Citation Nr: 18148431 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 15-21 784 DATE: November 8, 2018 REMANDED Entitlement to Dependency and Indemnity Compensation (DIC), on the basis of entitlement to service connection for the cause of the Veteran’s death, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1952 to December 1953. The Veteran died in April 2011. The appellant is the Veteran’s widow. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision by a Department of Veterans Affairs Regional Office (RO). The Board notes that the appellant was scheduled to appear at a Board videoconference hearing in October 2018. The record reflects that the appellant cancelled the scheduled Board hearing. 1. DIC The appellant asserts entitlement to service connection for the cause of the Veteran’s death. Specifically, the appellant asserts that the service-connected cold weather injuries caused or contributed to the conditions that caused the Veteran’s death. A review of the Veteran’s death certificate shows that the cause of death was metabolic encephalopathy due to or as a consequence of acute on chronic renal failure, heart failure; atrial fibrillation, hypertension, anemia; and amyloid heart disease. A VA medical opinion was obtained in May 2015. The examiner opined that the cause of the Veteran’s death was unrelated to his service-connected cold weather injures. In this regard, the examiner opined that the cold weather injury residuals of peripheral neuropathy of the lower extremities did not cause the Veteran’s heart failure, heart disease or hypertension, nor did it contribute to his death. In support of this opinion, the examiner noted that peripheral neuropathy did not cause a lack of circulation in the lower extremities or cause heart disease. In addition, the examiner found that the stated causes of death were not directly related to service. In this regard, the examiner noted pre-existing conditions of hypertension and tachycardia prior to service with no evidence in the STRs showing that either condition was aggravated during service. Since separation from service, the examiner noted that the Veteran progressively gained weight and became morbidly obese in 2004. In addition, the examiner noted the development of subsequent diseases including hyperlipidemia in 2003, and diabetes in 2009. The examiner further noted the subsequent development of coronary artery disease (CAD), which was found to have eventually contributed to the terminal medical conditions noted on the death certificate. Accordingly, the examiner found that the Veteran had multiple risk factors for the development of CAD including age, gender, morbid obesity, hyperlipidemia, diabetes and hypertension. The Board finds the May 2015 VA examination inadequate. First, the Board notes that the examiner raised the issue of whether the Veteran’s hypertension, an identified risk factor in the development of the Veteran’s CAD, was directly related to service. In this regard, the death certificate lists hypertension as a contributing cause of death and a February 2003 private medical record states that the Veteran’s long-standing hypertension “undoubtedly” contributed to the development of his CAD. The examiner noted that the Veteran’s STRs showed he had a pre-existing hypertension condition prior to service and opined that STRs contained no evidence that the condition was aggravated during service. While the January 1952 enlistment examination documents a pre-existing hypertension condition, the STRs further document continual treatment for hypertension during service including admissions for medical observation. In one such instance, the STRs show the Veteran’s was admitted for observation secondary to anxiety attacks with symptoms of dizziness and headaches. The examiner did not address those STRs. Accordingly, the Board finds the examiner’s opinion is not supported by an adequate rationale. Second, the examiner failed to opine whether the Veteran’s service-connected cold weather injury residuals aggravated the conditions that caused his death. In this regard, an April 2004 VA examination shows the Veteran reported cold weather injury residuals including swelling and stiffness, and the examiner noted swelling of the hands during the examination. While the May 2015 examiner opined that cold weather injury residuals of peripheral neuropathy of the lower extremities did not cause the Veteran’s heart failure, heart disease or hypertension or contribute to his death, the examiner did not address symptoms of swelling of the upper extremities or whether such residuals aggravated the conditions that caused the Veteran’s death. The examiner only focused on the service-connected cold weather injuries involving the bilateral lower extremities. Accordingly, a new VA examination is necessary to adequately adjudicate the claim on appeal. The matter is REMANDED for the following action: Send the claims file, including a copy of this Remand, to an appropriate examiner for an addendum to the May 2015 VA opinion as to the nature and etiology of the Veteran’s cause of death listed as metabolic encephalopathy due to or as a consequence of acute on chronic renal failure, heart failure, atrial fibrillation, hypertension, anemia and amyloid heart disease and his service-connected bilateral upper and lower extremity cold weather residuals. The examiner should provide the following medical opinions: a. Whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s hypertension clearly and unmistakably (i.e., undebatably) existed prior to his enlistment in service (prior to February 1952)? b. If so, is there clear and unmistakable evidence that the pre-existing hypertension was not aggravated (i.e., is it undebatable that the disability did not undergo a permanent increase in severity) during the Veteran’s period of active service. If the Veteran’s pre-existing hypertension did undergo a permanent increase in severity, was that permanent increase in severity during service clearly and unmistakably due to the natural progress of the condition? The examiner is asked to address the Veteran’s STRs noting treatment and medical observation for hypertension. c. If not, whether it is at least as likely as not (50 percent or greater probability) that the hypertension is etiologically related to the Veteran’s service? d. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected bilateral upper and lower extremity cold weather injury residuals caused or contributed substantially or materially to the Veteran’s death, to include his metabolic encephalopathy due to or as a consequence of acute on chronic renal failure, heart failure, atrial fibrillation, hypertension, anemia and amyloid heart disease? The examiner is asked to address the Veteran’s symptoms related to the cold weather injury residuals involving both the bilateral upper and lower extremities. The examination report must include a complete rationale for all opinions expressed. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lamb, Associate Counsel