Citation Nr: 18155635 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 15-22 393 DATE: December 4, 2018 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1960 to June 1985. The Veteran died in June 2013. The Appellant is the Veteran's widow. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA). The Appellant contends that the Veteran served in Vietnam, which exposed him to "herbicide agents," which in turn caused his death. VA had not service connected any disabilities for the Veteran when he passed, nor did he have any pending disability claims. He died of "presumed cardiopulmonary arrest," which is also known as sudden cardiac arrest. Therefore, for the Appellant to prevail, the Board needs to determine 1) if service connection is warranted for a cardiac disorder, and 2) if this cardiac disorder caused the Veteran's death. For the first question, the undersigned notes a September 2003 treatment record from Eglin Air Force Base shows the Veteran "received 2 units of packed red blood cells for symptomatic postoperative anemia with a history of coronary artery disease." This satisfies the first prong of a direct service connection claim. Additionally, the Appellant's representative, in its November 2018 brief, highlighted service personnel records showing the Veteran had temporary assignments at Tan Son Nhut Air Force Base in Vietnam. The undersigned has reviewed these records and concurs with the representative. Therefore, VA presumes the Veteran, by his Vietnam service, was exposed to "herbicide agents," as defined in 38 C.F.R. § 3.307(a)(6). Additionally, the undersigned notes that VA presumes that exposure to "herbicide agents" causes "ischemic heart disease," as defined in and pursuant to 38 C.F.R. § 3.309(e). The definition of "ischemic heart disease" is critical to this case. VA defines it as: "including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina" Taken together, VA will presume that the Veteran's "herbicide agents" exposure caused his coronary artery disease. This, however, is only half of the equation. Now, we need to determine if this cardiac disorder caused the Veteran’s death. The undersigned takes judicial notice that, as cited by numerous medical institutions including the Mayo Clinic on its website, "most cases of sudden cardiac arrest occur in people who have coronary artery disease." Given this, remand is warranted for a medical opinion on the relationship, if any, between the Veteran's coronary artery disease and his sudden cardiac arrest. The matter is REMANDED for the following action: 1. Send the Veteran’s file to a cardiologist to answer the following question: a) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease cause his sudden cardiac arrest? Why or why not? In answering this question, expressly address the relevance of the Mayo Clinic's statement on its website that "most cases of sudden cardiac arrest occur in people who have coronary artery disease." b) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease was the immediate or underlying cause of the Veteran's death? Why or why not? c) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease was etiologically related to the Veteran's death? Why or why not? d) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease contributed substantially or materially to the Veteran's death? Why or why not? e) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease combined to cause the Veteran's death? Why or why not? (Continued on the next page)   f) Is it at least as likely as not (50 percent probability) that the Veteran's coronary artery disease aided or lent assistance to the Veteran's death? Why or why not? KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Sopko, Counsel