Citation Nr: 18142921 Decision Date: 10/17/18 Archive Date: 10/17/18 DOCKET NO. 10-13 544 DATE: October 17, 2018 ORDER Entitlement to service connection for the cause of the Veteran's death is denied. FINDING OF FACT 1. During his lifetime, the Veteran was service-connected for bilateral hearing loss, rated as zero percent disabling. Service connection was not in effect for any other disability. 2. The Veteran died in July 2004. The cause of his death was suicide by firearm. 3. A service-connected disability did not cause or contribute materially or substantially to the Veteran’s death, combine with another disorder to cause his death, or aid or lend assistance to his death. CONCLUSION OF LAW The requirements for service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. § 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1963 to July 1967. He died in July 2004. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in May 2009. The appellant provided testimony at RO hearings in July 2010 and October 2010. A second hearing was conducted because recording equipment was not functioning properly at the July 2010 hearing. A transcript of the October 2010 hearing is associated with the claims file. In March 2015, the Board remanded the matter for additional evidentiary development. Following the completion of that evidentiary development, the VA Appeals Management Center continued the previous denial in an August 2018 supplemental statement of the case (SSOC). The claims file has been returned to the Board for further appellate proceedings. Dependency and Indemnity Compensation (DIC) Dependency and indemnity compensation (DIC) is awarded to a veteran’s surviving spouse for death resulting from a service-connected disability. 38 U.S.C. § 1310. To establish service connection for the cause of the veteran’s death, the evidence must show that disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. A service-connected disability will be considered as the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312(b). A contributory cause of death is inherently one not related to the principal cause. 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 causally shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). “It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran.” Gilbert, 1 Vet. App. at 54. Entitlement to service connection for the cause of the Veteran's death The appellant contends that the Veteran took his own life because he was struggling with the consequences of alcoholism and depression which had been caused by his service in Vietnam. It is undisputed that the cause of the Veteran’s July 2004 death was suicide. The certificate of death indicates that the Veteran died as a direct result of a self-inflicted gunshot wound to the head and that his death was determined to be a suicide. At the time of his death, service-connection was in effect for bilateral hearing loss rated as zero percent disabling. The Veteran filed no other claims for service connection during his lifetime. The Veteran’s service personnel records show that he participated in the 1966 Western Pacific cruise of the U.S.S. Yorktown which included 56 days of operations in the South China Sea and the Tonkin Gulf. He received the Vietnam Service Medal and the Republic of Vietnam Campaign Medal. The Veteran’s service treatment records are negative for complaints or findings of a psychiatric disability. He underwent an aircrew candidate examination in November 1965, at which psychiatric evaluation was normal. In April 1967, he underwent a physical and was found to be fit for continued duty involving flying as a crewmember. At his July 1967 military separation medical examination, psychiatric evaluation was normal. The post-service record on appeal shows that in April 1989, the appellant submitted an application for VA compensation benefits seeking service connection for hearing loss. His application is silent for any mention of a psychiatric disability, as is the clinical evidence assembled in support of his claim. Following the Veteran’s death in July 2004, the appellant submitted a claim of entitlement to Dependency and Indemnity Compensation as the Veteran’s surviving spouse. She indicated that she had known the Veteran since high school. After his return from Vietnam, he became quiet, a loner, and drank a lot. She indicated that it was her belief that the Veteran had a service-connected disability for which he had never filed a claim. In support of her claim, the appellant submitted private clinical records showing that while receiving treatment at a private medical facility from February 2004 to April 2004 for alcoholism, the Veteran reported that he had been a daily drinker for over 10 years. He did not blame his drinking on external events or persons, and was willing and motivated to give up using lifestyle and friends and obtain a sober support system to assist with immediate recovery. He was diagnosed as having alcoholism and symptoms of “depression (NOS) as a result of behavior related to his chemical use.” Another private medical facility assessed the Veteran in February 2004 with “chemical dependence to alcohol” and “possible depression, substance induced versus endogenous.” In March 2004, the facility noted that the Veteran had continuous alcohol dependence and rule out depressive disorder not otherwise specified. It also noted that the Veteran “is seeking treatment services regarding his alcohol dependency.” The appellant also submitted excerpts from an October 2004 private examination report in which an orthopedic surgeon noted that the appellant was in the grieving process following the Veteran’s death from a self-inflicted gunshot wound. The clinician noted that the Veteran had been “struggling with his end-of-life medical problems, hemorrhaging profusely from an upper GI bleed that could not be controlled by medical management, as a result of alcoholism and depression as a direct consequence of the life-changing event in the Vietnam War.” The appellant and others have submitted lay observations of the Veteran’s alcohol misuse and its effect on his family, friends, and occupation. Observations include accounts of the Veteran’s heavy drinking after service, stress during service caused by flying combat missions, and possible incident of physical abuse during service. The appellant described the Veteran having dreams of his experiences in service in which he would toss and turn and scream. She also described periods of violence in which he would abuse her, break furniture and kick the television. The appellant recalled the Veteran being hypervigilant. A fellow service member indicated that the Veteran had nightmares of being shot down while flying in reconnaissance aircrafts, although he had never been in an aircraft that was shot down. In an October 2007 letter, V. Gupta, M.D., a private physician who had treated both the Veteran and the appellant for many years for a variety of ailments opined that “it is quite possible that his alcoholism was a result of his service in the military.” In connection with the appellant’s claim, the RO solicited a medical opinion. In July 2018, a VA clinician reviewed the record on appeal in great detail, including lay testimony of record. After conducting the review, the clinician opined that it was less likely than not that the Veteran had a psychiatric disability that began during or was related to his active service. The clinician noted that the Veteran’s service treatment records showed that a psychiatric disability had not been present in service. In addition, the post-service treatment records showed that the Veteran did not describe PTSD symptoms in clinical settings, nor were they noted by any treatment provider. The clinician noted that he only symptoms of note appear to have been tied to alcohol dependence and that the depressive symptoms were highly likely secondary to the alcohol dependence or substance-induced. The clinician explained that the Veteran’s alcohol use appeared to be primarily recreational and that it was “alcohol misuse in combination with the Veteran having difficulties coping with the stress of ongoing medical problems” that contributed to his death. The clinician explained that alcohol use disorder did not have to be an indicator of another underlying mental illness and that it was often the primary presenting problem. The clinician found no probative evidence suggesting that alcohol misuse and substance induced depressive symptoms, and resulting suicide, were the result of military service or any service-connected mental disorder. The clinician considered the opinion of the appellant’s orthopedic surgeon, but noted that the nature and etiology of the Veteran’s psychiatric disability was outside both the orthopedic surgeon’s expertise and his personal experience, as he had not treated the Veteran. Upon weighing the evidence of record, the Board finds that the preponderance of the evidence is against the award of service connection for the cause of the Veteran’s death. The Board has considered the opinion from Dr. Gupta to the effect that ailments opined that “it is quite possible” that the Veteran’s “alcoholism was a result of his service in the military.” However, the Board assigns this opinion limited probative weight, given its speculative nature and lack of rationale. Medical opinions that are inconclusive in nature do not provide a sufficient basis upon which to support a claim. See e.g. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006) (finding doctor’s opinion that it is possible and it is within the realm of medical possibility too speculative to establish medical nexus); Goss v. Brown, 9 Vet. App. 109, 114 (1996) (using the words could not rule out was too speculative to establish medical nexus); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992) (holding that a physician’s statement that a service-connected disorder may or may not have prevented medical personnel from averting a Veteran’s death was not sufficient). Similarly, the opinion of the appellant’s orthopedic surgeon does not provide a basis upon which to grant the claim. It does not appear that the physician was fully informed of the pertinent factual premises, as there is no indication that the physician ever examined or treated the Veteran or had access to his medical records. More importantly, the opinion was not supported by a rationale or reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. On the other hand, the July 2018 VA opinion includes a detailed rationale. The opinion was based on a full review of the lay and clinical evidence of record, as well as the clinician’s expertise as a clinical psychologist. This July 2018 VA examiner’s opinion is also supported by the Veteran’s own statements. Months before his death, when checking into a private treatment center, the Veteran admitted to his drinking problem but denied that it was caused by any external problems or persons. The credibility of this admission is enhanced by the Veteran’s contemporaneous statements such as his self-assessments that show the Veteran’s ability to evaluate his situation. He also admitted that his “peer group and leisure activities are based around chemical use,” supporting the July 2018 VA examiner’s opinion that the Veteran’s alcohol dependence was more recreational than related to his service. During his treatment, the Veteran also did not mention his military service, although he discussed other problems such as lack of education regarding addiction, medical problems, impact of use, attempts to quit, and depression. The Board has carefully considered the appellant’s contentions to the effect that his death was the result of alcoholism or a psychiatric disability related to his Vietnam service. Such an opinion, however, involves medical inquiry into psychological processes and functioning. Such internal processes are not readily observable and thus the opinion is not within the competence of the appellant or other lay persons. Questions of competency notwithstanding, the Board finds the July 2018 VA opinion to be of greater probative weight than the lay assertions as to the etiology of the Veteran’s alcohol dependency and death.   Although the Board recognizes the Veteran’s honorable service on behalf of this country and is deeply sympathetic to the appellant’s loss of her husband, in light of the evidence discussed above, the preponderance of the evidence is against the claim of service connection for the cause of the Veteran’s death. As the evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53–56 (1990). K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yun, Associate Counsel