Citation Nr: 18158107 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-01 483 DATE: December 14, 2018 ORDER Entitlement to service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The official death certificate demonstrates that the Veteran died in February 2013, and the immediate cause of death was listed as acute on chronic renal failure, acute on chronic systolic congestive heart failure, pleural effusion, and encephalopathy metabolic. 2. At the time of his death, the Veteran was not service connected for any conditions. 3. The probative evidence of record does not show the Veteran’s death resulted from any disorder incurred in or caused by service. CONCLUSION OF LAW The criteria for entitlement to service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1110, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty with the U.S. Army from November 1963 to November 1965. The Veteran died in February 2013, and the appellant is his surviving spouse. The Board remanded the appeal in August 2018 for an addendum opinion, which was obtained in September 2018 and is associated with the record. 1. Entitlement to service connection for the cause of the Veteran's death. To establish service connection for the cause of the Veteran’s death, the evidence must show that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(a). To constitute the principal cause of death, the service-connected disability must be one of the immediate or underlying causes of death, or be etiologically related to the cause of death. 38 C.F.R. § 3.312(b). It is not sufficient to show that a service-connected disability casually shared in producing death; rather, it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1). A contributory cause of death is defined as one inherently not related to the principal cause. 38 C.F.R. § 3.312(c). For a service-connected disability to constitute a contributory cause, it must be shown that it “contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death.” Id. The Board must also determine whether the Veteran had a disability incurred in or aggravated by service that was either the principal or the primary cause of death, or that it was a contributory cause of death. The Veteran’s official death certificate shows that he died in February 2013, and the immediate cause of death was listed as acute on chronic renal failure, stage 5; acute on chronic systolic congestive heart failure; pleural effusion and encephalopathy metabolic. The appellant contends that the Veteran’s death was related to service; specifically, chest pain, high blood pressure, and diagnoses of urethritis due to gonococcus, staphylococcus coagulase (positive and negative), and diphtheroid. At the time of his death, the Veteran was not service connected for any disabilities. The Veteran’s service treatment records (STRs) were negative for any diagnosis or treatment for any of the conditions that were noted to have caused his death. On an October 1965 report of medical history, the Veteran indicated that he experienced pain or pressure in his chest and selected boxes indicating that he (1) experienced high or low blood pressure, and (2) had never experienced high or low blood pressure. In a separate report of medical history completed on that same day, the Veteran denied having high blood pressure or chest pains. The Veteran’s STRs do not show any complaints or treatment for chest pains or high blood pressure. A September 1965 treatment note showed a diagnosis of acute urethritis due to gonococcus that was treated with bicillin. Lab results of a penile culture showed staphylococcus coagulase positive, staphylococcus coagulase negative, and diphtheroid. The October 1965 separation exam did not show any clinical abnormalities. Post-service medical records from cardiology specialists showed various diagnoses including hypertension, pleural effusion, and cardiomyopathy, as well as extensive monitoring and treatment; however, there was no indication that his conditions were related to service. A VA medical opinion was obtained in December 2016 and the examiner noted that the Veteran’s cause of death was less likely than not related to service. As noted above, the appellant has argued that the Veteran’s death was related to in-service diagnoses of acute urethritis due to gonococcus and staphylococcus coagulase positive, negative, and diphtheroid. Upon review, the examiner noted that there was “no evidence of ongoing diagnosis of, nor evidence for, nor residuals of, nor complications of urethritis following treatment while in service nor within one year of military separation.” The examiner noted that the Veteran was on diuretic therapy which is used to treat hypertension and peripheral edema and that he had a history of hypertension and diabetes mellitus, which are noted factors for kidney disease. As a result, the examiner concluded that the Veteran was predisposed to the development of renal failure based on these nonservice-connected disabilities. An addendum opinion was obtained in September 2018 and the examiner provided a negative opinion based on a review of the Veteran’s medical records, including his death certificate, the Board remand, and the previous medical opinion. The examiner wrote: “…although on page 29 of 34 in the STRs, there was a check mark showing “yes” after high or low blood pressure, that “yes” mark was actually for venereal disease, not high or low blood pressure, there was no evidence of hypertension or report of history of hypertension from the Veteran while in service, nor were there evidence of a diagnosis of nor treatment for the conditions noted that led to the Veteran’s renal failure, to include hypertension, while in service nor within one year of military discharge nor were there any supporting evidence in the medical records reviewed that would provide evidence to support the above claim.” The examiner also addressed whether the Veteran’s death was related to air-gun vaccinations received during service. Specifically, the examiner noted that the STRs were silent as to any adverse reactions or complications following the vaccinations that would have predisposed, or led to any conditions of renal failure more than four decades after his separating from service. The Board considers both the December 2016 and September 2018 VA opinions to be highly probative. They are well supported by rationale and based on accurate facts and a review of the record. Nieves-Rodriguez, 22 Vet. App. at 302-05. Importantly, the Board notes that there are no opposing opinion of record. The Board finds that service connection for cause of death due to chronic renal failure, chronic systolic congestive heart failure, pleural effusion, and encephalopathy, or any other condition mentioned in the medical evidence is not warranted. For a condition to qualify as a service-connected cause of death, it must be shown that the condition contributed substantially or materially to cause death. Here, the most recent medical determination of death is principally renal failure, and congestive heart failure. The medical evidence of record, however, does not establish a nexus relationship between the Veteran’s renal or heart failure, or any other listed condition and active service. There is also no probative evidence to suggest that the causes of the Veteran’s death began in military service, or were caused by some event or experience in service. In addition, there is no evidence of his heart condition manifesting to a compensable degree within one year of military discharge. The weight of the evidence does not demonstrate a link between his death and military service. Therefore, service connection for the cause of the Veteran’s death is denied because the evidence fails to show it was related to military service. As there is no evidence of in-service injury or manifestation within the first post service year, service connection for these disabilities is not warranted in this case. 38 C.F.R. §§ 3.303, 3.307, 3.309(a). In assessing the evidence, the Board acknowledges the appellant is competent to provide evidence regarding the symptoms she observed the Veteran exhibited prior to his passing. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007) (holding that while a layperson is not competent to opine as to medical etiology or render medical opinions, they are competent to establish the presence of observable symptomatology). The Board notes the appellant’s lay statements as to the etiology of the Veteran’s death; however, the Board is unable to accord the appellant’s statements probative weight because she is not competent to render a medical diagnosis or opinion on such a complex medical question. See Jones v. West, 12 Vet. App. 460, 465 (1999) (holding that only those with specialized medical knowledge, training, or experience are competent to render a medical diagnosis); see also Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). As the weight of the competent and probative evidence does not demonstrate a nexus between the Veteran’s cause of death and service, the Board finds that service connection for the Veteran’s cause of death is not warranted. Because the preponderance of the evidence is against the claim for service connection for the Veteran’s cause of death, the claim must be denied and the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Price, Associate Counsel