Citation Nr: 18148780 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-53 799 DATE: November 8, 2018 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1953 to May 1955. The Veteran died in July 2014, and the appellant is his surviving spouse. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran’s death certificate shows that he died in July 2014, and the cause of death is listed as aspiration pneumonia due to or as a consequence of respiratory failure. Dysphagia was also listed as another significant condition. During his lifetime, the Veteran was service-connected for lymphoma, an adjustment disorder with anxious and depressive elements, and folliculitis with eczema and a residual scar. The most recent medical evidence in the claims file is a December 2009 VA lymphatics disorders examination report. In a September 2016 VA Form 9, the appellant’s representative asserted that a 2009 assessment of the Veteran’s lymphoma is not an accurate depiction of his lymphoma at the time of his death. She asserted that VA failed to properly adjudicate the claim because developmental efforts have not been made to obtain more recent medical records. She also requested an opinion regarding the relationship between the Veteran’s lymphoma and his death. The Board finds that an attempt should be made to obtain any outstanding records and that a VA medical opinion is needed to determine the etiology of the Veteran’s cause of death. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the appellant provide the names and addresses of any and all health care providers who provided treatment for any of the Veteran’s service-connected disabilities, particularly from 2009 to 2014, as well as any treatment for a respiratory disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records, to include any records dated from 2009 to July 2014. 2. After completing the foregoing development, the AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a VA medical opinion to determine the nature and etiology of the cause of the Veteran’s death. The examiner is requested to review all pertinent records associated with the claims file. The examiner should note that laypersons are considered competent to attest to factual matters of which they had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should state this with a fully reasoned explanation. The examiner should address whether any service-connected disability, including the Veteran’s lymphoma, caused his death; contributed substantially or materially to his death; combined with another disorder caused his death; or aided or lent assistance to his death. In formulating this opinion, the examiner consider whether such a condition affected a vital organ and was of itself of a progressive or debilitating nature as to be considered a material influence in accelerating death. In rendering this opinion, the examiner should consider the appellant’s February 2016 notice of disagreement, citing the Cancer Journal for Clinicians, linking cancer and cancer therapy to pulmonary complications, immunosuppression, infectious disease, and respiratory symptoms. The representative has asserted that the Veteran’s lymphoma and associated treatment suppressed his immune system and made him more susceptible to infection, which resulted in aspiration pneumonia. (The term “at least as likely as not “does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]”38 C.F.R. 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing the foregoing development, the AOJ should undertake any further development that may be indicated as a result of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski