Citation Nr: 18145757 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 13-08 035 DATE: October 30, 2018 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Entitlement to Parents' Dependency and Indemnity Compensation benefits on and after October 1, 2009 is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1978 to April 1979. The Veteran died in August 2008. The Appellant is his mother. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 administrative decision and a January 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded by the Board in March 2015 and June 2017. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in August 2013. A transcript of that hearing is of record. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The May 2016 VA medical opinion found that it is less likely as not that medication administered during a VA hospital stay for schizophrenia from June 2008 to August 2008 caused or contributed to the Veteran’s death. As rationale, the clinician noted that a detailed review of hospital records did not indicate that the medication administered to the Veteran during his VA hospital stay for schizophrenia caused or contributed to the Veteran’s death. According to an August 2008 autopsy report, the Veteran’s cause of death was cardiac arrhythmia. A September 2007 VA treatment note stated that the Veteran has intermittently been tachycardic, and found that the most likely etiology of the patient’s tachycardia is side effect of his current medications, specifically olanzapine and trihexyphenidyl. Tachycardia is a type of cardiac arrhythmia. See https://www.uptodate.com/contents/arrhythmia-management-for-the-primary-care-clinician (last visited October 24, 2018). Olanzapine and trihexyphenidyl are listed among the Veteran’s active medications in the September 2008 VA treatment record discussing the course of the Veteran’s treatment before his death, and they are also found among the Veteran’s gastric content in the August 2008 autopsy report. Although the Board sincerely regrets the additional delay, a remand is required to obtain a medical opinion that discusses the relevant September 2007 treatment note and whether the medications olanzapine and trihexyphenidyl were prescribed to treat the Veteran’s service-connected schizophrenia, and if so, whether it is at least as likely as not that they caused or contributed to the cardiac arrhythmia that was the cause of the Veteran’s death. 2. Entitlement to Parents' Dependency and Indemnity Compensation benefits on and after October 1, 2009 is remanded. Finally, because a decision on the remanded issue of entitlement to service connection for the cause of the Veteran’s death could significantly impact a decision on the issue of entitlement to Parents’ Dependency and Indemnity Compensation benefits on and after October 1, 2009, the issues are inextricably intertwined. A remand of the claim of entitlement to Parents’ Dependency and Indemnity Compensation benefits on and after October 1, 2009 is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician as to whether it is at least as likely as not (50 percent or greater probability) that any medication prescribed to the Veteran to treat his service-connected schizophrenia, including olanzapine or trihexyphenidyl, caused or contributed to the Veteran’s death due to cardiac arrhythmia? The clinician must respond to the September 2007 VA treatment note finding that the most likely etiology of the Veteran’s tachycardia was side effect of the medications olanzapine and trihexyphenidyl, and is asked to discuss whether, considering that these medications most likely caused one type of arrhythmia in September 2007, they at least as likely as not also caused the fatal cardiac arrhythmia in August 2008. The clinician is advised that both olanzapine and trihexyphenidyl are listed in the Veteran’s gastric content according to the August 2008 autopsy report. The opinion offered must be supported by a complete rationale. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to Parents’ Dependency and Indemnity Compensation benefits on and after October 1, 2009. If any benefit sought is not granted to the Veteran’s satisfaction, send the Appellant a   Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Budd, Counsel