Citation Nr: 18159053 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 09-34 529 DATE: December 18, 2018 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from December 1971 to February 1974. The Veteran passed away in December 1989. The appellant is his surviving spouse. In June 2014, the Board denied the appellant’s claim for entitlement to service connection for the cause of the Veteran’s death. The appellant appealed to the United States Court of Appeals for Veterans Claims (Court). In a June 2015 Order, the Court granted the VA General Counsel’s and Appellant’s Joint Motion for Remand, vacating the Board’s decision and remanding the claim to the Board. This case was most recently remanded by the Board in March 2018 for further development. While the Board sincerely regrets the delay, additional development is needed prior to further disposition of the claim for service connection for the Veteran’s cause of death. Entitlement to service connection for the cause of the Veteran’s death is remanded. During his lifetime, the Veteran was only service-connected for schizophrenia, rated as 100 percent disabling at the time of his death. The Veteran’s death certificate lists respiratory failure and bronchopneumonia as the immediate causes of death. It does not list any other significant conditions contributing to the Veteran’s death. The appellant previously asserted that service connection is warranted for the Veteran’s cause of death because the Veteran’s service-connected schizophrenia caused him to in engage in illicit drug use, which caused him to contract HIV or AIDS and thereby led to his death from respiratory failure and bronchopneumonia as complications of HIV or AIDS. This case was most recently remanded by the Board in March 2018 to obtain a VA opinion regarding whether it was at least as likely as not that the Veteran had a diagnosis of HIV or AIDS during his lifetime. The March 2018 remand instructions requested, in pertinent part, the examiner opine as follows: a) Provide an opinion as to whether it at least as likely as not (50 percent probability or greater) that the Veteran had a diagnosis of HIV or AIDS during his lifetime. b) If so, then provide an opinion as to whether it is at least as likely as not that the Veteran’s drug abuse during his lifetime caused his HIV or AIDS. c) If the responses to a) and b) above are both in the affirmative, provide an opinion as to whether it is at least as likely as not that the Veteran’s drug abuse was proximately due to, the result of, or aggravated by the [sic] his service-connected schizophrenia. d) If the responses to a), b), and c) above are all in the affirmative, provide an opinion as to whether it is at least as likely as not that the Veteran’s HIV or AIDS was a principal or contributory cause of his death. In October 2018, a VA examiner opined that it was less likely than not that the Veteran had a diagnosis of HIV or AIDS during his lifetime. Following consultation with an infectious disease specialist and a radiologist, the examiner explained that the October 1998 chest x-ray findings are not pathognomonic for an AIDS-related pulmonary condition with 50 percent or greater probability, and that the accepted standard for a diagnosis of AIDS is a positive blood test for HIV, not a chest x-ray reading. It was noted that no positive blood test finding for HIV was found. In addition, the examiner noted that the October 1998 chest x-ray was non-specific and could represent multiple causes, but was not diagnostic for AIDS. In light of the foregoing, the October 2018 VA examiner appropriately found remand directives b) through d) moot. In August 2018 correspondence, the appellant, through her representative, raised the theory that the Veteran’s service-connected schizophrenia caused his substance abuse, which contributed to his respiratory problems and ultimately led to his death. The appellant also submitted a medical opinion by Dr. M.C., stating that, apart from any determination of whether the Veteran had a diagnosis of HIV or AIDS, the Veteran’s schizophrenia was a causative factor in the development of a substance abuse disorder and intravenous drug use, which led to the development of the pulmonary disease that caused the Veteran’s death. Citing medical literature and lay evidence regarding the Veteran’s history of intravenous drug use, Dr. M.C. opined that both intravenous drug use and schizophrenia can lead to a significantly higher risk of developing pneumonia, which was the Veteran’s cause of death. As the prior VA examinations of record did not address this new theory of service connection for the Veteran’s cause of death, specifically, whether the Veteran’s schizophrenia caused or aggravated his intravenous drug use, and then whether the intravenous drug use directly (apart from any HIV or AIDS) led to the development of the respiratory disorder that caused the Veteran’s death, the issue should be addressed on remand. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether: (a.) It is at least as likely as not that the Veteran’s drug abuse was 1) proximately due to his service-connected schizophrenia or 2) aggravated beyond its natural progression by his service-connected schizophrenia. In providing the opinion requested, the clinician should accept as true the reports from the appellant and other lay witnesses that the Veteran abused drugs during his lifetime and administered at least some of the drugs intravenously. (b.) It is at least as likely as not that the Veteran’s drug abuse during his lifetime caused his respiratory disorder, including respiratory failure or bronchopneumonia. The examiner should specifically address the June 2018 medical opinion by Dr. M.C., submitted by the appellant’s representative in August 2018. (c.) If the responses to a) and b) are both in the affirmative, provide an opinion as to whether it is at least as likely as not that the Veteran’s drug abuse was a principal or contributory cause of his death. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Freeman, Associate Counsel