Citation Nr: 18145422 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 13-25 006 DATE: October 29, 2018 ORDER Entitlement to service connection for cause of death is granted. FINDING OF FACT The Veteran died in September 2012; the death certificate lists the cause of death as end stage chronic obstructive pulmonary disease (COPD) and cirrhosis of the liver as the leading cause of death. CONCLUSION OF LAW The criteria for service connection for the Veteran's cause of death have been met. 38 U.S.C. §§ 1110, 1310, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1965 to October 1968. The Veteran died in September 2012. The appellant is the Veteran's widow. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision of the Department of Veterans Affairs (VA) Pension Center in Milwaukee, Wisconsin. The Agency of Original Jurisdiction (AOJ) for this matter is the Regional Office (RO) in New Orleans, Louisiana. In May 2015, the Board denied the claim. The Appellant appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In May 2016, the Court granted a Joint Motion for Remand (JMR) that vacated the Board's May 2015 decision and remanded the case for further development and consideration. Subsequently, in August 2016 the Board remanded the issue for further development. With respect to the Veteran's claim decided herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). Entitlement to service connection for cause of death The appellant contends that the Veteran's death is related to his military service. The death of a Veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. See 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (a). For a service-connected disability to be considered the primary cause of death, it must singly, or with some other condition, be the immediate or underlying cause, or be etiologically related thereto. 38 C.F.R. § 3.312 (b). 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, or that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312 (c)(1). Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting 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. Where the service-connected condition affects vital organs as distinguished from muscular or skeletal functions and is evaluated as 100 percent disabling, debilitation may be assumed. 38 C.F.R. § 3.312 (c)(3). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). The appellant asserts that the Veteran's cirrhosis of the liver and COPD was related to his service-connected PTSD. The question for the Board is whether the evidence establishes that the Veteran's COPD and/or cirrhosis were related/secondary to his service-connected PTSD. The Board finds that competent, credible, and probative evidence establishes that the Veteran's cirrhosis was secondary to his service-connected PTSD. The Veteran died in September 2012, and his death certificate indicates that the immediate cause of death was COPD and cirrhosis of the liver as a leading cause of death. The Veteran's death certificate does not note any condition or disease leading or contributing to his immediate cause of death. At the time of the Veteran's death, he was not service-connected for COPD or cirrhosis. In an August 12, 2018 VA medical opinion, the VA psychologist opined that the Veteran’s alcohol and tobacco use was as least as likely as not caused by or exacerbated by his PTSD. The examiner explained that professional literature clearly and unequivocally established a higher abuse of substances including alcohol and tobacco in subjects with PTSD as compared to the general public. The examiner further noted that medical records establish the Veteran’s cirrhosis was caused by his alcohol use. However, the examiner explained that an opinion regarding the cause of the Veteran’s COPD is beyond the scope of his practice. In August 2012-prior to the Veteran's death-he was assessed as having "etoh liver disease" and alcohol abuse. A sonogram revealed a possible liver disorder and the Veteran was subsequently diagnosed as having advanced liver cirrhosis. See August 2012 VA medical record. The Veteran's ex-wife-who was married to the Veteran during his military service and for many years after, testified in writing that the Veteran drank heavily after he returned from service. See September 2011 Statement. The Appellant testified that the Veteran had a long history of alcohol abuse and "apparent dependency." See August 2013 Statement of the Case (SOC) and February 2014 Statement of Accredited Representative (noting a history of and diagnosis for alcohol abuse). The Board finds the evidence is at least in equipoise that the Veteran's alcohol abuse which resulted in cirrhosis of the liver was secondary to his service-connected PTSD. Thus, the evidence establishes the Veteran's cirrhosis of the liver, for which was the leading cause of his death, was secondary to his service-connected PTSD. Giving the appellant the benefit of the doubt, the Board finds that the evidence is at least in equipoise as to whether the Veteran's cirrhosis of the liver was secondary   to his service-connected PTSD and was the principal cause of his death. Accordingly, service connection for the cause of death of the Veteran is granted. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Brandon A. Williams, Counsel