Citation Nr: 18151490 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 16-48 520 DATE: November 19, 2018 ORDER Entitlement to service connection for the Veteran's cause of death is denied. FINDINGS OF FACT 1. The Veteran died in December 2003; the death certificate shows the immediate cause of death was cardiac standstill due to or as a consequence of valvular heart disease, with hypertension and left ventricular hypertrophy listed as other significant conditions. 2. At the time of his death, the Veteran was not service-connected for any disabilities. 3. The Veteran is presumed to have been exposed to Agent Orange during service while stationed in Vietnam. 4. There is no competent evidence that the Veteran was diagnosed with ischemic heart disease. 5. The Veteran’s death was not related to any service-connected disability, or any disease of service origin. 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, 1131, 1310, 5107(b) 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from November 1969 to August 1971. The Veteran died in December 2003. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. Entitlement to service connection for the Veteran's cause of death The appellant contends that she is entitled to service connection for the Veteran’s cause of death because his death is related to the vertigo and heart problems he developed from service. See August 2012 VA Form 21-534 Application for Dependency and Indemnity Compensation. She further contends that the Veteran suffered from ischemic heart disease secondary to his in-service exposure to Agent Orange. For the reasons explained below, the Board finds that the service connection for the Veteran’s cause of death is not warranted. Service connection for the cause of a Veteran’s death is warranted if a service-connected disability either caused or contributed substantially or materially to the cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In determining whether a service-connected disability contributed substantially or materially to death, the evidence must show that it combined to cause death or 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 (c)(1); see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). In this instance, the primary cause of the Veteran’s death was cardiac stand still due to or as a consequence of valvular heart disease. Hypertension and left ventricular hypertrophy were also listed as significant conditions contributing to death. Service connection was not in effect at the time of his death for any disabilities. If a veteran was exposed to Agent Orange during active service, presumptive service connection is warranted for certain specified diseases, including ischemic heart disease. 38 C.F.R. §§ 3.307, 3.309. A veteran is presumed exposed to Agent Orange if he or she had active military, naval, or air service, in the Republic of Vietnam from January 9, 1962 through May 7, 1975, “unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service.” 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). Here, the Veteran’s DD-214 reflects that the Veteran received the Vietnam Campaign and Service medals. Accordingly, he is presumed exposed to Agent Orange. See 38 C.F.R. § 3.307 (a)(6)(iii). However, as will be discussed, there is no competent evidence that the Veteran suffered from ischemic heart disease. Therefore, presumptive service connection is not warranted under 38 C.F.R. 3.309 (e). Notwithstanding the foregoing, the Veteran may still establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disorder; (2) an 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 disorder. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service treatment records are silent for a diagnosis of heart disease, including ischemic heart disease or hypertension. Private treatment records from The Methodist Hospitals, Inc. indicate that the Veteran was unsuccessfully treated for cardiac respiratory arrest and died in December 2003. Previous treatment history from Dr. A.A. indicates that the Veteran had a family history of heart disease. His father and brother died from a heart attack and his mother died from a stroke at age 39. The Veteran also had a history of treatment for hypertension, which was noted to be responsive to exercise. A January 2001 echocardiogram from the Heart Center of Lake County indicated that the Veteran had left ventricular hypertrophy. None of the records related the Veteran’s disabilities to service. The RO obtained a medical opinion in July 2016 where the clinician opined that it was less likely than not that the Veteran had a diagnosis of ischemic heart disease. The clinician reasoned that “testing did not show signs of ischemic heart disease including a stress test and echo prior to death.” The clinician further opined that the Veteran’s service treatment records did not reveal a diagnosis which would have at least as likely as not contributed to the Veteran’s death. The clinician reasoned that “[t]here was no evidence of valvular heart disease in the records and the Veteran had normal blood pressure documented at discharge. None of the records indicate a chronic medical condition making it likely that all the conditions that contributed to the Veteran’s death developed after discharge.” The Board finds the July 2016 opinion to be probative in nature. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); see also Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). The clinician reviewed the Veteran’s claims folder and specifically addressed the Veteran’s in-service and available post-service medical records. Ultimately, the clinician opined against a finding that the Veteran’s death was caused by a service-connected disability. The Board notes that the appellant stated that the Veteran sought treatment for his heart condition from private providers during his lifetime, post-service; however, his records had been destroyed. See September 2016 VA Form 9. She indicated that she had forwarded all available private treatment records to VA. The Board finds that a remand is not necessary to attempt to obtain missing private treatment records as further development of the record is neither required nor likely to yield any substantial benefit to the appellant’s claim. The Board also notes that the appellant stated that she received the Veteran’s medical records from B.G., support services division chief of the Regional Office in Indianapolis, Indiana. She reported that B.G. “specifically stated,” that the Veteran’s death should be service-connected. See September 2016 VA Form 9. However, the Board does not attach any probative value to this statement. The appellant does not contend nor does the evidence indicate that B.G. is competent to opine on the etiology of the Veteran’s death. Further, there is no supporting documentation to state how B.G. may have arrived at this conclusion. Without more, the Board cannot assign any probative value to this statement. The Board acknowledges the appellant’s belief that the Veteran’s death was caused by a disability related to service, specifically ischemic heart disease. However, the appellant is not competent to provide such an opinion. The July 2016 VA clinician specifically opined that the Veteran did not have a diagnosis of ischemic heart disease. Therefore, the Board does not assign any probative value to the appellant’s assertions that the Veteran’s death was related to service. (Continued on the next page)   In denying this claim, the Board does not intend to diminish the Veteran’s service to his country. However, for the above reasons, the Board concludes that the preponderance of the evidence is against a finding that a disability incurred in or caused by service caused or contributed substantially or materially to the Veteran’s death. As the preponderance of the evidence is against the claim of service connection for the Veteran’s cause of death, the benefit of the doubt doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b). Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs