Citation Nr: 18156052 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 12-16 884 DATE: December 6, 2018 ORDER The claim for entitlement to service connection for the cause of the Veteran's death is granted. FINDINGS OF FACT 1. The Veteran died in July 2008 due to continuous ambulatory peritoneal dialysis peritonitis. Significant conditions contributing to his death were end-stage renal disease, hepatitis, and hypertension. 2. At the time of the Veteran’s death, service connection was not established for any disabilities. 3. The Veteran’s hypertension had its onset during active duty and was a contributory cause of his death. CONCLUSION OF LAW Service connection for the cause of the Veteran’s death is warranted. 38 U.S.C §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1970 to January 1974. He died in July 2008. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. This case was previously before the Board in June 2015 and May 2017 when it was remanded for further development. It has now returned to the Board for additional appellate action. 1. Entitlement to service connection for the cause of the Veteran's death. The Veteran died on July [redacted], 2008. The death certificate shows that the cause of death was continuous ambulatory peritoneal dialysis peritonitis. Other conditions contributing to his death were end-stage renal disease, hepatitis, and hypertension. The appellant contends that the Veteran hypertension was a contributory cause of his death and is etiologically related to the Veteran’s in-service exposure to herbicide agents. The death of a veteran is considered due to a service-connected disability where the evidence establishes that such disability was either the principal or contributory cause of death. 38 C.F.R. § 3.312(a). A principal cause of death is one which, singularly 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 one which contributes substantially or materially to death, or aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c). The Board finds that service connection is warranted for the Veteran’s cause of death. The record establishes that hypertension was a contributory cause of his death and had its onset during active duty service. Service records note several findings of elevated blood pressure, to include in June 1973. At that time, the Veteran received a cardiac work-up and limited duty profile for persistent chest pain. Echocardiograms performed in June 1973 indicated abnormalities consistent with early polarization, an acute late myocardial infarction, or pericarditis. The Veteran’s blood pressure was also elevated at the January 1974 separation examination when it was measured to 140/88. The record contains several medical opinions weighing both for and against service connection—though the medical opinions agree that the Veteran’s end-stage renal disease (and related peritoneal dialysis and peritonitis) were related to uncontrolled hypertension. VA examiners in July 2008 and April 2018 issued medical opinions against service connection for the cause of the Veteran’s death; however, these medical opinions are inadequate and focus on the appellant’s contention of in-service exposure to herbicide agents. The appellant also submitted a private medical opinion in support of the claim, but this opinion is speculative and similarly of reduced probative value. The most persuasive competent evidence is a November 2018 opinion from a VA expert in cardiology. After reviewing the claims file, the VA expert concluded that the Veteran’s hypertension had its onset prior to his separation from active duty service. Based on the November 2018 VA expert opinion, the contents of the Veteran’s service records, and the death certificate, the Board finds that service connection is warranted for the Veteran’s death. The evidence establishes that the hypertension   had its onset during the Veteran’s active duty service and was a contributory cause of his death in July 2008. The claim is therefore granted. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Riley, Counsel