Citation Nr: 18159356 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-57 670 DATE: December 18, 2018 ORDER Entitlement to service connection for early onset Alzheimer’s disease is denied. Entitlement to service connection for cause of death is denied. FINDINGS OF FACT 1. Alzheimer’s disease was not shown in service and is shown to have caused by any incident of service, including exposure to asbestos, by competent evidence. 2. The Veteran died in July 2015. A death certificate shows the immediate cause of death was cardiac arrest due to, or as a consequence of, Alzheimer’s disease. 3. During the Veteran’s lifetime, service connection was not established for any disability. CONCLUSIONS OF LAW 1. The criteria for service connection for early onset Alzheimer’s disease have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1973 to December 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from October 2013 and November 2015 rating decisions by Department of Veterans Affairs (VA) Regional Offices (RO). The Veteran died in July 2015 and the Appellant is surviving spouse. In October 2016 the RO found the Appellant to be a qualified to be a substitute claimant. 1. Entitlement to service connection for early onset Alzheimer's disease is denied. 2. Entitlement to service connection for cause of death is denied. The Appellant seeks to establish service connection for early onset Alzheimer’s disease. She also seeks to establish service connection for the cause of the Veteran’s death. Specifically, the Appellant avers that Alzheimer’s, which contributed to the Veteran’s cause of death, was related to service injuries. In the alternative, it is asserted that asbestos exposure may be related to his cause of death. The Veteran’s original certificate of death shows the immediate cause of death was cardiac arrest due to, or as a consequence of, atherosclerosis. Alzheimer’s disease is not included as a primary or contributing cause. In January 2016 correspondence, the Appellant indicated that the death certificate was changed to reflect Alzheimer’s disease at her request. She noted that she requested this change of Dr. B. (who completed the original certificate) because various clinicians who saw the Veteran during clinical trials had informed her that his death was due to the death of his brain cells which led to his heart stopping. A March 2016 letter from Dr. B. shows that he did in fact amend the death certificate at the Appellant’s request. A death certificate received in March 2016 lists the immediate cause of death as cardiac arrest due to, or as a consequence of, Alzheimer’s disease. To establish service connection for the cause of the Veteran’s death, the evidence must show that a service-connected disability was either the principal cause or a contributory cause of death. For a service-connected disability to be the principal (primary) cause of death, it must singly or with some other condition be the immediate or underlying cause of death or be etiologically related. For a service-connected disability to constitute a contributory cause, it must contribute substantially or materially; it is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”-the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for organic diseases of the nervous system if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1112; 38 C.F.R. §§ 3.307, 3.309. Based on consideration of all of the evidence of record, the Board finds the evidence does not establish a nexus between the Veteran’s Alzheimer’s disease and active service. As service connection is not established, entitlement to service connection for the cause of death is also not warranted. The Veteran and the Appellant have asserted that he hit his head a lot during service because he was tall and the ship quarters were tight. The Board finds the Veteran’s statements in this regard credible as he was competent to recall hitting his head on several occasions. The Board also acknowledges that the Veteran was exposed to asbestos in service. Service discharge documents show he served aboard the USS Manitowoc. The National Personnel Records Center states the Naval job title of EN (engineman) is probable for asbestos exposure. Thus, exposure to asbestos during active military service has been conceded. However, a review of the Veteran’s service records indicates that he was not diagnosed with Alzheimer’s during service or shortly thereafter. Moreover, the weight of the competent evidence of record is against a finding that the Alzheimer’s that contributed to his death was related to service, to include the asbestos exposure and/or head injuries therein. In August 2015, a VA physician opined that it was less likely than not that the Veteran’s Alzheimer’s was related to service, either as a result of head trauma or due to any exposure to asbestos. The VA physician’s opinions are competent and highly probative. The opinions were based on review of the claims folder, literature and accepted medical principles, and included a medical rationale. The opinions and supporting rationale address the Appellant’s contentions, the circumstances of the Veteran’s military and medical history, and accepted medical principles. The VA physician demonstrated that the medical records did not actually contain any clinical findings indicative of severe head trauma or head trauma sequelae in service, and that Alzheimer’s is not a disease which the medical community has found to be related to asbestos. There is no competent and equally probative evidence of record to support direct service connection. The record does not show that the Veteran’s Alzheimer’s was present in service or for decades after service, well beyond the one-year presumptive period after service for manifestation of an organic diseases of the nervous system as a chronic disease under 38 U.S.C. §§ 1112 and 1137 and 38 C.F.R. §§ 3.307, 3.309. As the evidence does not show the Veteran’s disability was incurred in, or is otherwise associated with, active service, a nexus has not been established. Service connection for early onset Alzheimer’s is not warranted. Moreover, as service connection for this disease has not been established, service connection for the cause of the Veteran’s death is not warranted either. The Board acknowledges Appellant’s contentions that head injuries and/or exposure to asbestos in service contributed to the Veteran’s Alzheimer’s. However, the etiology of Alzheimer’s is a complex medical issue requiring expertise the Appellant has not been shown to possess. Therefore, her lay opinions regarding the etiology of the Alzheimer’s and, the Veteran’s cause of death, are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The competent and probative evidence weighs heavily against the claim. With regard to any treatise evidence in the form of medical articles regarding Alzheimer’s disease and head trauma/asbestos exposure and health effects provided in support of this claim, there is no competent medical opinion evidence linking this literature to the cause of the Veteran’s death. While a medical article or treatise “can provide important support when combined with an opinion of a medical professional” such a medical article or treatise evidence must discuss generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least “plausible causality” based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222, 228 (1999). The Board is sympathetic to Appellant’s beliefs; however, the preponderance of the competent evidence is against the claim. Accordingly, the benefit of the doubt rule does not apply and service connection for early onset Alzheimer’s, as well as service connection for cause of the Veteran’s death, is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Lauritzen, Associate Counsel