Citation Nr: 18146966 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 15-00 475A DATE: November 2, 2018 REMANDED Entitlement to service connection for the Veteran’s cause of death is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from April 1980 to June 1992. He passed away in December 1994. An amended death certificate dated February 1997 lists cardiac arrhythmia due to cardiomyopathy as the cause of death. The Appellant, his spouse, seeks survivor benefits. Specifically, she contends that the Veteran incurred posttraumatic stress disorder (PTSD) as the result of his service, which subsequently caused his terminal heart failure. Accordingly, she seeks entitlement to service connection for his cause of death. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Appellant submitted a notice of disagreement in June 2014. A statement of the case (SOC) was issued in December 2014. The Appellant perfected a timely substantive appeal via VA Form 9 in January 2015. Unappealed August 1995, October 1995, and April 1997 rating decisions denied service connection for the Veteran’s cause of death. Generally, once an issue is finally denied, it may be reopened only upon the submission of new and material evidence. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156, 20.1103 (2017). After the earlier rating decisions, however, relevant official service department records that existed but had not been associated with the claims file were received. Specifically, the Appellant submitted a Certificate of Achievement awarded to the Veteran during Operation Desert Storm by the Second Armored Cavalry Regiment for carrying out his mission in the face of inhospitable weather, logistical difficulties, and enemy action. Eleven pages of his military personnel record were also associated with the claims file in May 2016, reflecting four months of overseas service in Saudi Arabia. These service records, which existed but had not been obtained at the time of the prior rating decisions, are relevant to the Appellant’s cause of death claim. Specifically, the October 1995 rating decision denied the claim in part because the evidence was inadequate to establish that a stressful experience occurred sufficient to cause PTSD. The April 1997 rating decision did not discuss PTSD, but relied on the lack of a nexus between the Veteran’s heart conditions and his service to deny the claim. Accordingly, the claim is for reconsideration. See 38 C.F.R. § 3.156(c)(1). 1. Entitlement to service connection for the Veteran's cause of death is remanded. The Appellant contends that the Veteran experienced PTSD as a result of his service, culminating in stress upon his heart causing his death. The record, as discussed above, contains evidence that the Veteran was exposed to combat while serving in Saudi Arabia during Operation Desert Storm. There is no evidence or allegation that he engaged directly in combat with the enemy. However, the Appellant described how the Veteran was affected by the sight of dismembered bodies on the battlefield. The May 1991 Certificate of Achievement awarded to the Veteran for his support of the Second Regiment while it conducted combat operations confirms that he carried out his mission in the face of inhospital weather and terrain, logistical difficulties, and enemy action. Thus, the Board finds that there has been adequate independent corroboration of the occurrence of the in-service event or stressor involving combat exposure. Additionally, the record contains post-service treatment records diagnosing the Veteran with PTSD, as well as drug and alcohol dependency. In January 1993, a Ph.D. and director of the PTSD Program at the Coatesville, Pennsylvania VA Medical Center wrote that a diagnosis of PTSD was supportable, although the level of severity was sufficiently mild that inpatient treatment was not necessary. He noted that the Veteran was exposed to mild combat-related stress of a traumatic nature. The major focus of his experiences was the loss of a man from his unit. The doctor noted that a number of the Veteran’s symptoms may have been contributed to by prolonged substance abuse. Ultimately, the Board is without the medical expertise necessary to determine whether the Veteran’s diagnosed PTSD was etiologically related to his in-service stressors or the cause of his heart conditions. Colvin v. Derwinski, 1 Vet. App. 171 (1991). In order to properly adjudicate this appeal, a factually accurate, fully articulated, and soundly reasoned medical opinion addressing these claims is necessary. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records for the Veteran prior to his death, to include November 1994 to December 1994. 2. After the above development has been completed to the extent possible, send the claims file to a VA examiner (a licensed psychiatrist) for an opinion as to whether the Veteran’s diagnosed PTSD, and any other psychiatric disorder, was related to his military service. (a.) The electronic claims file, to include the Veteran’s service treatment records, personnel records, post-service treatment records, and supporting lay statements from the Appellant, must be reviewed by the examiner, and a note that it was reviewed should be included in the report. (b.) Following a review of the record, the examiner is asked to address the following: i. Identify all psychiatric disorders present prior to the Veteran’s death. ii. For each diagnosed psychiatric disorder, to include PTSD, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any such disorder is related to his active duty service, to include combat exposure. iii. With respect to PTSD, the examiner should determine whether exposure to the corroborated in-service stressor of serving in Saudi Arabia in support of combat operations with the Second Regiment resulted in PTSD. If a PTSD diagnosis is deemed appropriate, the examiner should comment upon whether it is at least as likely as not (50 percent or greater probability) that any PTSD was due to the claimed incidents in service, or due to the fear of hostile military or terrorist activity during service. iv. As to the diagnosed drug and alcohol dependence, the examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that the drug and alcohol abuse disorder was caused by, aggravated by, or a symptom of any of the Veteran’s psychiatric disorders. If the examiner finds that the drug or alcohol dependence disorder was aggravated by another psychiatric disorder, the examiner must attempt to establish a baseline level of severity of the drug and alcohol dependence disorder prior to aggravation by the psychiatric disorder. (c.) All opinions provided should be thoroughly explained. If any requested opinion cannot be provided without resort to speculation, the examiner should so state and explain why an opinion cannot be provided without resort to speculation. 3. Obtain a medical opinion from a VA examiner (a cardiologist) regarding the Veteran’s heart conditions. (a.) The electronic claims file, to include the Veteran’s service treatment records, service personnel records, post-service treatment records, and supporting lay statements from the Appellant, must be reviewed by the examiner, and a note that it was reviewed should be included in the report. (b.) Following a review of the record, the examiner is asked to address the following: i. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s psychiatric disorder caused or aggravated, or contributed substantially to the Veteran’s death or to his heart conditions as listed on his death certificate, or was a contributory cause of the Veteran’s death or materially hastened his death? TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jamison, Elizabeth G.