Citation Nr: 18149455 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-38 659 DATE: November 9, 2018 REMANDED Entitlement to service connection for the cause of death of the Veteran is remanded. REASONS FOR REMAND The Veteran served in the Marines from April 29, 1968 to May 12, 1972. The Veteran passed away in March 2015. The appellant is the Veteran’s surviving spouse. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, which, in pertinent part, denied entitlement to service connection for the cause of the Veteran’s death. Although further delay is regrettable, the issue of entitlement to service connection for the cause of death of the Veteran is REMANDED to the Agency of Original Jurisdiction (AOJ). Entitlement to service connection for the cause of death for the Veteran is remanded. Here, the appellant seeks service connection for the cause of the Veteran’s death. The Veteran died in March 2015; the death certificate lists the immediate cause of death as Wernicke’s encephalopathy due to alcoholism. During the Veteran’s lifetime, service connection was established for prostate cancer evaluated as 100 percent disabling, diabetes mellitus II evaluated as 20 percent disabling, diabetic neuropathy of the right lower extremity evaluated as 10 percent disabling, diabetic neuropathy of the left lower extremity evaluated as 10 percent disabling, and residuals of malaria evaluated as 0 percent disabling. The appellant claims that the Veteran had undiagnosed psychiatric disorders, namely post-traumatic stress disorder (PTSD) and depression, due to his multiple service-connected disabilities and military service, and that caused his alcoholism, which ultimately caused or contributed to his death from Wernicke’s encephalopathy. The appellant alleges that the Veteran had psychiatric symptoms since service, such as social anxiety, irritability, anger, and emotional detachment. In support of the appellant’s claim, four statements were provided by the Veteran’s children, as well as an additional statement submitted by his representative, all of who attested to witnessing the Veteran’s above-noted psychiatric symptoms. See Lay Statements dated May 2015; June 2015; August 2016. Although the opinions provided by the Veteran’s surviving spouse, children, and representative are competent as a general matter, psychiatric disorders, in particular PTSD, are disorders that must be diagnosed by mental health professionals. Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (“Mental health professionals are experts and are presumed to know the DSM requirements applicable to their practice and to have taken them into account in providing a PTSD diagnosis”). See also Id. at 142 (holding that determining the validity of claimed stressors for purposes of seeking benefits for PTSD “is a medical question requiring examination and assessment of the veteran by a mental-health professional”). Similarly, the record reflects that the Veteran was diagnosed with anxiety disorder in 2004 and subsequently had positive screenings for PTSD and depression. See May 2004, June 2012 and January 2015 VA Treatment Records. He was denied service-connection for PTSD but the record does not reflect that he ever applied for service connection for his depression or anxiety disorder. Further, the appellant, the Veteran’s children, and his representative have all asserted that the Veteran was resistant to discussing his psychiatric symptoms. See Lay Statements dated May 2015; June 2015; August 2016. This is also supported by the record. For example, at an August 2014 evaluation where the Veteran was denied for PTSD, it was noted that the evaluation was “as best as could be determined”. Therefore, despite the fact that that the Veteran did not appeal his denial for service-connected PTSD, a remand is warranted to obtain a medical opinion to address whether the Veteran had a psychiatric disorder related to service that contributed to his death. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The appellant also contended in a May 2015 Lay Statement that the Veteran may not have died from Wernicke’s encephalopathy, but may instead have passed away from a blood clot related to his service-connected diabetes and/or prostate cancer. This is also supported in two of the statements from the Veteran’s children who reported witnessing what they perceived as symptoms of a blood clot, including his leg being extremely cold and having poor circulation the night before the Veteran died. One of the Veteran’s children who reached this conclusion asserted that she did so “by [her] medical training”, although she does not specify what the training entails. Regardless, the contention that the Veteran may have died from a blood clot should also be addressed on remand and the appellant should be provided the opportunity to substantiate her contention. The matter is REMANDED for the following actions: 1. Solicit any outstanding information from the appellant pertaining to her contention regarding the Veteran’s blood clot. 2. Following the completion of step one, arrange to obtain a medical opinion from a competent medical professional regarding the cause of the Veteran’s death. The claims file, to include a copy of this Remand, must be made available to the examiner and be reviewed. After a full review of the claims file, the examiner should offer an opinion and answer the following questions: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any psychiatric disability was caused by service and/or service-connected disabilities? If so, opine whether such a psychiatric disorder caused or aggravated the Veteran’s alcohol abuse. The examiner is requested to address the VA examination reports that showed positive PTSD and depression screenings, the Veteran’s 2004 diagnosis of anxiety disorder, the contentions by the appellant, the Veteran’s children, and the representative that the Veteran suffered from PTSD and possibly depression as a result of his service and/or service-connected disabilities. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cause of death (including those listed on his death certificate) was due to or the result of any disease or injury incurred in service? The examiner should address the contention that the Veteran died from a blot clot associated with his service-connected disabilities. The examiner is requested to provide a rationale for any opinion expressed, based on the examiner’s clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resorting to speculation, then the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Thereafter, readjudicate the claim. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the appellant. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.Smith, Law Clerk