Citation Nr: 18147806 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 15-40 564 DATE: November 6, 2018 REMANDED The issue of entitlement to dependency and indemnity compensation (DIC) under 38 U.S.C. § 1318 is remanded. The issue of entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND 1. The issue of entitlement to dependency and indemnity compensation under 38 U.S.C. § 1318 is remanded. 2. The issue of entitlement to service connection for the cause of the Veteran's death is remanded. The appellant seeks DIC under 38 U.S.C. § 1318 and service connection for the cause of the Veteran’s death. The death certificate indicates that the Veteran died of unknown natural causes in May 2009 while he was under hospice care, and that multi infarct dementia was a significant condition contributing to death. While there are private medical records in the claims file, the most recent is dated in 2007. More recent records, to include terminal records, are not associated with the claims file. They should be sought. The appellant contends that the Veteran had posttraumatic stress disorder (PTSD), and that such aggravated his heart condition, which in turn led to his fatal multi infarct dementia. As such, the threshold question is whether the Veteran did in fact have a confirmed diagnosis of PTSD. During an October 2018 hearing before the undersigned, the appellant’s representative indicated that a diagnosis of PTSD was rendered in 2007; however, the Board’s review of the claims file does not reveal such a diagnosis. The appellant should be requested to submit evidence disclosing a diagnosis of PTSD. If evidence of a diagnosis of PTSD is received, the Agency of Original Jurisdiction (AOJ) should obtain an opinion from an appropriate clinician regarding whether PTSD caused or aggravated the Veteran’s cardiovascular disability. If the clinician determines that PTSD caused or aggravated the cardiovascular disability, the clinician should also be asked to provide an opinion regarding whether the Veteran’s fatal multi infarct dementia was proximately due to or aggravated by his cardiovascular disability. The matters are REMANDED for the following action: 1. Request that the appellant provide or identify non-VA treatment records that are relevant to her claims, for the period from 2007 to 2009, copies of which then should be sought. Request that the appellant provide or identify evidence of a diagnosis of PTSD. If, after making reasonable efforts to obtain named records the AOJ is unable to secure same, the AOJ must notify the appellant and her representative and (a) identify the specific records the AOJ is unable to obtain; (b) briefly explain the efforts that the AOJ made to obtain those records; (c) describe any further action to be taken by the AOJ with respect to the claim; and (d) inform the appellant that she is ultimately responsible for providing the evidence. The appellant must then be given an opportunity to respond. 2. If, and only if, evidence of a diagnosis of PTSD is received, the AOJ should request an opinion from an appropriate clinician regarding whether PTSD caused or aggravated the Veteran’s cardiovascular disability. The claims file must be made available to the examiner. Following review of the record, the clinician should provide an opinion with respect to whether it is at least as likely as not (50 percent or more probability) that the Veteran’s cardiovascular disability was caused or aggravated (worsened beyond normal progression) by PTSD. If the clinician determines that the cardiovascular disability was caused or aggravated by PTSD, he should also provide an opinion regarding whether it is at least as likely as not (50 percent or more probability) that multi infarct dementia was caused or aggravated (worsened beyond normal progression) by the cardiovascular disability. The clinician is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. If the clinician is unable to offer any of the requested opinions, a rationale for the conclusion that an opinion cannot be provided without resort to speculation should be provided, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. The complete rationale for any conclusion reached should be provided. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Barone, Counsel