Citation Nr: 18147849 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 14-10 695A DATE: November 6, 2018 ORDER The claim for entitlement to service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The Veteran died in September 2010 from cardiopulmonary arrest due to a non-traumatic intracranial bleed and acute stroke. 2. At the time of his death in September 2010, the Veteran was service-connected for posttraumatic stress disorder (PTSD) and Parkinson’s disease. 3. The Veteran’s intracranial bleed and stroke were not incurred during service or until many years after discharge and are not otherwise etiologically related to active duty service, to include exposure to herbicide agents, or a service-connected disability. 4. Service-connected PTSD and Parkinson’s disease did not cause or contribute substantially or materially to the Veteran’s death. CONCLUSION OF LAW Service connection for the cause of the Veteran’s death is not warranted. 38 U.S.C. § 1310; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1956 to September 1975 with service in the Republic of Vietnam. He died on September [redacted], 2010 and the appellant is his surviving spouse. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for the cause of the Veteran's death. The Veteran died on September [redacted], 2010 and the appellant is his surviving spouse. The death certificate lists the cause of death as cardiopulmonary arrest due to a non-traumatic intracranial bleed and acute stroke. The appellant contends that the Veteran’s service-connected PTSD and Parkinson’s disease contributed to his death by stroke. The appellant also contends that the Veteran’s exposure to herbicide agents while serving in Vietnam contributed to his death. In the instance of a Veteran’s death, certain enumerated survivors are eligible for compensation if the death is found to be service connected. The evidence must show that a disorder incurred in or aggravated by service either caused or contributed substantially or materially to the cause of the Veteran’s death. For a service connected disability to be the cause of death it must singly or with some other condition be the immediate or underlying cause, or be etiologically related. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death. Rather, it must be shown that there was a causal connection. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. At the time of his death, the Veteran was service-connected for PTSD and Parkinson’s disease. The appellant contends that the Veteran’s PTSD and Parkinson’s contributed materially to his death, though she does not describe any specific mechanism between the Veteran’s service-connected conditions and his final stroke. She also contends that the Veteran’s death is associated with his exposure to herbicide agents in Vietnam. Initially, the Board notes that service treatment records are negative for evidence or indications of stroke or a cerebrovascular accident (CVA). There are no complaints or treatment for vascular or neurological problems during active duty, and the Veteran was physically normal at the September 1975 separation examination. There is also no post-service evidence of vascular or neurological deficiencies for years following the Veteran’s discharge from active military service. Post-service treatment records show that the Veteran was diagnosed with diabetes in 1986 and treated for lower extremity claudication related to diabetes in 1996, more than 10 years after discharge. The Veteran passed away on September [redacted], 2010. The medical evidence, including the death certificate, clearly establishes that his death was due to cardiopulmonary arrest (the sudden cessation of the heart and normal blood circulation) caused by an intracranial bleed and acute stroke. There is no medical evidence of a link between the Veteran’s death and active duty service or evidence of these conditions during his period of active service. Furthermore, the Board observes that the appellant does not contend that the Veteran’s death was directly related to service; rather, she argues that his death was due to service-connected PTSD and Parkinson’s disease and/or exposure to herbicide agents. Thus, the Board must determine whether the Veteran’s service-connected disabilities or exposure contributed substantially or materially to his cause of death. Treatment records from the VA Medical Center (VAMC) establish that the Veteran experienced strokes in July 2001, June 2003, November 2004, with a smaller stroke-like episode occurring in 2005. He was provided an ultrasound in May 2003 that indicated severe stenosis (blockages) in both internal carotid arteries. A brain MRI performed in the same month showed extensive areas of white matter and occipital ischemia. The Veteran was diagnosed with cerebrovascular disease by VA vascular surgeons and neurologists and received treatment for the condition from 2001 to the time of his death in September 2010. In August 2005 and June 2006, his VA doctors identified several risk factors for the Veteran’s strokes, to include nonservice-connected diabetes, hypertension, hyperlipidemia, and carotid artery atherosclerotic disease. These risk factors, including the Veteran’s long history of poorly controlled diabetes, were identified well before the first indications of Parkinson’s disease in July 2006. This evidence of nonservice-connected risk factors for strokes, as well as the timing of the CVAs in relation to the diagnosis of Parkinson’s, all weighs against the appellant’s claim. The appellant maintains that the Veteran’s final stroke in September 2010 was related to his PTSD, Parkinson’s disease, and exposure to herbicides. There is no competent evidence of a link between the Veteran’s PTSD or herbicides and a CVA, but private medical records do contain some indication that the Veteran’s Parkinson’s may have been responsible for syncopal episodes leading up to the September 2010 stroke. In August 2010, the Veteran was seen at a private hospital for recurrent spells of passing out. These syncopal episodes were attributed to severe postural hypertension due, in part, to Parkinson’s. On September 9, 2010, the Veteran was brought to the emergency department of the same private facility, having been found unconscious by his son at home. He was diagnosed with syncope, an abnormal EKG, and a likely myocardial infarction. While hospitalized, the Veteran became comatose and a CAT scan of the head showed evidence of past CVAs, as well as a large subdural hematoma with evidence of a midline shift. He passed away on September [redacted], 2010 due to the most recent intracranial bleed and stroke. Although the Veteran’s Parkinson’s disease may have been one of the factors leading to his syncopal episodes and hospitalization on September 9, 2010, there is no competent evidence associating the service-connected condition with the Veteran’s actual cause of death by stroke. As noted above, the Veteran was found to have severe cerebrovascular disease and experience strokes well before Parkinson’s disease was diagnosed or manifested. Treatment records associated with the Veteran’s final hospitalization also do not identify Parkinson’s disease as a cause of the Veteran’s CVA and death. None of the Veteran’s treating physicians has ever identified PTSD, Parkinson’s disease, or herbicide exposure as a cause of the Veteran’s strokes and the record contains a June 2018 VA medical opinion weighing against the claim. After examining the complete claims file, the June 2018 VA examiner concluded that the Veteran’s cause of death was not related to service-connected disability or exposure to an herbicide agent; rather, the Veteran manifested multiple nonservice-connected risk factors for non-traumatic intracranial bleeds and stroke including age, prior CVAs, and hypertension. The Board has considered the statements of the appellant, but as a lay person, she is not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Grover v. West, 12 Vet. App. 109, 112 (1999). The Board acknowledges that the appellant is competent to describe the Veteran’s observable symptoms, such his anxiety and decline in function, but her opinion as to the cause of his death simply cannot be accepted as competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1131, 1336 (Fed. Cir. 2006). Thus, the appellant’s lay statements are clearly outweighed by the competent medical evidence weighing against the claim. The Board is sympathetic to the appellant’s claim, but the evidence does not establish that service connection is warranted for the cause of the Veteran’s death. The evidence is against a finding that the Veteran’s service-connected PTSD, Parkinson’s disease, or exposure to herbicide agents caused or otherwise contributed substantially or materially to his death due to a non-traumatic intracranial bleed and acute stroke. The Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the preponderance of the evidence is against the claim. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel