Citation Nr: 18156924
Decision Date: 12/11/18	Archive Date: 12/11/18

DOCKET NO. 16-56 858
DATE:	December 11, 2018
REMANDED
Entitlement to service connection for the cause of the Veteran's death is remanded.
REASONS FOR REMAND
The Appellant is the surviving spouse of a Veteran who served on active duty from December 1966 to November 1968. The Veteran died in April 2010. This matter is before the Board of Veterans Appeals (Board) on appeal from a February 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. 
1. Entitlement to service connection for the cause of the Veteran's death is remanded.
The Veteran’s death certificate lists his cause of death as chronic pulmonary obstructive disease (COPD). An August 2016 VA examination noted that the COPD was “mostly due to smoking” and that it was “unclear what caused the paralyzed diaphragm.” The examiner concluded that it was less likely than not that the Veteran’s service-connected shrapnel wounds or PTSD, or medication used to treat these conditions, materially or substantially contributed to his death. 
As a rationale, the examiner explained that medical records do not indicate that pain medications were being used in volumes that would have led to breathing impairment. Further, the Veteran’s separation examination and post-service medical records are absent any condition dating back to his service that may have contributed to his death. 
Additionally, the examiner referenced an undated psychologist note from M.J., Ph.D., in which the psychologist opined that it was at least as likely as not that the wounds the Veteran suffered in-service contributed to his “final demise.” The psychologist explained in a subsequent note that an episode of PTSD caused a January 2001 motor vehicle accident in which the Veteran sustained “insurmountable trauma” to his right lung due to rib fractures. Upon receiving treatment for these injuries, the Veteran had another PTSD episode, causing him to thrash about, which caused his pneumothorax (collapsed lung). Thereafter, the Veteran had continued difficulty breathing, requiring oxygen therapy until his death. The VA examiner’s opinion did not address this well-reasoned and highly probative positive evidence. Accordingly, an addendum opinion must be obtained to determine whether the Veteran’s cause of death was in any way related to his PTSD. 
The matter is REMANDED for the following action:
1. Request a records review and medical opinion from an appropriate specialist to determine whether the Veteran’s cause of death is related to his service in any way. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. 
2. The reviewing clinician is asked to respond to the following:
(a). Is it at least as likely as not (a 50 percent probability or greater) that any identified cause of death or significant contributing condition is causally related to the Veteran’s PTSD?
(b) Is it at least as likely as not (a 50 percent probability or greater) that any identified cause of death or significant contributing condition was aggravated beyond the normal course of the condition (i.e., any increase in severity beyond natural progression of the disability) by his PTSD?
Specifically, the examiner MUST address whether the Veteran’s PTSD caused or contributed to the Veteran’s rib injuries suffered during the January 2001 motor vehicle accident, and whether those injuries were aggravated by a “thrashing” episode in the hospital also caused by the Veteran’s PTSD.


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In forming this opinion, the examiner MUST address whether these injuries caused or materially contributed to the COPD which caused the Veteran’s death. 
 
VICTORIA MOSHIASHWILI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. McKone, Law Clerk