Citation Nr: 1319369 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 11-16 750 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for cause of death. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD R. Dodd, Associate Counsel INTRODUCTION The Veteran served on active duty from June 1943 to October 1945 and October 1950 to June1952. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2010 rating decision by the Nashville, Tennessee Regional Office (RO) of the Department of Veterans Affairs (VA). A review of the Virtual VA paperless claims processing system revealed nothing further pertinent to the present appeal. 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). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Although the Board regrets the additional delay, remand is necessary to ensure that there is a complete record upon which to decide the appellant's claim. Specifically, a remand is required to obtain a VA medical opinion. In a cause of death claim, VA must make reasonable efforts to assist a claimant in obtaining a medical opinion when such opinion is necessary to substantiate the claimant's claim for a benefit. 38 U.S.C.A. § 5103A(a) (2012); DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008). To establish service connection for the cause of the Veteran's death, the evidence must show that a service-connected disability was either the principal cause or a contributory cause of death. 38 U.S.C.A. § 1310 (West 2002); 38 C.F.R. § 3.312 (2012). For a service-connected disability to be the primary cause of death, it must singly or with some other condition be the immediate or underlying cause of death or be etiologically related. Id. For a service-connected disability to constitute a contributory cause, it must contribute substantially or materially; 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. Id. The Veteran died in August 2010 at the age of 90. He was service connected for profound bilateral hearing loss, 100 percent disabling, an angioneurotic edema with brachial plexus causalgia involving the ulnar and medial nerve, 50 percent disabling, removal of the first rib associated with an angioneurotic edema with brachial plexus causalgia involving the ulnar and medial nerve, 10 percent disabling, and residuals of a left leg gunshot wound. The appellant has asserted that the Veteran's death was related to complications sustained from a fall related to the Veteran's left leg gunshot wound. Here, the record does not include a sufficient medical opinion regarding any relationship between the Veteran's service-connected disabilities and the cause of death. Although, the appellant submitted a private treatment record dated October 2010, in which it stated that the Veteran's death was due to complications sustained in a fall related to instability from a left leg gunshot wound, there was insufficient rationale provided. Further, private treatment records relating to the Veteran's fall and treatment in July 2010 do not specifically support the assertion that the Veteran fell due to his left leg gunshot wound or that such fall caused complications leading to death. The only other medical record discussing the Veteran's cause of death is the death certificate, showing the cause as natural causes. A medical opinion is thus necessary to explore the relationship between the Veteran's cause of death and his service-connected disabilities. As such, on remand, a medical opinion must be obtained. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. The appellant should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated her husband for the conditions that have been indicated as related to the Veteran's death. After the appellant has signed the appropriate releases, those records should be obtained and associated with the claims folder. Appropriate efforts must be made to obtain all available VA treatment records, as well as treatment records from Jefferson City Health and Rehab, Jefferson City, Tennessee. All attempts to procure records should be documented in the file. If the AMC cannot obtain records identified by the appellant, a notation to that effect should be inserted in the file. The appellant is to be notified of unsuccessful efforts in this regard, in order to allow her the opportunity to obtain and submit those records for VA review. 2. After any additional records are associated with the claims file, obtain a medical opinion to ascertain the etiology of the Veteran's death. The entire claims file (i.e., both the paper claims file and any electronic medical records) should be made available to and be reviewed by the examiner, and it should be confirmed that such records were available for review. If the examiner does not have access to electronic medical records, any such relevant treatment records must be printed and associated with the paper claims file so they can be available to the examiner for review. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner must provide an opinion, in light of the evidence in the claims file, as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected disorders, including residuals of a left leg gunshot wound, singly or with some other condition were the immediate or an underlying cause of death, or contributed substantially or materially to the Veteran's death. The contentions that atrophy and weakness associated with the residuals of a gunshot wound of the left leg caused a fall resulting in a fracture of the left hip and that complications of such fracture led to the Veteran's death should be addressed. 3. Review the examination report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AMC must implement corrective procedures. Stegall v. West, 11 Vet. App. 268, 271 (1998). 4. After completing the above action, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim must be readjudicated. If the claim remains denied, a supplemental statement of the case must be provided to the appellant and her representative. After the appellant and her representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ WAYNE M. BRAEUER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).