Citation Nr: 18150181 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 14-42 772 DATE: November 14, 2018 REMANDED The issue of entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1966. He passed away in February 1986; the appellant is his surviving spouse. This matter comes to the Board of Veterans’ Appeals (Board) from a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania that denied the benefit sought on appeal. Service connection for the cause of the Veteran’s death is remanded. A February 1986 certificate of death shows that the cause of the Veteran’s death was determined to be ischemic heart disease. The Appellant asserts that the Veteran developed ischemic heart disease as a result of in-service exposure to Schistosomiasis Mansoni. For this reason, she asserts that service connection for the cause of his death is warranted. September 1965 service treatment records demonstrate that the Veteran was treated for intestinal schistosomiasis, confirmed by biopsy. The treating clinician noted that work up had revealed evidence of electrocardiographic changes, but the changes were assessed as minor and of no clinical significance. Subsequently, a November 1965 narrative summary stated that “[t]his man was born and raised in Puerto Rico where he contracted an infestation with schistosoma mansoni, probably from river bathing, swimming, etc.” In support of her claim, the appellant submitted April 2012 correspondence from Dr. E.R., in which Dr. E.R. stated that the Veteran “suffered from ‘bilharzia’ or schistosomiasis, a disease known to cause ischemic cardiomyopathy. In contrast to the conclusion reached by the clinicians who treated the Veteran in service, Dr. E.R. opined that it was very likely that the Veteran developed ischemic cardiomyopathy as a result of schistosomiasis that was acquired in the Veteran’s “Vietnam War scenario,” as the Veteran was a healthy person all his life and died at an early age, as a result of undiagnosed, untreated ischemic heart disease. A July 2012 VA examiner concluded that it was less likely than not that the Veteran’s ischemic heart disease was proximately due to or otherwise the result of the Veteran’s service. In reaching this conclusion, the examiner stated that she was unaware of any medical literature that etiologically linked schistosomiasis with coronary artery disease, which was the underlying cause of ischemic cardiomyopathy or ischemic heart disease. In response to the July 2012 VA opinion, the Appellant submitted two medical articles pertaining to the relationship between chronic bilharzia or schistosomiasis mansoni and heart conditions. The documents were later translated in June 2018. Given the possible relationship between the in-service diagnosis of schistosomiasis and ischemic heart disease, the Board finds that an additional medical opinion should be obtained prior to adjudication of the claim. The Board acknowledges the positive nature of the April 2012 correspondence from Dr. E.R., however the opinion lacked an adequate rationale and did not offer any supporting evidence. Stefl v. Nicholson, 21 Vet. App. 120 (2007). In addition, the Veteran’s service records demonstrate that the Veteran served in Germany, not Vietnam as Dr. E.R. suggested. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion must be based upon an accurate factual premise). As such, a new medical opinion should be obtained on remand. The matter is REMANDED for the following action: 1. If there is outstanding evidence, the Appellant should be invited to submit such evidence, including medical literature or nexus opinions. The Appellant should be provided an appropriate amount of time to submit this evidence. 2. Obtain an opinion from a qualified clinician addressing whether it is at least as likely as not (i.e., a probability of 50 percent or more) that the Veteran’s ischemic heart disease, or other heart condition, was related to his service, to include the schistosomiasis for which he was treated therein? Please explain why or why not. In answering this question, the examiner should bear in mind that although the service treatment records document a conclusion that the Veteran contracted and/or was infected with the parasite causing schistosomiasis prior to his entrance into service, he is presumed to have been in sound condition upon service entry, as the enlistment records do not reflect any relevant abnormalities. If the examiner determines that there is a positive causal relationship between the schistosomiasis and the later development of ischemic heart disease, the examiner should state whether it is undebatable that the Veteran did indeed contract and/or become infected with the parasite causing schistosomiasis prior to his entrance into service. The examiner must explain the reasons for the conclusion reached. In answering each of these questions, the examiner should specifically consider and comment on the following: (a.) A September 1965 service treatment records documenting treatment for intestinal schistosomiasis. (b.) An April 2012 correspondence where Dr. E.R. found that the Veteran “suffered from ‘bilharzia’ or schistosomiasis, a disease known to cause ischemic cardiomyopathy.” (c.) The July 2012 VA medical opinion. (Continued on the next page)   (d.) The medical literature submitted by the Appellant and translated in June 2018. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Altendorfer, Associate Counsel