancer. Thus, in order to prevail on the accrued benefits claim, it must be shown that the Veteran would have prevailed on the claim if he had not died. Here, at the time of the Veteran's death, the only evidence of record were private treatment records showing that he had glioblastoma, VA treatment records, personnel records, and statements from the appellant on behalf of the Veteran. Subsequent to the Veteran's death, new evidence was incorporated into the record consisting of the appellant's contentions, articles regarding the BOMARC incident and the relationship of brain cancer to radiation, the March 2006 private radiation analysis and opinion, the January 2007 memorandum from the Under Secretary for Health, and the January 2007 supervisory opinion from VA's Under Secretary for Benefits. In this case, the Board finds that the January 2007 memorandum and supervisory opinion are evidence considered to have been "in file" at the time of the Veteran's death. This is so as the memorandum and supervisory opinion were based on the Veteran's service department records, which are considered to have been "in file" at the time of the Veteran's death. See Hayes, supra. Additionally, the Board also notes that the obtainment of the memorandum and supervisory opinion was mandated by 38 C.F.R. § 3.311 (2009) as the claim was for a radiogenic disease based on exposure to ionizing radiation. Similar to the analysis of the cause of death claim, the evidence of record at the time of the Veteran's death does not support an award of service connection for glioblastoma on a direct or presumptive basis, for accrued benefits purposes. As discussed above, the January 2007 memorandum and supervisory opinion show that the Veteran's glioblastoma was not related to his ionizing radiation exposure in service, nor does the evidence show that the glioblastoma was otherwise related to service. As the preponderance of the evidence is against the appellant's claim, the benefit-of-the-doubt rule does not apply, and the appellant's claim of entitlement to service connection for glioblastoma for accrued benefits purposes is denied. See 38 U.S.C.A §5107. II. The Veterans Claims Assistance Act of 2000 (VCAA) Under the Veterans Claims Assistance Act (VCAA), when VA receives a complete or substantially complete application for benefits, it must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 8 U.S.C.A. § 5103(a) (West 2002). 38 C.F.R. § 3.159 (2009). See also Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II). In the instant case, the appellant received notification prior to the initial unfavorable agency decision in August 2005 and March 2006. The RO's notice letters advised the appellant what information and evidence was needed to substantiate the claim decided herein and what information and evidence must be submitted by her, namely, any additional evidence and argument concerning the claimed condition and enough information for the RO to request records from the sources identified by the appellant. She was specifically told that it was her responsibility to support the claim with appropriate evidence. Finally the letter advised her of what information and evidence would be obtained by VA, namely, records like medical records, employment records, and records from other Federal agencies. The duty to notify the appellant was satisfied under the circumstances of this case. 38 U.S.C.A. § 5103. The United States Court of Appeals for Veterans Claims (Court) recently held in Hupp v. Nicholson, 21 Vet. App. 342 (2007), that when adjudicating a claim for Dependency and Indemnity Compensation (DIC), VA must perform a different analysis depending upon whether a Veteran was service connected for a disability during his or her lifetime, and concluded generally, that 38 U.S.C.A. § 5103(a) notice for a DIC case must include (1) a statement of the conditions, if any, for which a Veteran was service connected at the time of his or her death, (2) an explanation of the evidence and information required to substantiate a DIC claim based on a previously service-connected condition, and (3) an explanation of the evidence and information required to substantiate a DIC claim based on a condition not yet service connected. As discussed above, the notice letters fully satisfied the third element of Hupp. In addition, although the Veteran was service connected for residuals of pilonidal cyst, since the appellant has not contended that that disability caused his death, the absence of notice regarding elements one and two of Hupp should not prevent a Board decision as it did not affect the essential fairness of the adjudication. See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007). Regarding VA's duty to assist, the RO obtained the Veteran's service treatment records (STRs), personnel records, post- service medical records, and obtained opinions regarding whether the Veteran's glioblastoma was caused by radiation exposure. VA has no duty to inform or assist that was unmet. With respect to the opinions from the Under Secretary for Health and VA's Under Secretary for Benefits, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As noted above, the Board finds that the opinions obtained in this case were sufficient, as they were predicated on a full reading of the pertinent evidence and provide explanations for the opinions stated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issue on appeal has been met. 38 C.F.R. § 3.159(c)(4). The Board acknowledges VA has not obtained a medical opinion with respect to whether the Veteran's glioblastoma was otherwise related to his military service or whether his service-connected disability of residuals of pilonidal cyst caused the Veteran's death. But in DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008), the Federal Circuit Court held that 38 U.S.C. § 5103A(a) does not always require the Secretary of VA to assist a claimant in obtaining a medical opinion or examination for a DIC claim, but it does require VA to assist a claimant in obtaining such whenever it is necessary to substantiate the DIC claim. The Federal Circuit Court added that there was no duty to provide a VA opinion in a DIC claim under 38 U.S.C.A. § 5103A(d) since this provision is explicitly limited to claims for disability compensation (service connection), which is defined as a monthly payment made by VA to a veteran, and therefore does not pertain to a DIC claim. Id. But Wood v. Peake, 520 F.3d 1345 (Fed. Cir. 2008)(holding that in the context of a DIC claim, VA must also consider that 38 U.S.C. § 5103A(a) only excuses VA from making reasonable efforts to provide an examination when no reasonable possibility exists that such assistance would aid in substantiating the claim). In the present case, the appellant has not contended that the Veteran's glioblastoma was caused by anything other than exposure to radiation, or that the Veteran's residuals of pilonidal cyst contributed to his death; the competent medical evidence of record is sufficient to decide the claim; and the Board finds that that no reasonable possibility exists that a VA opinion would aid in substantiating the claim as the evidence shows that the Veteran's glioblastoma was not related to his service and his residuals of pilonidal cyst did not contribute to his cause of death. ORDER Entitlement to service connection for the cause of the Veteran's death is denied. Entitlement to service connection for glioblastoma for accrued benefit purposes as a result of exposure to ionizing radiation is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs