Citation Nr: 18155873 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 13-23 996 DATE: December 6, 2018 ORDER Entitlement to service connection for the cause of the Veteran’s death is granted. FINDINGS OF FACT 1. The Veteran served in Vietnam and is presumed to have been exposed to herbicide agents. 2. The Veteran died in May 2010; the death certificate lists the immediate cause of death as stroke due to, or as a consequence of, acute subdural hematoma due to, or as a consequence of anticoagulation therapy. 3. The Veteran’s hypertension, along with his history of smoking, is etiologically related to the immediate cause of death, a stroke. CONCLUSION OF LAW The criteria for establishing service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 1110, 1310, 1312, 5107; 38 C.F.R. §§ 3.303, 3.312 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service in the U.S. Army from September 1966 to August 1968. The Veteran died in May 2010. The appellant is the Veteran’s surviving spouse. Dependency and Indemnity Compensation benefits are payable to the surviving spouse of a veteran if the veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5 (2017). A veteran’s death will be considered as being due to a service-connected disability when the evidence establishes that the service-connected 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) (2017). 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) (2017). VA laws and regulations provide that, if a Veteran was exposed to herbicide agents during service, certain listed diseases are presumptively service connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). Where, as here, a Veteran “served in the Republic of Vietnam” between January 9, 1962 and May 7, 1975, the Veteran is presumed to have been exposed during such service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). Under 38 U.S.C. 1116, the National Academy of Science’s (NAS’s) Institute of Medicine is authorized to conduct biennial surveys of studies related to Agent Orange exposure and report to VA any scientific association found between exposure and specific diseases. See VBA Manual, M21-1, IV.ii.2.C.3.b. Recently, the NAS moved hypertension to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association between exposure to Agent Orange, an herbicide agent, and the development of hypertension. See Veterans and Agent Orange: Update 11 (2018), National Academies of Sciences, Engineering, and Medicine, http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25137 (November 28, 2018). In this case, the Veteran had service in Vietnam and as such, is presumed to have been exposed to herbicide agents. VA treatment records show that the Veteran developed hypertension by 2003. See, e.g., November 2003 VA treatment record. The Veteran died in May 2010. The death certificate indicates that the immediate cause of death was stroke due to, or as a consequence of, acute subdural hematoma due to, or as a consequence of anticoagulation therapy. At the time of his death, the Veteran was service connected for diabetes mellitus and PTSD. Following his death, the appellant claimed, among other things, that the Veteran’s death was related to his service-connected diabetes mellitus. Accordingly, in September 2010, a VA opinion was obtained. The examiner there concluded that it was less likely as not that the Veteran’s service-connected diabetes was related to his death. The examiner reasoned that the stroke/hematoma was unrelated to diabetes because the stroke was from a head bleed which had been facilitated by anticoagulation therapy. The examiner stated that although diabetes can predispose patients to stroke, typically they are ischemic strokes and not hemorrhagic strokes as in the Veteran’s case. The examiner further noted that the Veteran had multiple risk factors for developing such a stroke including hypertension, stating, “The cause of death was the stroke which was hemorrhagic and facilitated by anticoagulation therapy from the aortic valve replacement in addition to the fact that he had other risk factors including hypertension and a long history of smoking.” Based on the above, the Board finds that service connection for the cause of the Veteran’s death is warranted. In sum, competent and credible medical evidence has linked the Veteran’s service in Vietnam to his subsequent development of hypertension. In addition, the September 2010 VA opinion indicates that the Veteran’s hypertension and his history of smoking were significant risk factors for his development of a hemorrhagic stroke, which was the immediate cause of death. In other words, the Veteran’s hypertension, jointly with his history of smoking, was etiologically related to the immediate cause of death – the stroke. Hypertension is therefore a principal cause of death. See 38 C.F.R. § 3.312(b). Again, a veteran’s death will be considered as being due to a service-connected disability when the evidence establishes that the service-connected disability was either the principal or a contributory cause of death. 38 C.F.R. § 3.312(a). Accordingly, the appeal is granted. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Matthew Schlickenmaier, Counsel