Citation Nr: 18155030 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 15-15 498 DATE: December 4, 2018 ORDER Entitlement to service connection for cause of death is denied. FINDING OF FACT 1. The Veteran died in December 2011, and the death certificate documents the cause of his death as respiratory arrest, due to pneumonia, due to cerebral hemorrhage; no contributory cause of death was listed. 2. At the time of his death, the Veteran was service-connected for posttraumatic stress disorder (PTSD), atherosclerotic heart disease, diabetes mellitus, tinnitus, fracture residuals of the left index finger, allergic rhinitis, scars on the lip, acne vulgaris, erectile dysfunction, and loss of teeth. 3. The cause of the Veteran’s death is not reasonably shown to be related to service or a service-connected disability. CONCLUSION OF LAW Service connection for the cause of the Veteran’s death is not warranted. 38 U.S.C. §§ 1310, 5107 (2012); 38 C.F.R. § 3.312 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1966 to August 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for cause of death The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such a disability was either the principal or contributory cause of death. See 38 U.S.C. § 1310 (2012); see also 38 C.F.R. § 3.312 (2017). A service-connected disability is considered the “principal” cause of death when that disability, “singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto.” 38 C.F.R. § 3.312(b). A “contributory” cause of death is inherently one not related to the principal cause. 38 C.F.R § 3.312(c). A contributory cause must be causally connected to the death and must have “contributed substantially or materially” to death, “combined to cause death,” or “aided or lent assistance to the production of death.” Id. The Veteran died in December 2011, and his death certificate documents his cause of death as respiratory arrest, due to pneumonia, due to cerebral hemorrhage. The appellant asserts that the Veteran’s atherosclerotic heart disease caused an arteriosclerotic vessel to rupture, causing the cerebral hemorrhage. Alternatively, the appellant contends that the Veteran's PTSD led to alcohol use and abuse, which in turn led to his cerebral hemorrhage. Further, the Veteran has alleged that an undiagnosed traumatic brain injury (TBI) led to the Veteran's cerebral hemorrhage. In all instances, the appellant’s contention is that the cause of the Veteran’s death, began not with a cerebral hemorrhage, but with a service connected disability which caused the cerebral hemorrhage. The appellant has not argued, and the evidence does not otherwise suggest, that his cerebral hemorrhage was incurred in service or is otherwise directly related to service. See 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303(a) (2017). Except as provided in 38 C.F.R. § 3.300(c), a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310(a) (2017). This includes any increase in disability (aggravation) that is proximately due to or the result of a service connected disease or injury. See 38 C.F.R. § 3.310(b) (2017). Establishing service connection on a secondary basis requires (1) medical evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). In December 2016, the appellant asserted that the Veteran’s death was caused by his atherosclerotic heart disease. The appellant noted that cerebral hemorrhage is usually the result of a ruptured arteriosclerotic vessel. While the Veteran was service-connected for atherosclerotic heart disease, it is not shown that this condition caused the Veteran’s cerebral hemorrhage. In a January 2017 VA opinion, the physician noted that atherosclerosis in the heart does not cause cerebral hemorrhage, nor does it cause atherosclerosis in other anatomic locations, including the cerebral vessels. While the appellant believes there is a nexus between the Veteran’s atherosclerotic heart disease and his cerebral hemorrhage, she is not competent to provide a nexus opinion in this case. The issue is medically complex as it requires a detailed knowledge of the development of vascular diseases. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the January 2017 VA opinion. At various times the appellant has asserted that the Veteran’s cerebral hemorrhage was due to an undiagnosed TBI. In a September 2013 VA opinion, the physician indicated that the effects of a TBI do not take 40 years to manifest. As the Veteran did not have any manifestation of TBI symptoms for more than 40 years after service, it was less likely than not that if the Veteran had a TBI, it was related to service. Further, that physician stated that it was less likely than not that any of the Veteran’s service-connected disabilities contributed to his death. In a September 2004 VA examination, the Veteran denied a history of alcohol abuse prior to and during his military service. Additionally, the Veteran reported only infrequent use of alcohol, and in detailing his symptoms associated with PTSD, the Veteran did not include alcohol use or abuse. The September 2004 examiner diagnosed the Veteran with PTSD, chronic, moderate with delayed onset. The examiner did not include an indication that alcohol use or abuse was included in the diagnosis. In a September 2013 VA opinion, the physician stated that while alcohol use may have been the source of the Veteran's balance problems, tremors, and peripheral neuropathy conditions, none of his service-connected disabilities contributed to his death. The physician also noted that the Veteran had suffered two strokes in 2011 prior to his death. In an October 2016 VA opinion, a psychologist indicated that there was no consistent documentation that the Veteran used alcohol as a maladaptive means of coping with his PTSD. Had this been the case, it would have been routinely documented in the Veteran's treatment records. The examiner notes that there are only a few scattered references to alcohol. While the appellant contends that the Veteran's alcohol use contributed to his death, the probative evidence of record does not support such a contention. Although the appellant has submitted evidence that over 60 percent of Veteran's suffering from PTSD abuse alcohol, no medical professional has linked the Veteran's alcohol use to his PTSD. While the appellant believes there is a nexus between the Veteran’s alcohol use and his PTSD, the matter is medically complex and there is no indication in the record that the appellant has the requisite knowledge to provide an opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the multiple VA opinions. Based on the foregoing, the Board finds that the preponderance of the evidence is against the appellant’s claim for service connection for the cause of the Veteran’s death. In this regard, the Board places great probative weight on the VA examiners’ opinions (i.e., October 2012, September 2013, October 2016, and January 2017) that found, in part, it was not likely the Veteran’s service-connected PTSD or atherosclerotic heart disease contributed substantially or materially to the production of death, combined to cause death, or aided or lent assistance to the production of death. Collectively, these opinions had clear conclusions and supporting data, as well as reasoned medical explanations. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). The record reflects a history of mental health diagnoses, including PTSD. The fact that PTSD has been associated with service has been established, and was reflected in the award of service connection. The appellant is certainty capable commenting on the Veteran’s behavior over the years, and to the extent that such behavior is capable of lay observation, her statements are probative in describing it. Layno v. Brown, 6 Vet. App. 465 (1994). She contends, however, that the Veteran’s PTSD caused his alcohol abuse which in turn caused his cerebral hemorrhage which caused his death. Indeed, in several statements, appellant contends that the Veteran would drink due to his PTSD. This, she argues, really contributed to his health problems which lead to his death. The appellant does not possess the necessary medical expertise to assert to that the Veteran’s alcohol consumption is related to the service-connected PTSD and therefore contributed materially to his death. The assertion that his alcohol abuse was caused by his service-connected PTSD, is a conclusion of a complex medical nature, well beyond her lay expertise. The appellant’s representative submitted arguments that attempt to refute the examination opinions. The Board has considered the argument and medical references submitted, but find that it is of only limited value. The subject of such literature is sufficiently similar to the issue on appeal, however, generic information from a medical journal, treatise, or website is too “general and inconclusive” to establish a medical nexus to a disease or injury on its own. Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). A medical article or treatise can provide support for a claim, but must be combined with an opinion of a medical professional and be reflective of the specific facts of a case as opposed to a discussion of generic relationships. Sacks, 12 Vet. App. at 316-17. Here, no such medical opinion has been submitted along with the argument. Further, there is no indication that the appellant’s representative possesses the necessary medical expertise to offer an opinion. As a result, the submitted argument carries only minimal probative weight for the purposes of establishing a nexus between the relationship of PTSD and alcohol abuse. The Board is left without substantially probative evidence linking any service-connected disability to the Veteran’s death. Rather, the evidence clearly shows that the Veteran’s underlying cause of his death was respiratory arrest, due to pneumonia, due to cerebral hemorrhage. Without any evidence credibly showing one or more of the foregoing being related to service or a service-connected disability, the claim must be denied. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Uller, Associate Counsel