Citation Nr: 18150460
Decision Date: 11/15/18	Archive Date: 11/15/18

DOCKET NO. 14-40 512
DATE:	November 15, 2018
REMANDED
The issue of entitlement to service connection for cause of the Veteran’s death is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1969 to August 1970. The Veteran passed away in March 1998; the Appellant is his surviving spouse.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin.
The Appellant contends that her husband’s death is the result of his exposure to herbicide agents while serving in Vietnam.  
The Veteran’s Form DD-214 verifies that the he served in Vietnam between July 13, 1969 and August 10, 1970. 
The March 1998 Certificate of Death lists cardiopulmonary arrest as the immediate cause of the Veteran’s death, due to or as a consequence of “probable pulmonary embolus.”  Notably, an autopsy was not performed. 
In an April 2011 Statement in Support of Claim, the Appellant reported that “[o]n March 27, 1998, we had just gone to bed when I heard him making strange sounds.  When I turned on the light, he was already dead.” She stated that “I only just learned that there are many conditions and disabilities that have been found to have been caused by exposure to agent orange and that heart disease is one of them.” She maintained in an August 2014 notice of disagreement that her husband died of “cardiac causes.” She went on to say that “[h]He had no history or diagnosis of heart disease.” 
The Appellant stated that she does not have medical records documenting treatment of a cardiac condition prior to the Veteran’s death.  Specifically, in April 2011, the Appellant stated that “[t]here are no hospital records or medical treatment notes that I can submit in support of my claim.” 
As an autopsy was not performed at the time of death, it is unclear to the Board whether it is as likely as not that the Veteran’s death could have been caused by coronary artery disease rather than a pulmonary embolism.  As such, the Board finds that a VA medical opinion that addresses whether the Veteran had a cardiac condition prior to his death should be obtained on remand. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c); McLendon v. Nicholson, 20 Vet. App. 79 (2006).
The matter is REMANDED for the following action:
1. Ask the Appellant to complete a VA Form 21-4142 for the Veteran’s primary care provider.  Make two requests for the authorized records from any treatment records that are relevant to the Appellant’s claim, unless it is clear after the first request that a second request would be futile.
2. Send the Veteran’s claims file to a competent medical examiner for review. Following a thorough review of the claims file, the clinician should respond to the following:
Based on your review of the evidence of record, is it at least as likely as not (50 percent probability or more) that the Veteran’s death was related to underlying ischemic heart disease as opposed to pulmonary embolism. Please explain why or why not, specifically considering and discussing the Veteran’s medical history, the Appellant’s lay statements, and the certificate of death. 
If you determine that a pulmonary embolism was the more likely cause of death, please provide an opinion stating whether it is at least as likely as not that the pulmonary embolism was related in any way to the Veteran’s active service, to specifically include his service in Vietnam.
 
S. C. KREMBS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	I. Altendorfer, Associate Counsel