Citation Nr: 18149717 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 17-33 984 DATE: November 14, 2018 ORDER Entitlement to service connection for the Veteran's cause of death for purposes of entitlement to dependency and indemnity compensation (DIC) benefits is granted. Entitlement to accrued benefits is denied. FINDINGS OF FACT 1. It is at least as likely as not that the Veteran’s dementia and congestive heart failure were caused or aggravated by his service-connected posttraumatic stress disorder (PTSD). 2. The Veteran was not owed any money, nor did he have any pending claims open at the time of his death. CONCLUSIONS OF LAW 1. The criteria for service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 1110, 1131, 1310, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.312. 2. The criteria for a grant of accrued benefits have not been met. 38 U.S.C. § 5107, 5121; 38 C.F.R. §§ 3.31, 3.102, 3.1000. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1949 to November 1952. He was in receipt of multiple service commendations, to include the Purple Heart. The Veteran died in July 2016. The appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision and October 2016 notice letter issued by a Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction over the appeal presently rests with the VA Pension Management Center (PMC) in Philadelphia, Pennsylvania. 1. Entitlement to service connection for the Veteran's cause of death for purposes of entitlement to dependency and indemnity compensation (DIC) benefits The Veteran died in July 2016. His causes of death were listed as dementia, diabetes, congestive heart failure, and chronic obstructive lung disease. The appellant seeks service connection for the Veteran’s cause of death for purposes of entitlement to DIC benefits. Pursuant to 38 U.S.C.A § 1310, DIC benefits are paid to a surviving spouse, child, or parent of a qualifying veteran who died from a service-connected disability. See 38 U.S.C.A § 1310 (West 2014); Dyment v. West, 13 Vet. App. 141 (1999), aff’d sub nom. Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). A veteran’s death will be considered service connected where a service-connected disability was either the principal or a contributory cause of death. 38 C.F.R. § 3.312 (a). The disability is the principal cause of death if it was “the immediate or underlying cause of death or was etiologically related thereto.” 38 C.F.R. § 3.312(b). It is a contributory cause if it “contributed substantially or materially” to the cause of death, “combined to cause death,” or “aided or lent assistance to the production of death.” 38 C.F.R. § 3.312(c)(1). If multiple causes of death are given, only one need be service connected for purposes of entitlement to DIC benefits. The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). In determining whether a veteran’s death was service connected, the first element is always satisfied in that the current disability is the condition that resulted in the veteran’s death. See Carbino v. Gober, 10 Vet. App. 507, 509 (1997), aff’d sub nom. Carbino v. West, 168 F.3d 32 (Fed.Cir.1999). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (2017). The Board finds the claim should be granted. As noted above, the Veteran’s multiple causes of death were given as dementia, diabetes, congestive heart failure, and chronic obstructive lung disease. At the time of his death, the Veteran was service connected for posttraumatic stress disorder (PTSD), bilateral cold injury residuals of the feet, bilateral tinnitus, peripheral neuropathy of the bilateral lower extremities, and bilateral hearing loss. The appellant contends that the Veteran’s dementia and congestive heart failure were either caused by or aggravated by his PTSD, and therefore should be granted service connection on a secondary basis. The Board has reviewed the Veteran’s VA and private treatment records, but found no direct evidence linking either his congestive heart failure or dementia to PTSD. In August 2016, the appellant submitted a letter from the Veteran’s treating physician which stated that it was his opinion that the Veteran’s PTSD was a significant contributing condition to his cause of death. While this letter certainly raises the possibility that his PTSD may have contributed to his death, it is less than persuasive in this matter as it fails to provide any real discussion of how that conclusion was reached. In September 2017, the appellant submitted a new private medical opinion. The private physician reviewed the Veteran’s medical history, to include prior VA treatment records and examinations and concluded that the Veteran’s service-connected PTSD more likely than not contributed to his development and permanent aggravation of both dementia and congestive heart failure. In support of his conclusion, the physician cited to several studies and peer-reviewed articles which linked posttraumatic stress with both dementia and cognitive decline, as well as finding that congestive heart failure returned as substantial quantity of positive correlations to PTSD. Particularly, he noted that epidemiological studies reported in a 2014 report of the Alzheimer’s & Dementia journal confirms that chronic stress and PTSD are both associated with an increased statistical risk for various forms of dementia. The Board finds this opinion to be persuasive. It was rendered by a medical doctor with over 40 years of experience, and in contemplation of the Veteran’s complete medical history. It was further supported by known medical principles and multiple examples of medical treatise evidence, which the physician provided for the Board’s reference. The Board has carefully reviewed the other evidence of record, but found nothing that would contradict this medical opinion. Considering the above, and affording the appellant the complete benefit of the doubt, the Board finds that the Veteran’s cause of death, particularly his dementia and congestive heart failure, were at least as likely as not caused or aggravated by his service-connected PTSD. As such, service connection for the Veteran’s cause of death is granted for purposes of entitlement to DIC benefits. 2. Entitlement to accrued benefits In addition to her claim for DIC benefits, the appellant also filed a claim for accrued benefits. The law provides for payment of certain accrued benefits upon death of a beneficiary. 38 U.S.C. § 5121. Periodic monetary benefits under laws administered by the Secretary to which an individual was entitled at death under existing ratings or decisions or those based on evidence in the file at date of death and due and unpaid, shall, upon the death of a veteran, be paid to the living person first listed below: (A) the veteran’s spouse; (B) the veteran’s children (in equal shares); (C) the veteran’s dependent parents (in equal shares). 38 U.S.C. § 5121(a), 5121(a)(2); 38 C.F.R. § 3.1000 (a). In all other cases, only so much of the accrued benefits may be paid as may be necessary to reimburse the person who bore the expense of last sickness and burial. 38 U.S.C. § 5121(a)(6). The Board finds that the claim should be denied. Here, although the appellant, as the Veteran’s surviving spouse, would be entitled to any accrued benefits owed the Veteran at the time of his death, the Board must deny the claim as the record does not reflect that any benefits were accrued. Benefits become accrued if they are owed to a recipient, but unpaid at the time of the recipient’s death, or if the recipient had a claim pending at the time of their death which was later granted. In this case, there is no evidence of record that the Veteran was owed any benefits when he died in July 2016, nor did he have any pending claims at the time of his death. As such, no benefits were owed or potentially owed, and therefore no benefits became accrued upon his death. Therefore, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet App. 49 (1990); 38 C.F.R. § 3.102. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Pryce, Associate Counsel