Citation Nr: 18155252 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 15-03 875 DATE: December 3, 2018 ORDER Service connection for the cause of the Veteran’s death is denied. FINDING OF FACT The Veteran’s immediate cause of death was cardiopulmonary arrest as a consequence of pulmonary embolism which was not related to the Veteran’s military service. CONCLUSION OF LAW The criteria to establish service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1110, 1310, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.5, 3.102, 3.159, 3.301, 3.303, 3.307, 3.309, 3.312 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from July 1968 to July 1970. He died in early 1994. The appellant is the Veteran’s surviving spouse. The Veteran had no service-connected disabilities at the time of his death. This appeal was remanded by the Board in May 2018 for additional development. Entitlement for service connection for the cause of the Veteran’s death Dependency and indemnity compensation (DIC) is payable to the surviving spouse, parent, or child of a veteran if the veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The issue involved will be determined by exercise of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including, particularly autopsy reports. 38 C.F.R. § 3.312(a). The service connected disability will be considered as the principal (primary) cause of death when such 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). Contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it 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(c)(1). In order to establish service connection for the cause of death, there must be (1) evidence of death; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and death. Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999). In the Veteran’s early-2014 death certificate, his cause of death is listed as cardiopulmonary arrest as a consequence of pulmonary embolism. In September 2014 Dr. Gregory J. Healey, M.D. (hereinafter ‘Dr. G.H.’) provided a medical opinion regarding the Veteran’s cause of death. Dr. G.H. indicated that the Veteran’s likely cause of death was coronary artery disease. Dr. G.H. stated that cardiopulmonary arrest due to pulmonary embolism is a less likely cause but could not be ruled out. Dr. G.H. opined that the Veteran’s likely cause of death was cardiopulmonary arrest due to coronary artery disease. The clinician also noted undiagnosed type II diabetes as a possible contributory cause but did not explain possible links between diabetes and the Veteran’s cardiopulmonary arrest. In September 2018, the Veteran’s records were reviewed by a VA examiner. The examiner concluded that the Veteran’s cause of death was not related to his military service in any way. The examiner noted that the Veteran’s medical treatment records are silent for treatment or diagnosis for coronary artery disease or type II diabetes. The examiner opined that the Veteran’s diagnosis of pulmonary embolism is a more likely cause of death during the 3rd and 4th decades of life according to medical literature. The Board is presented with two medical opinions as to whether the Veteran’s death is related to his military service. Generally, the law recognizes that the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider is weighed by such factors as its thoroughness and degree of detail, and whether there was review of the veteran’s claims file. Prejean v. West, 13 Vet. App. 444 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. Bloom v. West, 12 Vet. App. 185 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379 (1998); see also Claiborne v. Nicholson, 19 Vet. App. 181 (2005) (rejecting medical opinions that did not indicate whether the physicians examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data); Miller v. West, 11 Vet. App. 345 (1998) (observing that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record). It is not clear from the opinion whether Dr. G.H. reviewed the Veteran’s medical records. Dr. G.H. also acknowledged that the Veteran had been previously asymptomatic with no history of recent injury or hospitalization. Dr. G.H. additionally noted that the Veteran was not being treated for any underlying medical problems. In light of these acknowledgements, Dr. G.H. does not explain how the Veteran’s cardiopulmonary arrest was more likely due to coronary artery disease when there is no evidence of a diagnosis or treatment for coronary artery disease. The VA examiner’s opinion clearly reviewed in depth the Veteran’s electronic file, his medical history, Dr. G.H.’s opinion and was fully explained. The VA examiner noted the absence of coronary artery disease in the Veteran’s file and opined that the more likely cause of death was due to a pulmonary embolism given the Veteran’s age and lack of medical conditions. The examiner noted that according to medical literature, pulmonary embolism is a more likely cause of death in this circumstance. A preponderance of the evidence is against a finding that the Veteran’s cardiopulmonary arrest was substantially caused by his military service. Therefore, service connection for the cause of the Veteran’s death is not warranted and the claim is denied. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Wozniak, Joshua