Citation Nr: 18143621 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-32 804 DATE: October 19, 2018 ORDER Entitlement to service connection for the cause of the Veteran’s death is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, the Veteran’s service-connected disabilities contributed materially to the cause of death. CONCLUSION OF LAW The criteria for entitlement to service connection for the Veteran’s cause of death have been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from January 1943 to January 1946, and served in World War II. The Veteran died in December 2014, and the Appellant is the surviving spouse. Entitlement to service connection for the cause of the Veteran's death The Appellant contends that the Veteran’s death was due to his service-connected disabilities of the bilateral feet. Legal Criteria 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 of 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). 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). Analysis The Veteran died on December [redacted], 2014. The Death Certificate identified the Veteran’s cause of death as small bowel obstruction and congestive heart failure. At the time of his death, the Veteran had already been found entitled to service-connection for residuals of cold injury to the right and left foot, which the Veteran sustained during the Battle of the Bulge in December 1944. The Veteran had also been found entitled to a total disability rating due to individual employability based on his service-connected disabilities. In July 2015, the Board received an undated letter from the Veteran’s private treating physician. Based on his many years of treatment for the Veteran, and after consideration of the medical record, the treating physician opined that it was as likely as not that the Veteran’s service-connected severe cold weather injury to both of his feet and the chronic stress it has caused to his cardiovascular system was a contributing factor in his death, due in part to congestive heart failure. In September 2016, a VA medical examiner reviewed the Veteran’s medical history and opined that his service-connected disabilities did not cause or contribute to the cause of the Veteran’s death. The examiner cited hospice treatment records, which showed causes of death including small bowel obstruction, congestive heart failure, coronary artery disease, anemia of chronic renal insufficiency, and chronic renal insufficiency. The examiner noted that the Veteran had a normal ejection fraction on echocardiogram and normal radial and pedal peripheral pulses. The VA examiner concluded that the bilateral foot condition was not a cause of death because there is evidence that the cold injury to the feet was not so severe as to obliterate the pedal pulses. The medical opinions of record are contradictory on the issue of whether the Veteran’s cold weather injury to the bilateral feet condition contributed to the cause of death. Here, both the VA examiner’s and the private treating physician’s opinions are competent and credible, and the Board will not assign greater probative weight to either. While the VA examiner cited to the Veteran’s medical history to support his medical opinion, the VA examiner never had an opportunity to personally examine the Veteran before his death. The private treating physician did not discuss the Veteran’s medical history, but had a longitudinal treatment relationship with the Veteran before his death. Therefore, the Board finds that the contrary opinions are at least in equipoise. In light of the above, the Board concludes that there is an approximate balance of positive and negative evidence regarding the claim of service connection for cause of death. Accordingly, the Board will resolve the benefit of the doubt in favor of the Veteran in this case as the law requires and grant service connection for the cause of the Veteran’s death. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 55 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Casey, Associate Counsel