Citation Nr: 18146727 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 10-22 491A DATE: November 1, 2018 ORDER Entitlement to service connection for the cause of the Veteran's death is denied. FINDING OF FACT 1. During his lifetime, the Veteran was service-connected for traumatic amputation of the index and middle finger tips of the right hand, and residuals of right distal fibula fracture, both rated as zero percent disabling. Service connection was not in effect for any other disability. 2. The cause of the Veteran’s death was acute coronary insufficiency. 3. A service-connected disability did not cause or contribute materially or substantially to the Veteran’s death, combine with another disorder to cause his death, or aid or lend assistance to his death. CONCLUSION OF LAW The requirements for service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. § 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1968 to January 1970, and from June 1973 to June 1979. He was subsequently a member of the Pennsylvania and South Carolina Army National Guard. He died in June 2008. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in August 2009. In September 2015, the Board remanded the matter for additional evidentiary development. Following the completion of that evidentiary development, the VA Appeals Management Center continued the previous denial in an August 2018 supplemental statement of the case (SSOC). The claims file has been returned to the Board for further appellate proceedings. 1. Entitlement to service connection for the cause of the Veteran's death The appellant contends that service connection for the cause of the Veteran’s death is warranted because the stress of parachute jumping on active duty caused the Veteran to develop diabetes which led to acute coronary insufficiency. She also contends that immunization with an infected air jet gun during active duty caused the Veteran to contract hepatitis, hypertension, and pancreatitis, which caused him to develop diabetes and acute coronary insufficiency. Factual background The Veteran’s June 2008 certificate of death indicates that he died as a direct result of acute coronary insufficiency. No other contributing causes were identified. At the time of the Veteran’s death, service-connection was in effect for the traumatic amputation of the index and middle finger tips of the right hand, and for the residuals of a right distal fibula fracture, both rated as zero percent disabling. The Veteran served on active duty from January 1968 to January 1970, and from June 1973 to June 1979. Service treatment records corresponding to the Veteran’s periods of active duty are negative for complaints or findings of a heart disability. Examinations conducted in January 1968, August 1969, November 1969, March 1970, July 1970, and May 1979 all showed that the Veteran’s heart and vascular systems were normal on those occasions, as were chest X-rays. Post active duty records include the Veteran’s enlistment examination in July 1981 for service in the Army National Guard. Again, at that time, examination of the heart and vascular system was normal. In April 1986, the Veteran reported that he was in good health and not on any medication, although he stated that he had a history of jaundice or hepatitis. In July 1986, the Veteran was diagnosed with pancreatitis. A July 1988 retention physical showed a history of removal of a pancreatic pseudocyst in 1986 and insulin dependence. In July 1988, the Veteran was found to be medically disqualified for retention in the South Carolina Army National Guard due to diabetes mellitus with insulin dependency. The Veteran was notified that his insulin dependency was “a condition for which the National Guard Bureau cannot waiver.” During his lifetime, the Veteran sought service connection for multiple disabilities, including diabetes mellitus and post-traumatic stress disorder (PTSD) but those claims were denied in a final 1989 rating decisions. In May 2017, a VA clinician reviewed the Veteran’s claims file for the purpose of providing a medical opinion regarding the cause of the Veteran’s death. The clinician indicated that based on a review of the record, there was no basis upon which to conclude that the cause of the Veteran’s death was related to his service-connected disabilities. Moreover, he indicated that he could find no evidence whatsoever that the Veteran developed diabetes mellitus secondary to the stress of parachute jumping, that he developed hepatitis, pancreatitis, or hypertension from air jet immunizations which produced either diabetes mellitus or acute coronary insufficiency. Analysis The cause of a Veteran’s death will be considered to be due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. 38 C.F.R. § 3.312(a). For a service-connected disability to be considered the principal or 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; that it aided or lent 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. 38 C.F.R. § 3.312(c)(1). Applicable law provides that service connection will be granted for disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Upon weighing the evidence of record, the Board finds that the preponderance of the evidence is against the award of service connection for the cause of the Veteran’s death. The appellant contends that service connection for the cause of the Veteran’s death is warranted because the stress of parachute jumping on active duty caused the Veteran to develop diabetes which led to acute coronary insufficiency. She also contends that immunization with an infected air jet gun during active duty caused the Veteran to contract hepatitis, hypertension, and pancreatitis, which caused him to develop diabetes and acute coronary insufficiency. As set forth above, however, the RO obtained a medical opinion in this case. After reviewing the record on appeal, including the documentation submitted by the appellant, the clinician concluded that there was no medical basis upon which to conclude that the Veteran’s death was in any way caused or otherwise related to his service-connected disabilities. In addition, the examiner indicated that there was no basis upon which to conclude that the Veteran’s death from acute coronary artery sufficiency was due to the stress of parachute jumping or an immunization with an infected air jet gun which caused hepatitis, pancreatitis, hypertension or diabetes. The Board finds the May 2017 VA opinion probative as it was based on a review of the entire record on appeal and pertains specifically to the Veteran’s cause of death. It also addresses the appellant’s contentions. The opinion is also consistent with the clinical evidence of record which shows that coronary artery insufficiency was not present during the Veteran’s active service. As discussed in detail above, the service treatment records show that the Veteran’s heart and vascular system were examined on multiple occasions during active duty and were repeatedly determined to be normal. The service treatment records further contain no notation of hepatitis, diabetes mellitus, or pancreatitis during active service. Indeed, the service treatment records reflect that laboratory testing was repeatedly normal. In addition, there is no competent evidence of record which contradicts the clinician’s conclusion or otherwise suggests that the Veteran’s fatal acute coronary artery insufficiency was incurred during active service or is otherwise causally related to active service. The Board has carefully considered the appellant’s contentions to the effect that his death was the result of service. Such an opinion, however, involves medical inquiry into physical processes and functioning. Such internal processes are not readily observable and thus the opinion is not within the competence of the appellant or other lay persons. Questions of competency notwithstanding, the Board finds the May 2017 VA examiner’s opinion to be of greater probative weight than the lay assertions as to the etiology of the Veteran’s hepatitis, diabetes mellitus, hypertension, pancreatitis and acute coronary insufficiency.   Although the Board recognizes the Veteran’s honorable service on behalf of this country and is deeply sympathetic to the appellant’s loss of her husband, in light of the evidence discussed above, the preponderance of the evidence is against the claim of service connection for the cause of the Veteran’s death. As the evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53–56 (1990). K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yun, Associate Counsel