Citation Nr: 18150497 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-35 286 DATE: November 15, 2018 ORDER Dependency and Indemnity Compensation (DIC) based on service connection for the cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died in March 2004; the appellant is the Veteran’s surviving spouse. 2. The death certificate lists the immediate cause of death as sudden cardiopulmonary arrest. 3. At the time of the Veteran’s death, service connection was in effect for gouty arthritis, tinnitus, scars from excision of thrombosed hemorrhoids, mild wedge compression at D7-D8, and hallux valgus with osteoarthritis of the left great toe. 4. The service-connected disabilities did not substantially or materially contribute to the cause of the Veteran’s death. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1310, 5103, 5103A, 5107; 38 C.F.R. §§ 3.5, 3.102, 3.159, 3.301, 3.303, 3.307, 3.309, 3.310, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from February 1976 to February 1996. The appellant is the surviving spouse of the Veteran. Service Connection for the Cause of the Veteran’s Death Service connection may be granted for the cause of a veteran’s death if a disorder incurred in or aggravated by service either caused or contributed substantially or materially to the cause of death. To establish service connection for the cause of a veteran’s death, competent evidence must link the fatal disease to a period of military service or an already service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. §§ 3.303, 3.312. In order to establish service connection for the cause of a veteran’s death, the evidence must show that a disability incurred in or aggravated by active service was the principal or contributory cause of death. In order to constitute the principal cause of death the service-connected disability must be one of the immediate or underlying causes of death, or be etiologically related to the cause of death. Contributory cause of death is inherently one not related to the principal cause. In order to constitute the contributory cause of death it must be shown that the service connected disability contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, service connection for a disability requires evidence of: (1) the existence of a present disability; (2) in service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). In this case, the cause of the Veteran’s death is sudden cardiopulmonary arrest (which is not a cardiovascular “disease”), which is not listed as a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) for “chronic” in-service symptoms and “continuous” post service symptoms do not apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The appellant generally contends that that service-connected gouty arthritis resulted in the sudden cardiopulmonary arrest. After carefully reviewing the evidence of record, the Board finds that the probative and persuasive evidence is against the grant of service connection for the cause of the Veteran’s death. The Veteran died in March 2004; the death certificate lists the immediate cause of death as sudden cardiopulmonary arrest. No contributing causes were listed. The medical evidence of record does not show that the Veteran’s death was related to any injury, disease, or event during active service. Service treatment records do not show any symptoms, complaint, diagnosis, or treatment for a heart disorder. A September 1995 service separation examination found the Veteran’s heart and vascular system to be clinically normal and chest X rays revealed normal results. A review of the record shows no medical evidence of record etiologically relating the cause of the Veteran’s death to active service or to any injury, disease, or event during active service. The record includes a May 2017 private medical statement from Dr. H.S., wherein Dr. H.S. opined that it is at least as likely as not that the Veteran’s service-connected gout contributed substantially and materially to the development of sudden cardiopulmonary arrest. Dr. H.S. based the May 2017 opinion on research articles that purportedly show that gout is linked to a higher risk of death from all causes, including cardiovascular deaths. Additionally, Dr. H.S. generally stated that gout is characterized by inflammation, which contributes to cardiovascular events and accelerate atherosclerosis. The Board has reviewed the medical literature attached to the May 2017 private medical opinion and find that they are not probative in showing a causal connection between gout and sudden cardiopulmonary arrest. The article titled, “When gout goes to the heart: does gout equal a cardiovascular disease risk factor?” discusses an association between gout and increased risk of cardiovascular disease but acknowledges that causality has not been proven and the data on gout as a risk factor for incident heart disease, the data is mixed and debatable; the article does not address any association between gout and sudden cardiopulmonary arrest. The article titled, “Gout: an independent risk factor for all-cause and cardiovascular mortality” discusses an association between gout and a higher risk of death from all causes and cardiovascular diseases in a Taiwanese population; however, this article also does not address any causal relationship between gout and sudden cardiopulmonary arrest. Furthermore, as noted above, sudden cardiopulmonary arrest is not a cardiovascular “disease.” Notably, in the May 2017 private medical statement, Dr. H.S. acknowledged the Veteran’s history of tobacco use, mixed hyperlipidemia, and heavy alcohol use, and stated that it would be impossible to determine whether tobacco use and other risk factors, or the Veteran’s gout, was the primary cause of the cardiopulmonary arrest; however, each of those factors most likely contributed equally to the development of the sudden cardiopulmonary arrest. As discussed above, it is not sufficient to show that gout casually shared in producing death, but rather it must be shown that there was a causal connection between gout and sudden cardiopulmonary arrest. 38 C.F.R. § 3.312. Even though Dr. H.S. acknowledged the Veteran’s other significant risk factors for sudden cardiopulmonary arrest such as tobacco use, mixed hyperlipidemia, and heavy alcohol use, Dr. H.S. did not provide a rationale for why the Veteran’s service-connected gout contributed substantially and materially to the development of sudden cardiopulmonary arrest, rather than the other three known risk factors the Veteran had. As such, the Board finds Dr. H.S.’s May 2017 private medical opinion is of no probative value in establishing the service-connected gout resulted in sudden cardiopulmonary arrest as it is not supported by rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (requiring medical examiners to provide a “reasoned medical explanation connecting” observations and conclusions). For the reasons discussed above, the Board finds that the weight of the competent and probative evidence does not demonstrate that sudden cardiopulmonary arrest was the result of an injury, disease, or event during service, and that sudden cardiopulmonary arrest was not the result of the service-connected gouty arthritis. Further, because none of the Veteran’s other service-connected disabilities at the time of death have been alleged or shown to have caused or substantially contributed to death, service connection for the cause of the Veteran’s death is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Choi, Associate Counsel