Citation Nr: 18139531 Decision Date: 10/01/18 Archive Date: 09/28/18 DOCKET NO. 13-31 814 DATE: October 1, 2018 REMANDED The appeal for service connection for the cause of the Veteran's death is remanded. REFFERRED MATTERS As an initial matter, the Board notes that in the month prior to his death, the Veteran filed service-connection claims for chronic polyps, prostate disorder, hypertension, sleep apnea, pulmonary embolism, stomach cancer, soft tissue sarcoma on the right leg, erectile dysfunction, shrapnel in the right leg, heart disease, tumor from intestines, rhinitis, spreading cancers, and hypertrophy of nasal turbinates, as well as an increased rating claim for posttraumatic stress disorder (PTSD), and a claim for special monthly compensation based on a need for aid and attendance. After the Veteran’s death, the Appellant filed a claim with the Agency of Original Jurisdiction (AOJ) for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits. In an April 2012 letter, the AOJ informed the Appellant that additional information with respect to her marital history and finances was necessary to adjudicate her death pension and accrued benefits claim. The Appellant did not respond, and in a letter dated May 11, 2012, the AOJ informed the Appellant that, in addition to her cause of death claim (which has been perfected and is presently before the Board), her claims for death pension and accrued benefits were denied for failure to provide the requested information. The letter indicated that she had until February 2013 to make sure she submitted the information and evidence requested of her. In June 2012, the Appellant submitted copies of divorce decrees and marriage licenses for the AOJ’s consideration, as well as a clarifying remark regarding her finances, as requested by the AOJ in its prior April 2012 letter. To date, it does not appear that the AOJ has taken further action on the accrued benefits claim or death pension claim, to include making any preliminary determinations as to substitution. Accordingly, the matters are referred to the AOJ for appropriate action. REASONS FOR REMAND The Veteran served on active duty from June 1965 to June 1967 and was awarded two Purple Hearts, among other citations, for his service. The Veteran died in December 2011 and the Appellant is his widow. Service connection for the cause of the Veteran's death. The Veteran died in December 2011. His death certificate listed the immediate cause of death as metastatic pancreatic cancer with contributing conditions of cerebrovascular accident, hypertension, and deep vein thrombosis (DVT). At the time of his death, the Veteran was service-connected for posttraumatic stress disorder (PTSD) and, as noted above, had claims pending for service connection for other disorders including hypertension. In pertinent part, the Appellant asserts that the Veteran’s service-connected PTSD led to his hypertension, which then contributed to his death. The Appellant also asserts that the Veteran had other disabilities, including soft tissue sarcoma, due to herbicide exposure that caused or substantially contributed to his death. See June 2012 notice of disagreement. In September 2016, the AOJ obtained a VA opinion to address the possibility of a relationship between the Veteran’s service-connected PTSD and death. The examiner issued an unfavorable opinion. In a February 2017 Informal Hearing Presentation, the Appellant’s representative argued that the September 2016 VA opinion was inadequate in that it relied on the assumption that there was no comorbidity between PTSD and other impacts on health. The representative cited an article in World Psychiatry regarding a nexus between PTSD and the development of hypertension. The representative also cited other articles indicating a relationship between PTSD and heart failure or cardiovascular disease. Although the representative provided citations for the articles discussed, the representative did not provide actual copies of the articles/studies mentioned. In February 2018, the Board sought an opinion from the Veterans Health Administration (VHA). The VHA physician addressed most of the Appellant’s theories; however, the VHA physician was not able to fully address the Appellant’s theory with respect to the connection between PTSD and hypertension, and the Veteran’s death. The VHA physician reported that she had been unable to access the medical treatise evidence cited by the Appellant’s representative and thus, was unable to comment on the same. In a July 2018 Appellant’s Brief, the Appellant’s representative pointed out the fact that he VHA physician could not review the treatise evidence, and contended that the opinion was inadequate. On remand, the Appellant and her representative should be asked to provide copies of the medical journal articles and Internet treatise evidence that the Appellant desires to be considered in this case. The entire claims file should then be sent to a VA examiner for a medical opinion. The matter is REMANDED for the following action: 1. Ask the Appellant and her representative to submit copies of all medical journal articles and Internet treatise evidence cited in the February 2017 Informal Hearing Presentation, as well as any other evidence the Appellant desires to submit in support of the appeal. 2. After the Appellant submits the requested copies of the medical journal articles and Internet treatise evidence cited in February 2017, or any other evidence, seek a VA addendum opinion from a VA physician of appropriate expertise to address whether it is at least as likely as not that the Veteran’s service-connected PTSD caused or aggravated his hypertension, which contributed to his death. The reviewing physician should indicate review and consideration of the treatise evidence submitted by the Appellant. 3. Defer readjudication of the Appellant’s cause of death claim until all appropriate action is completed with respect to the Appellant’s accrued benefits claim, referred above. ‘ (Continued on Next Page) 4. If the Appellant’s cause of death claim remains denied, issue the Appellant and her representative a supplemental statement of the case. An appropriate period should be allowed for response. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Donna D. Ebaugh, Counsel