Citation Nr: 18142280 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 09-24 158 DATE: October 15, 2018 ORDER Service connection for the cause of the Veteran’s death is granted. FINDINGS OF FACT 1. The Veteran died in March 2008; the immediate cause of his death was gunshot wound to the head. 2. At the time of the Veteran’s death, service connection was in effect for microvascular coronary disease with hypertension; hypertension; right carotid stenosis associated with microvasculature coronary disease with hypertension; hiatal hernia with peptic ulcer; residual fracture of left elbow; chronic sinusitis with headaches; and facial scar on left nose. 3. The Veteran’s service-connected cardiovascular disorders, to include medication therefore, were contributory causes of his death. CONCLUSION OF LAW Resolving reasonable doubt in the appellant’s favor, the criteria for entitlement to service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 1110, 1131, 1310, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.312 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force from September 1952 to September 1974. He died in March 2008. The appellant is his surviving spouse. In September 2012 and May 2014, the case was remanded for additional evidentiary development and has been returned to the Board for further appellate review. Entitlement to service connection for the cause of the Veteran’s death The appellant asserts that service connection is warranted for the Veteran’s death because of a service-related psychiatric disability. Alternatively, she asserts that the medications prescribed for the service-connected cardiovascular disorders caused or aggravated a psychiatric disability and contributed to his death. In order 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 or a contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(a). In order to constitute the principal cause of death, the service-connected disability must be, singly or jointly with some other condition, the immediate or underlying cause of death or be etiologically related thereto. 38 C.F.R. § 3.312(b). In order for the service-connected disability to be a contributory cause of 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. 38 C.F.R. § 3.312(c)(1). The Veteran’s death certificate shows that he died in March 2008. The immediate cause of death was gunshot wound to the head (a probable suicide). At the time of his death, service connection was established for microvascular coronary disease with hypertension; hypertension; right carotid stenosis associated with microvasculature coronary disease with hypertension; hiatal hernia with peptic ulcer; residual fracture of left elbow; chronic sinusitis with headaches; and facial scar on left nose. The Board notes that he was not service connected for any of the following diagnosed psychiatric disabilities raised during his lifetime: major depressive disorder (MDD), obsessive compulsive disorder (OCD), and bipolar disorder. In an August 2009 statement, Dr. N., in part, noted that “[v]arious medications, along with heart problems, carotid disease and hypertension, more likely than not, caused him to become depressed and mentally unsound and could have contributed to his suicide.” The Board finds this August 2009 statement is speculative as to a link between the Veteran’s service-connected cardiovascular disorders and his death. Medical evidence that is speculative, general, or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30, 33 (1993); see Warren v. Brown, 6 Vet. App. 4, 6 (1993). Pursuant to the appellant’s claim on appeal, a VA examiner provided an opinion in September 2014 and two Veterans Health Administration (VHA) medical experts provided opinions in April 2018. These opinions included discussions addressing a link between the Veteran’s service-connected cardiovascular disorders and his death. In a September 2014 VA medical opinion, the examiner explained why the Veteran’s service-connected heart disabilities, to include medications taken therefore, neither caused the Veteran’s death or contributed substantially or materially to his death. In April 2018, Dr. A. C. also explained why it is less likely as not that any of the service-connected cardiovascular disorders, to include medication therefore, caused the Veteran’s death or substantially or materially to his death. On the other hand, in April 2018 Dr. R. A. explained why it is in the realm of possibility that the Veteran’s service-connected cardiovascular disorders, to include medication therefore (hypertension, microvascular coronary disease with hypertension, and right carotid stenosis) contributed substantially or materially to the Veteran’s death through aggravation of his psychiatric condition. The Board finds the September 2014 and April 2018 medical opinions, specifically regarding a link between the Veteran’s service-connected cardiovascular disorders and his death, were provided by VA and VHA medical experts who relied on accurate facts and medical history and gave fully articulated opinions supported by sound reasoning. Resolving reasonable doubt in favor of the appellant, the Board finds that the Veteran’s service-connected cardiovascular disorders, to include medication therefore (microvascular coronary disease with hypertension, hypertension, and right carotid stenosis) were contributory causes of his death. As a result, service connection for the cause of the Veteran’s death is warranted. See 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312(c). D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Carter, Counsel