Citation Nr: 18149434 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 14-42 261 DATE: November 9, 2018 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Navy from June 1964 to August 1964 and from June 1968 to July 1988. The Veteran died in October 2012; the appellant is his surviving spouse. The matter is before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In her November 2014 VA Form 9, Appeal to Board of Veterans’ Appeals, the Appellant requested to appear at a hearing before the Board. In April 2018, the Appellant was notified at her most recent address of record of a hearing before the Board scheduled in April 2018. After receiving notification of the hearing date and time but before the hearing was scheduled to take place, the Appellant’s attorney indicated the Appellant wished to withdraw her hearing request. As such, her hearing request is considered withdrawn. 38 C.F.R. § 20.704(e). Entitlement to service connection for the cause of the Veteran’s death is remanded. The Board cannot make a fully-informed decision on the issue of service connection for cause of the Veteran’s death because no VA examiner has opined whether the Veteran’s service-connected diabetes mellitus II and coronary artery disease contributed to his cause of death. The Veteran’s death certificate lists renal failure as the immediate cause of death with severe end stage liver disease and severe congestive heart failure listed as other significant conditions contributing to death. The Veteran was not service-connected for any disabilities during his lifetime; however, a June 2018 rating decision awarded service connection for diabetes mellitus II and coronary artery disease, effective in May 2011. A June 2013 VA opinion concluded that the Veteran’s diabetes and ischemic heart disease did not cause or contribute to his death based on a finding that his diabetes was well controlled at death, that there was no evidence of a myocardial infarction, and there was no evidence of nephropathy in the time preceding his death. Subsequently, in September 2013, the Veteran’s private physician opined that the Veteran’s diabetes did contribute to his death since the changes associated with diabetic nephropathy are permanent, but that the Veteran’s renal failure was accelerated by nonischemic cardiomyopathy. In a December 2013 VA opinion, the examiner opined that the Veteran’s diabetes did not contribute to his cause of death as it did not contribute materially to his renal failure; however, the examiner noted that the Veteran had shown loss of protein in the urine in 2010, which can be indicative of diabetic renal failure. Although the December 2013 VA examiner indicated that he reviewed the conflicting medical opinions of record, he did not opine as to whether the Veteran’s coronary artery disease, diagnosed in 2009, materially contributed to the Veteran’s cause of death. The matter is REMANDED for the following action: 1. Contact the appellant and provide her the opportunity to identify or submit any additional evidence pertinent to the claim that is not currently of record. Based on her response, attempt to procure copies of all records identified that are not already of record. 2. Obtain an addendum opinion from an appropriate VA clinician to provide opinions on the following questions: A) Is it at least as likely as not (50 percent or greater probability) that any of the listed immediate, underlying, or contributory causes of the Veteran’s death (renal failure, severe end stage liver disease, severe congestive heart failure) is related to an in-service injury, event, or disease, including his presumed exposure to herbicide agents? B) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected disabilities of diabetes mellitus II and coronary artery disease were a principal or contributory cause of his death? The clinician is advised that the term “contributory cause of death” means one inherently not related to the principal cause; which contributed substantially or materially to cause death; which combined to cause death; or which aided or lent assistance to the production of death. It is not sufficient that a disorder may have casually shared in the production of death; rather there must be a causal connection. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K Pak, Associate Counsel