Citation Nr: 18144830 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 14-38 143A DATE: October 25, 2018 ORDER Entitlement to service connection for cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died in February 2014, at the age of 89. The immediate cause of death was asystole due to ischemic cardiomyopathy and coronary artery disease (CAD). 2. At the time of the Veteran’s death, he was service-connected for bilateral hearing loss, posttraumatic stress disorder (PTSD), wound to left hip and thigh with injury to muscle groups, residual of shrapnel wound to left hand, residual of shrapnel wound to right inguinal region, and malaria; he was not service-connected for asystole, ischemic cardiomyopathy or CAD; and, there were no service connection claims pending at the time of his death. 3. A disability of service origin was not involved in the Veteran’s death. CONCLUSION OF LAW The criteria for service connection for cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1944 to June 1946. The Veteran died in February 2014. The Veteran’s surviving spouse is the appellant herein. The appellant seeks service connection for the cause of the Veteran’s death, claiming it was due to the Veteran’s service-connected disabilities. In an April 2014 rating decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied the appellant’s claim. The matter is now before the Board for appellate review. Duty to notify and assist The appellant has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA medical opinions obtained in October 2014. The appellant has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the appellant is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). 1. Entitlement to service connection for cause of the Veteran’s death In order to establish service connection for the cause of a Veteran’s death, the evidence must show that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 C.F.R. § 3.312(a). In order 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). A contributory cause of death is inherently not one related to the principal cause. In order to constitute the contributory cause of death, it must be shown that the service-connected disability contributed substantially or materially; that it combined to cause death; or that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c)(1). In determining whether the disability that resulted in the death of the Veteran was the result of active service, the standards and criteria applicable to service connection claims generally are to be applied. See 38 U.S.C. §§ 1110, 1131, 1310(a). Generally, service connection will be granted if there is competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Here, the appellant claims the Veteran’s death was due to his service-connected disabilities. More specifically, the appellant argues that the Veteran died from heart problems brought on by his PTSD. The Veteran died in April 2015 at the age of 89. The Veteran’s death certificate states the cause of death was asystole due to ischemic cardiomyopathy and CAD. The Veteran was not service-connected for asystole, ischemic cardiomyopathy or CAD. The disabilities that the Veteran was service connected for were bilateral hearing loss, PTSD, wound to left hip and thigh with injury to muscle groups, residual of shrapnel wound to left hand, residual of shrapnel wound to right inguinal region, and malaria. The Veteran did not have any service connection claims pending at the time of his death. In fact, the last rating decision of record prior to the Veteran’s death is an August 2010 rating decision that denied service connection for prostate cancer, diabetes, and skin cancer; granted entitlement to individual unemployability; and, granted eligibility for Dependents’ Educational Assistance. No Notice of Disagreement was noted with regard to the August 2010 rating decision. Service treatment records are associated with the Veteran’s claims file. These records are silent as to any complaint, diagnosis, or treatment for asystole, ischemic cardiomyopathy, CAD, or any other heart disease. After careful review of the medical records, the Board notes that the only diagnoses noted in service were related to shrapnel wounds and malaria. A July 1945 record reflects that the Veteran had an operation to remove metallic foreign body and close wounds of the left thigh, and that he also had a diagnosis of malaria. An October 1945 record reflects the Veteran was treated for shrapnel wounds to left hand, left thigh, and right inguinal region. Post service treatment records from Pulmonary Consultants are also associated with the file. A November 2005 record reflects the Veteran’s current problems included CAD. A November 2006 record reflects the Veteran was seen in follow up for status post coronary artery graft. However, none of these records provide a nexus opinion to the Veteran’s military service. VA obtained a medical opinion in October 2014 to ascertain whether there was a nexus between the Veteran’s cause of death and his service-connected disabilities. The examiner opined that it is less likely than not the Veteran’s service-connected conditions contributed substantially or materially to his death. As rationale, the examiner stated that current medical research does not recognize PTSD, hearing loss, malaria, thigh/hip wounds, or residuals of shrapnel wounds to the right inguinal region and left hand as causes of CAD or ischemic cardiomyopathy. Another VA medical opinion was obtained from a psychologist in October 2014 to ascertain whether there was a nexus between the Veteran’s cause of death and PTSD, as the appellant contends. The examiner opined that it is less likely than not the Veteran’s PTSD substantially contributed to his death. As rationale, this examiner stated that based on a review of the claims file, no medical records were found to establish a causal relationship between PTSD and the stated causes of death. Further, she noted that although medical literature indicates an “increased risk of PTSD and heart conditions,” there is no established causal link between the disorders. That is, despite the noted increased correlation between the two disorders, medical research does not account for additional variables that may lead to the shared development of these disorders or predispose an individual to both PTSD and heart conditions. The examiner thus concluded that it is less likely as not that the Veteran’s service-connected PTSD contributed to his death. Upon consideration of the evidence, the Board finds that the preponderance of the evidence is against the claim for service connection for the cause of the Veteran’s death. The Board concludes that there is simply no competent evidence relating the Veteran’s fatal asystole, ischemic cardiomyopathy, or CAD to service, or to any service-connected disability, to include PTSD. The Board has considered the lay evidence in this case, to include the appellant’s lay statements that the Veteran’s death was due to his service-connected PTSD. The Board notes that the appellant is competent to testify to observable lay evidence. However, she is not competent to testify to whether there is a nexus between the Veteran’s service-connected PTSD and his cause of death, as this would be a medical determination. There is simply no competent medical evidence of record that links the Veteran’s asystole, ischemic cardiomyopathy, or CAD with any service-connected disability, to include PTSD, or with his active service. Therefore, the Board finds that the claim fails to meet the criteria for service connection for the cause of the Veteran’s death. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the preponderance of the evidence is against the appellant’s claim for service connection for the cause of the Veteran’s death. In sum, there is nothing of record, other than the appellant’s contentions, to support a conclusion that the Veteran’s asystole, ischemic cardiomyopathy, or CAD was attributable to military service, or to any service-connected disability. For all the foregoing reasons, the claim of service connection for the cause of the Veteran’s death must be denied. The Board has considered the benefit of the doubt doctrine, but as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 55-57. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jiggetts, Associate Counsel