Citation Nr: 18157967
Decision Date: 12/13/18	Archive Date: 12/13/18

DOCKET NO. 14-28 428A
DATE:	December 13, 2018
ORDER
Entitlement to service connection for cause of death is granted.
FINDING OF FACT
The Veteran’s service-connected psychiatric disorder was a substantial contributing factor to his death.
CONCLUSION OF LAW
The criteria for entitlement to service connection for cause of death have been satisfied. 38 U.S.C. §§ 1310, 5103, 5103A, 5107; 38 C.F.R. § 3.312.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty in the United States Marine Corps from November 1942 to October 1945, including combat service during World War II and his decorations included the Purple Heart Medal.  He died in April 2013.  The appellant is the Veteran’s surviving spouse.  
This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).
Service Connection for Cause of Death
The appellant seeks service connection for the cause of the Veteran’s death, contending that his service-connected psychiatric disorder ultimately resulted in his death.  The Veteran died in April 2013.  The cause of death listed on the death certificate was Alzheimer’s dementia.  Prior to his death, he was service-connected for post-traumatic stress disorder (PTSD).  The appellant asserts that the Veteran’s Alzheimer’s dementia was related to his PTSD.  
To establish service connection for the cause of a veteran’s death, the evidence must show that a disability incurred in or aggravated by active service was either (1) the principal (primary) cause of death or (2) a contributory cause of death.  To be considered a principal (primary) cause of death, a service-connected disability, singly or jointly with some other condition, must have been the immediate or underlying cause of death or have been etiologically related to the cause of death.  38 C.F.R. § 3.312(b).  For a service-connected disability to be a contributing cause, it must have substantially or materially contributed to the Veteran’s death.  Id.  
The Board finds that the competent and credible evidence is in approximate balance on the issue of whether the Veteran’s death was due to a psychiatric disorder that is related to service.  A September 2009 VA examiner essentially said that the Veteran’s PTSD and dementia were of the same disease process and noted that the Veteran’s PTSD symptoms were an Axis IV stressor that was etiologically related to his Axis I diagnosis of Alzheimer’s dementia.  See Hernandez-Toyens v. West, 11 Vet. App. 379, 382-83 (1998) (observing that the Axis IV assessment includes a determination as to etiologically significant psychosocial stressors and finding that, by listing the veteran’s military service as part of the Axis IV assessment, the examining physician made a determination that the veteran’s period of service was an “etiologically significant psychosocial stressor” contributing to the current acquired psychiatric condition diagnosed under Axis I).  Based on this assessment, the Board finds that entitlement to service connection for cause of death is warranted.
 
STEVEN D. REISS
Veterans Law Judge
Board of Veterans’ Appeals
TTORNEY FOR THE BOARD	Tracie N. Wesner, Counsel