Citation Nr: 18148917 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 18-24 017 DATE: November 8, 2018 ORDER Entitlement to service connection for the cause of the Veteran’s death is denied. (The substitution issues of service connection for sinusitis, left wrist disability, sleep apnea and a heart disability; as well as the increased issues for bilateral hearing loss, tinnitus, bilateral feet, bilateral knees, and GERD are the subject of another decision issued simultaneously.) FINDINGS OF FACT 1. The Veteran died in February 2017; the death certificate shows the immediate cause of death was out of hospital cardiac arrest due to chronic systolic heart failure due to ischemic heart disease due to cardiogenic shock. 2. A heart disability was not incurred in or aggravated by active service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1110, 1131, 1310; 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty for more than 20 years prior to his retirement in November 1993. He passed away in February 2017. The appellant is his surviving spouse. Entitlement to service connection for the cause of the Veteran’s death To establish entitlement to service connection for the cause of the Veteran’s death, the evidence of record must show that a disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death. 38 U.S.C. § 1310; 38 C.F.R. §§ 3.303, 3.312. The service-connected disability will be considered as the principal cause of death when such disability, singly or jointly with another condition, was the immediate underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312(b). To be considered a contributory cause of death, it must be shown that the service-connected disability contributed substantially or materially; that it combined to cause death; or that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c)(1). It is not sufficient to show that the service-connected disability casually shared in producing death; rather, a causal connection must be shown. Id. During the Veteran’s lifetime, he was service connected for posttraumatic stress disorder; right and left knee disabilities; lumbar spine; right and left foot disability; hiatal hernia; bilateral hearing loss, and tinnitus. His death certificate reflects that he died in February 2017; the immediate cause of his death was cardiac arrest due to chronic systolic heart failure due to ischemic heart disease due to cardiogenic shock. The appellant generally contends that the Veteran’s death was related to service and that service connection for the cause of his death is warranted. Service treatment records (STRs) do not document any problems related to a heart disability. The Board observes the Veteran was seen in service for chest pain; however, it was determined to be non-cardiac related. Post-service treatment records reveal the Veteran was diagnosed with coronary artery disease (CAD) in 2005, and he subsequently had heart surgery. During an October 2012 VA examination, 3-vessel CAD was diagnosed. The examiner reviewed the file, examined the Veteran and found that his current heart disease was not related to his military service, to include the in-service chest complaints. She reasoned that the in-service chest pain was non-cardiac in nature, and diagnostic testing performed at the time showed no ischemic changes. She opined that the Veteran’s heart disease manifested many years after service discharge, and that the disability was most likely related to the Veteran’s personal risk factors of elevated lipids and prior tobacco use. The evidence of record is against finding that the Veteran’s heart disability was incurred in or aggravated by his active service. In another decision, issued simultaneously with this decision, the Board has determined that the Veteran’s heart disability was not service related. The October 2012 VA opinion is the most probative evidence as to the etiology of the Veteran’s heart disease. The only evidence relating the Veteran’s death to service is the appellant’s contention. The appellant requested that the heart disability be considered in her service connection claim for the cause of the Veteran’s death. The appellant offered no explanation as to how the Veteran’s death is related to service. See April 2017 Report of General Information. Although lay persons are competent to provide opinions on some medical issues, here, the matter of the etiology of the Veteran’s fatal disability is a complex medical matter that falls outside the realm of common knowledge of a lay person. As the appellant is not shown to be other than a layperson without appropriate training and expertise, she is not competent to offer an etiology opinion as to the cause of the Veteran’s death. Id. Therefore, regarding this claim, the appellant’s assertion that the Veteran’s death was related to service is not competent. There is no competent, probative evidence that the Veteran’s death was in any way medically related to his period of service to support the appellant’s contention, nor was a chronic heart disability shown within his first post-service year. The only evidence linking the Veteran’s death to service are the bare statements of the appellant that the Veteran’s death is related to service. Thus, the evidence is not sufficient to trigger VA’s duty to obtain a medical opinion in this case. Cf. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010). For all the foregoing reasons, the claim for service connection for the cause of the Veteran’s death must be denied. In reaching the conclusion to deny the claim, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as no competent, probative evidence supports the claim, that doctrine is not applicable. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel