Citation Nr: 1318996 Decision Date: 06/11/13 Archive Date: 06/21/13 DOCKET NO. 11-12 078 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office and Insurance Center in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for the cause of the Veteran's death. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. Smith, Counsel INTRODUCTION The Veteran served on active duty from January 1945 to August 1946, and June 1951 to October 1958. The Veteran died on August [redacted], 2009. The appellant is his surviving spouse. The appellant's claim comes before the Board of Veterans' Appeals (Board) on appeal from an August 2010 rating decision of the Department of Veterans Affairs' (VA) Regional Office (RO). In September 2012 and March 2013 the Board remanded the matter for additional development. That development having been completed, the claim has been returned to the Board and is now ready for appellate disposition. The Board has considered documentation included in the Virtual VA system in reaching the determinations below. No new records pertinent to this appeal were found therein. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). FINDINGS OF FACT 1. The Veteran died in August 2009; the certificate of death lists the immediate cause of his death as congestive heart failure, with coronary artery disease listed as a condition contributing to death but not related to the cause. 2. At the time of his death, the Veteran was not service-connected for any disability. 3. Cardiovascular disease, to include congestive heart failure and coronary artery disease, was not incurred in or aggravated by active military service, is not shown to be etiologically related to the Veteran's periods of service, and was first shown years after separation from active service. 4. The weight of the competent and credible evidence is not in equipoise as to whether the Veteran suffered from a psychiatric disorder, to include posttraumatic stress disorder (PTSD), prior to his death. 5. A service-related disability did not constitute the principal or a contributory cause of the Veteran's death. CONCLUSION OF LAW Service connection for the cause of the Veteran's death is not warranted. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 1310, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.312 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION Notice and Assistance Under applicable law, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA 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; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ). Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Board finds that the content requirements of a duty to assist notice have been fully satisfied. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). A pre-adjudication letter from the RO dated in June 2010 was provided the appellant with an explanation of the type of evidence necessary to substantiate her claim, as well as an explanation of what evidence was to be provided by her and what evidence the VA would attempt to obtain on her behalf. The letters also provided her with information concerning effective date that could be assigned should service connection be granted, pursuant to Dingess v. Nicholson, 19 Vet. App. 473 (2006). While the notices provided do not include any information concerning the evaluation that could be assigned should service connection be granted pursuant to Dingess, since this decision affirms the RO's denial of service connection, the appellant is not prejudiced by the failure to provide her that further information. VA has no outstanding duty to inform the appellant that any additional information or evidence is needed. The Board additionally calls attention Hupp v. Nicholson, 21 Vet. App. 342, 352-53 (2007) which pertains to claims for Dependency and Indemnity Compensation. In the context of a claim for Dependency and Indemnity Compensation (DIC) benefits, section 5103(a) notice 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. In this case, the Veteran was not service-connected for any disability. The June 2010 letter advised the appellant of this fact, and provided notice regarding what information and evidence would be required to substantiate a DIC claim based on a condition not yet service connected. The Board finds the requirements of Hupp are satisfied. VA also has a duty to assist the appellant in the development of the claim. This duty includes assisting the appellant in the procurement of service treatment records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. Here, the Board finds that all relevant facts have been properly developed, and that all evidence necessary for equitable resolution of the issue has been obtained. The Veteran's service treatment records and post service treatment records have been obtained. The appellant was afforded the opportunity for a personal hearing. A VA medical opinion has been obtained. The Board does not have notice of any additional relevant evidence which is available but has not been obtained. The Board is further satisfied that the RO has substantially complied with its March 2013 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). See also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (finding that only substantial compliance, rather than strict compliance, with the terms of a Board engagement letter requesting a medical opinion is required). As directed by the Board, the AOJ secured a VA medical opinion for the claim. 38 U.S.C. § 5103A(a); Wood v. Peake, 520 F.3d 1345, 1347 (Fed.Cir.2008). In this regard, the Board acknowledges that the VA examiner did not address two articles of record that were submitted to VA in April 2011 associating PTSD with heart disease, as requested by the Board. However, because the VA examiner determined that PTSD or another psychiatric disability did not exist, there was no need to further discuss the relationship of any such disability to heart disease. The Board finds that substantial compliance has been achieved. For the foregoing reasons, the Board concludes that all reasonable efforts were made by the VA to obtain evidence necessary to substantiate the appellant's claim. Therefore, no further assistance to the appellant with the development of evidence is required. Analysis The appellant in this case asserts that the Veteran suffered from PTSD during his lifetime, and that this PTSD caused or contributed to his heart disease, which was the cause of his death. When it is determined that a Veteran's death is service connected, with service connection determined according to the standards applicable to disability compensation, his surviving spouse is generally entitled to DIC. 38 U.S.C.A. § 1310 (West 2002 & Supp. 2012); 38 C.F.R. § 3.5(a) (2010); see generally 38 U.S.C.A. Chapter 11. Generally, a Veteran's death is service connected if it resulted from a disability incurred or aggravated in the line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 101(16), 1110, 1131; 38 C.F.R. §§ 3.1(k), 3.303. Direct service connection generally requires evidence of a current disability with a relationship or connection to an injury or disease or some other manifestation of the disability during service. 38 U.S.C.A. §§ 1110 (wartime service), 1131 (peacetime service); 38 C.F.R. § 3.303; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). Disorders diagnosed after discharge may still be service connected if all the evidence, including pertinent service records, establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d). In such case, the physician must relate the current condition to the period of service. Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Service connection may be demonstrated either by showing direct service incurrence or aggravation, as discussed above, or by use of applicable presumptions, if available. 38 C.F.R. § 3.303(a); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). To establish service connection for the cause of the Veteran's death, the service-connected disability must be either the principal or a contributory cause of death. 38 C.F.R. § 3.312(a). A disability is the principal cause of death if it was the immediate or underlying cause of death, or was etiologically related to the death. 38 C.F.R. § 3.312(b). A disability is a contributory cause of death if it contributed substantially or materially to the cause of death, combined to cause death, or aided or lent assistance to producing death - e.g., when a causal (not just a casual) connection is shown. 38 C.F.R. § 3.312(c). 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). There are primary causes of death that, 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 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, itself, of a progressive or debilitating nature. 38 C.F.R. § 3.312(c)(4); Galvagno v. Derwinski, 3 Vet. App. 118, 119 (1992). In short, the appellant is entitled to DIC benefits if the principal or contributory cause of the Veteran's death was (1) an already service-connected disability that caused or aggravated another disability, directly leading to the Veteran's death; or (2) a previously nonservice-connected disability that was in fact incurred or aggravated by service. 38 U.S.C.A. § 1310; 38 C.F.R. §§ 3.303(a), 3.310, 3.312. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). VA is to give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for death benefits. 38 U.S.C.A. §§ 1154(a) (West 2002). With regard to lay evidence, the Federal Circuit Court has held that lay evidence from the Veteran's spouse, when competent, can establish a nexus between the Veteran's death and an in-service disease or injury. Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009). Therefore, a medical opinion is not always required to establish such a nexus. See id. As pertinent to this holding, the Federal Circuit has also previously rejected as "too broad" the proposition that competent medical evidence is always required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). On this point, lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (e.g., a broken leg), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377 (footnote omitted). In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C.A. 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1991); Alemany v. Brown, 9 Vet. App. 518 (1996). Here, the Veteran's certificate of death shows that he died in August 2009. The certificate of death lists the immediate cause of his death as congestive heart failure, with coronary artery disease listed as a condition contributing to death but not related to the cause. At that time, the Veteran was 82 years old. He was not service connected for any disabilities at the time of his death. A review of the Veteran's service medical records does not reveal the existence of any cardiovascular disease, including congestive heart failure or coronary artery disease, in service. Service medical examinations were normal in this regard. Since service, the record reveals no competent evidence of a nexus between the causes of the Veteran's death and his period of service. Boyer v. West, 210 F.3d 1350, (Fed. Cir. 2000) 1353; Maggitt v. West, 202 F.3d 1370, 1375 (Fed. Cir. 2000). That is, there is simply no medical evidence that establishes a link between the Veteran's congestive heart failure or coronary artery disease and his period of service. The Board acknowledges that no medical opinion has been obtained on this point. However, the Board finds that the evidence, which reveals that the Veteran did not have these disabilities or any cardiovascular abnormality during service, and does not reflect competent evidence showing a nexus between service and the disorders, warrants the conclusion that a remand for an examination and/or opinion is not necessary to decide the claim. As service and post-service medical records provide no basis to grant this claim, and in fact provide evidence against this claim, the Board finds that no reasonable possibility exists that such an opinion would aid in substantiating the appellant's claim. 38 U.S.C. § 5103A(a); Wood v. Peake, 520 F.3d 1345, 1347 (Fed.Cir.2008). Moreover, chronic disabilities, such as cardiovascular-renal disease, including hypertension, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. However, as there is no medical evidence documenting cardiovascular-renal disease from within one year of the Veteran's discharge from active duty in October 1958, the Board finds that presumptive service connection is not warranted on this basis. Additionally, the Board notes that the appellant has not alleged, nor does the evidence show, continuity of symptomatology since service. The United States Court of Appeals for the Federal Circuit recently clarified that the continuity of symptomatology language in § 3.303(b) "restricts itself to chronic diseases" found in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). (holding, "nothing in § 3.303(b) suggests that the regulation would have any effect beyond affording an alternative route for proving service connection for chronic diseases."). As cardiovascular disease is a chronic disease under § 3.309(a), the appellant may attempt to establish continuity of symptomatology in lieu of a nexus. In this case, however here, the earliest post-service evidence of record is dated from 1999, more than 50 years after the Veteran's 1958 discharge from service. See Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000) (holding that evidence of a prolonged period without medical complaint after service can be considered along with other factors in the analysis of a service connection claim.). Therefore, the Board finds that continuity of symptomatology regarding the Veteran's cardiovascular disease has not been established. The Board will now turn to the appellant's specific arguments regarding PTSD. In an October 2009 report, the Veteran's private treating physician, Dr. T., stated he had known the Veteran for several years prior to his death. He stated that following the Veteran's death, the appellant submitted the Veteran's military papers to him, and he was astounded by the fact that the Veteran was so highly decorated and participated in so many campaigns during the Korean War. Upon noting these accomplishments, Dr. T. began to realize the Veteran had been keeping things to himself. Dr. T. noted there were small tell-tale signs of PTSD, such as nervousness, not liking crowds, having a difficulty waiting, and difficulty sleeping, and felt that the Veteran kept his emotions hidden and everything inside. Dr. T. opined that this "certainly contributed to if not caused his heart attack and ultimate death." On review of this report in September 2012, the Board noted that while Dr. T. was a treating physician, the record also showed treatment from other physicians and that there were no underlying treatment records from Dr. T. in the file. The record was devoid of documentation of PTSD during the Veteran's lifetime, other than the October 2009 report. The appellant was asked to submit or identify any pertinent evidence, including the treatment records of Dr. T., the Veteran's terminal records, and any other evidence to support that the Veteran suffered from PTSD and its symptoms during his lifetime. A medical opinion was also requested in order to determine whether it was at least as likely as not that, during his lifetime, the Veteran suffered from PTSD, as defined by the Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994) (DSM-IV), due to military combat, or from any other DSM-IV disorder related to military service. If so, the examiner was asked to opine on whether such psychiatric diagnosis was at least as likely as not to have caused or contributed substantially or materially to his death. In March 2013, the Board noted that despite VA's attempts, the record remained devoid of terminal hospital treatment records or treatment records from Dr. T. While, following the most recent remand, VA requested that the appellant submit the records herself, or sign appropriate releases to enable VA to obtain those on her behalf, she had not taken advantage of that opportunity. As such, the Board found that no further efforts by VA were necessary in that regard, but the Board encouraged the appellant to submit the requested materials in support of her claim. The appellant was also encouraged to provide any evidence she might have which tends to show that the Veteran suffered from PTSD during his lifetime. The Board noted that such evidence may include statements of her own observations, or those of anyone else, which discuss observable events or the presence of disability, or symptoms of disability, based on first-hand knowledge, that the Veteran suffered from PTSD and its symptoms prior to his death. Additionally, because the medical opinion requested in September 2012 had not been obtained, the matter was again remanded, pursuant to Stegall v. West, 11, Vet. App. 268 (1998). Subsequent to the March 2013 remand, the appellant again did not submit the evidence previously discussed in both remands. A VA medical opinion, however, was obtained in April 2013. The April 2013 VA examiner reviewed the Veteran's entire claims file. She opined that after reviewing this evidence, it was her professional opinion that the Veteran did not meet the diagnostic criteria for PTSD, pursuant to the DSM-IV. She further opined that it was less likely as not that the Veteran suffered from any mental illness related to his military service. As rationale, she stated that there was no documentation of any mental health issues in the claims file. She noted that the Veteran died at age 82 from congestive heart failure. In his lifetime, he suffered from multiple risk factors for heart disease, and multiple medical conditions contributing to heart disease, such as hypothyroidism, diabetes, and hypertension, among others. These medical conditions were not related to any mental health issue that could have arisen from military service. As an example, the examiner cited a specific VA treatment record in which the Veteran denied having psychiatric symptoms. She further discussed a diagnosis of insomnia appearing in the medical record beginning in 2007, but noted first that it was unclear under what setting the Veteran was suffering from insomnia (such as whether it was occurring in the hospital), and also noted that many elderly people experience sleep pattern changes, which is normal. The examiner acknowledged the Veteran's receipt of the Purple Heart, but found it did not mean he was suffering from resulting mental health issues. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). In assessing medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical opinion may not be discounted solely because the examiner did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). On review of all of this evidence, the Board finds the opinion of the VA examiner outweighs that of Dr. T., and that the evidence is not in equipoise on the issue of whether the Veteran suffered from PTSD prior to his death. There is no indication that Dr. T. reviewed the Veteran's medical records in rendering his opinion. The Board does not discount the opinion solely on this basis, but finds this fact significant because the entirety of the medical records in the claims file contradicts the finding offered by Dr. T. There is simply no documentation whatsoever of any mental health problem in the post-service medical evidence, and the appellant has submitted no such evidence, despite VA's attempts in this regard. To the contrary, on several occasions, including August 2005 and March 2008, the Veteran's psychiatric functioning was assessed. Judgment and insight were normal. He was oriented to time, person, and place. His mood and affect were normal and appropriate, and his recent and remote memory were intact. The only diagnosis appearing in the entire medical record remotely related to a psychiatric diagnosis is that of insomnia. However, as discussed by the April 2013 examiner, this is not abnormal or uncommon in the elderly population. Further, the diagnosis of insomnia is unaccompanied by any other psychiatric complaints or diagnoses. Dr. T.'s own underlying treatment records are not of record, again despite VA's attempts. The Board acknowledges that Dr. T. was a treating physician of the Veteran, but the Court has previously and expressly rejected a "rule that would give the opinions of treating physicians greater weight in evaluating claims made by veterans." See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993); see also Van Slack v. Brown, 5 Vet. App. 499, 502 (1993); Harder v. Brown, 5 Vet. App. 183, 188 (1993). Additionally, Dr. T's report contains no reference to the DSM-IV in rendering the diagnosis, in accordance with VA regulation, namely, 38 C.F.R. § 4.125(a). All of these factors diminish the probative value of the October 2009 report. By contrast, the April 2013 report is adequate for the purposes of adjudication. The applicable and appropriate history was recorded, and there is no showing that the examination report provided a substantially different picture of the Veteran's disability, or lack thereof, than the other evidence in the claims file. The medical examiner's findings were factually accurate and fully articulated, and valid medical analyses were applied. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinion was based on a thorough review of the claims file and the examiner offered a number of factors considered in reaching the conclusion. For these reasons, the Board simply cannot find that the Veteran suffered from PTSD or any other psychiatric disorder during his lifetime. In the absence of diagnosis, there is no need to further discuss the other elements of service connection for the claim. The Board does not find that a service-related disability constituted the principal or a contributory cause of the Veteran's death. With regard to lay evidence, as noted above, in certain instances lay evidence from the Veteran's spouse, when competent, can establish a nexus between the Veteran's death and an in-service disease or injury. Davidson, 581 F.3d at 1315-16. Here, the appellant contends that the Veteran's death was the result of PTSD from military service. The appellant, however, has not been shown to have the medical training or expertise to be competent to render an opinion as to the medical diagnosis or etiology of PTSD, a disorder requiring medical testing. See 38 C.F.R. § 3.159(a)(1)-(2); Jandreau, 492 F.3d at 1377. Also the credibility of the assertions are severely undermined by the absence of any post-service diagnosis of PTSD or any psychiatric illness (other than the problematic opinion of Dr. T., as discussed above), as well as by the reasoned explanations of the April 2013 medical examiner. The question regarding the diagnosis of PTSD, as well as the potential relationship between PTSD and the Veteran's military service, is complex in nature. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). In short, while the appellant is competent to describe the Veteran's post-service symptoms, the Board accords the statements of little probative value as she is not competent to opine on such a complex medical question. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the appellant has offered only conclusory statements. In contrast, the April 2013 VA examiner reviewed the entirety of the Veteran's medical records, and utilized medical expertise in rendering the opinion. Therefore, the Board finds that the April 2013 VA opinion is the most probative evidence of record. The Board has additionally considered the articles submitted by the appellant regarding the relationship of trauma, to include PTSD, and heart disease. This evidence, however, does not address the facts that are specific to this Veteran's case. As such, the Board finds that the information reflected in the submitted articles is not probative of the medical questions at issue in this appeal. The Board also recognizes that the appellant has submitted a copy of a past Board decision. In this regard, the appellant, in essence, cites to the Board's disposition of that case as precedential in establishing her claim. The Board emphasizes, however, that Board decisions are not precedential. See 38 C.F.R. § 20.1303 (2012). Rather, the Board must weigh the facts of each case and apply the governing laws and regulations without regard to dispositions in other appellants' cases based on separate and unique facts. Accordingly, the Board finds that the preponderance of the evidence is against service connection for the cause of the Veteran's death, so there is no reasonable doubt to resolve in the appellant's favor. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. (The Order follows on the next page.) ORDER Service connection for the cause of the Veteran's death is denied. ____________________________________________ M. Mac Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs