Citation Nr: 18143973 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 15-19 862 DATE: October 22, 2018 ORDER Entitlement to service connection for the cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died on December [redacted], 2013; the death certificate lists cardiac arrest as the immediate cause of death. 2. The Veteran’s service connected coronary artery disease (CAD) is not the principal or contributory cause of his death. CONCLUSION OF LAW The criteria for entitlement to service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1110, 1111, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Air Force from March 1969 to March 1973. In June 2018, the appellant testified at a Board hearing. The transcript is of record. 1. Service Connection for Cause of Death Compensation may be awarded for the cause of a veteran's death where the evidence shows that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(a). To constitute the principal cause of death the service-connected disability must be one of the immediate or underlying causes of death or be etiologically related to the cause of death. 38 C.F.R. § 3.312(b). In the case of contributory cause of death, it must be shown that a service-connected disability contributed substantially or materially to cause death. 38 C.F.R. § 3.312(c)(1). Service connection for the cause of a veteran's death may be demonstrated by showing that the veteran's death was caused by a disability for which service connection had been established at the time of death or for which service connection should have been established. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. See 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). A service-connected disability will be considered as the contributory cause of death when that disability contributed substantially or materially to death, combined to cause death, or aided assistance to the production of death. 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. Service-connected diseases involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, with debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. 38 C.F.R. § 3.312(c). To be a contributory cause of death, it must be shown that there were “debilitating effects” due to a service-connected disability that made the veteran “materially less capable” of resisting the effects of the fatal disease or that a service-connected disability had “material influence in accelerating death,” thereby contributing substantially or materially to the cause of death. Lathan v. Brown, 7 Vet. App. 359 (1995); 38 C.F.R. § 3.312(c)(1). The Board expresses great sympathy for the appellant's loss; however, a review of the evidence establishes that service connection for the cause of the Veteran's death is not warranted. The procedural history prior to the Veteran’s death establishes that, in June 2012, the Veteran attended a VA examination and the examiner noted a diagnosis of CAD and/or ischemic heart disease (IHD) as of 2009 and a diagnosis of atrial fibrillation as of 2011. An interview based METs test was conducted and the examiner concluded the Veteran had dyspnea at greater than five but less than seven METs. Based on this examination and available medical records, the April 2013 rating decision granted service connection for CAD at a 30 percent rating effective October 2010. In June 2013, the Veteran filed a claim for an increased rating. In September 2013, the Veteran underwent a VA examination via telephone interview with an examiner, who also reviewed the evidence of record. The examiner concluded that the Veteran did not have IHD and opined that it was less likely than not that the Veteran had CAD based on his heart catherization in June 2008 showing non-occlusive coronary arteries and his nuclear cardiology study from June 2012 that yielded normal results. The examiner noted that there is no relation between atrial fibrillation or left ventricular hypertrophy and CAD. Based on the findings that it was less likely than not that the Veteran had CAD, the October 2013 rating decision proposed to decrease the Veteran’s rating to zero percent. Review of the private treatment records establish that the Veteran had ischemic changes and mild non-occlusive multi-vessel coronary artery disease as well as a history of atrial fibrillation that required frequent treatment. Most notably, the private treatment records contain a disability benefits questionnaire (DBQ) dated February 2012 provided by the Veteran’s cardiologist stating that the Veteran did not have a diagnosis of IHD. The DBQ referenced the Veteran’s June 2008 heart catherization and reported a LVEF of greater than 50 percent. Upon the Veteran’s death in December 2013, the appellant filed a claim alleging that the Veteran’s death from cardiac arrest is related to his service connected coronary artery disease. In April 2015, a VA opinion was sought regarding service connection for cause of death. The examiner reviewed the available records and opined “with a very high degree of medical certainty that it is less likely as not that the Veteran warranted a diagnosis of an ischemic heart disease.” The examiner noted that the medical evidence does not prove the presence of CAD and cited to private treatment records noting ischemic changes and mild non-occlusive multi-vessel coronary artery disease on the June 2008 cardiac catherization. The examiner reported that the echocardiogram and nuclear stress tests did not provide any evidence that the Veteran suffered from a clinically significant CAD condition. See C&P Examination April 2015. While the record indicates that the Veteran had difficulties related to his heart, the evidence is insufficient to establish that the Veteran had a diagnosis of CAD prior to death. The Board finds the opinions of the September 2013 and April 2015 VA examiners persuasive, as they reviewed the Veteran’s medical history, cited to the medical evidence of record, and provided a well-reasoned rationale to support the finding that the evidence does not establish a diagnosis of CAD and/or IHD. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Furthermore, the Board notes the opinions of the VA examiners are consistent with the DBQ provided by the Veteran’s cardiologist also finding that the Veteran did not have a diagnosis of IHD. The Board has considered the appellant’s testimony regarding the Veteran’s symptoms and her opinion that his death is the result of CAD. While the appellant is credible to describe the observable symptoms from which the Veteran suffered, determining the exact nature and diagnosis of CAD requires medical knowledge and training and specialized testing which the appellant is not shown to have. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Board places more weight on the opinions and findings of the Veteran’s cardiologist and the September 2013 and April 2015 VA examiners. As the evidence establishes that the Veteran did not have a diagnosis of CAD or IHD prior to his death, the Board finds the preponderance of the evidence is against finding that CAD is the principal or contributory cause of the Veteran’s death. As such, service connection for cause of death is not warranted. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. A. Prinsen, Associate Counsel