Citation Nr: 18160793 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 16-46 435 DATE: December 27, 2018 REMANDED The issue of entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1986 to January 1990, with subsequent service in the Ohio Air National Guard from 1990 to 2010. The Veteran died in May 2010. The appellant is the Veteran’s surviving spouse. This matter comes to the Board of Veterans’ Appeals (Board) on appeals from a March 2012 rating decision from the Department of Veterans Affairs (VA) Pension Management Center (PMC) in Milwaukee, Wisconsin. The appellant submitted a Notice of Disagreement in March 2013; a Statement of the Case was issued in July 2016; and a VA Form 9 was received in September 2016. The appellant testified before the undersigned Veterans Law Judge in December 2017; a transcript is of record. Cause of Death The record reflects that the Veteran died in May 2010; the Death Certificate lists the immediate cause of death as complications from anoxic brain injury, due to or as a consequence of cardiopulmonary arrest, due to or as a consequence of hypertensive and arteriosclerotic cardiovascular disease. The Veteran was not service-connected for any disabilities at the time of his death. Review of the available National Guard service treatment records (STRs) and private medical records suggest that the Veteran was initially diagnosed with hypertension sometime between 2006 and 2007. In this regard, a National Guard STR dated October 11, 2006, shows a diagnosis of borderline hypertension. Thereafter, a National Guard STR dated August 29, 2007, reflects a diagnosis of hypertension and notes that the Veteran was hospitalized for such in January 2007 at Community Hospital (Springfield, Ohio). A private treatment record from Dr. S.D.T. dated September 4, 2007, indicates that the Veteran was seen for a follow up of elevated blood pressure; he reported that he recently underwent a National Guard physical and was diagnosed with hypertension at that time. A notation in the treatment record reflects that the Veteran’s “stress from the National Guard” was causing an increase in his blood pressure. The available personnel records confirm that the Veteran was on a period of Inactive Duty for Training (INACDUTRA) on August 15, 2009, and August 16, 2009. The appellant has asserted that the Veteran requested to leave his National Guard duty early on the afternoon of August 16th because he was not feeling well (i.e., stomach complaints and an excruciating headache). See, e.g., October 2011 Correspondence. The Veteran underwent a routine colonoscopy the following morning on August 17, 2009. He was driven home by a friend and subsequently experienced two episodes of syncope with a loss of consciousness. The Veteran was admitted to the ICU on August 17, 2009, with an admitting diagnosis of cardiac arrest, and a final diagnosis of (1) cardiac arrest due to ventricular tachycardia; (2) acute myocardial infarction; (3) hypoxic encephalopathy; and (4) hypertension. A contemporaneous coronary angiogram showed a 90 percent blockage of the left anterior descending artery; an angioplasty was performed. The Veteran was discharged to a long-term care facility but did not regain consciousness and subsequently died in May 2010. For a claimant to be considered a “veteran” for any period of service other than active duty, it must be shown that he became disabled from a disease or injury incurred or aggravated in the line of duty during a period of Active Duty for Training (ACDUTRA), or that he became disabled from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during INACDUTRA. See 38 U.S.C. § 101 (2, 22, 24) (2012); 38 C.F.R. §§ 3.1 (d), 3.6(a, c, d) (2018). In this case, the appellant asserts that the Veteran’s hypertensive disease (and/or arteriosclerotic cardiovascular disease), which is listed as one of the causes of death on the Death Certificate, had its onset during a period of ACDUTRA in or around 2006-2007. Alternatively, she asserts that if the Veteran’s hypertension pre-existed a period of ACDUTRA, that it was aggravated therein. Considering the appellant’s contentions, as well as the STRs documenting hypertension, the AOJ must verify all periods of the Veteran’s ACDUTRA and/or INACDUTRA service and obtain outstanding service treatment and personnel records covering such periods of service on remand. Of particular importance is the type of service the Veteran was on (i.e., ACDUTRA, or INACDUTRA) from 2006 to 2007. As noted, the evidence already establishes that the Veteran was neither on a period of ACDUTRA nor INACDUTRA when he sustained the fatal myocardial infarction/cardiac arrest on August 17, 2009. However, the appellant appears to assert that the proximity of the MI/cardiac arrest to his INACDTRA service is relevant, and that the Veteran was essentially symptomatic on August 16, 2009, the day prior to the MI/cardiac arrest and during a period of INACDUTRA. In light of this, on remand, a VA examiner should address whether the Veteran’s MI/cardiac arrest was clincially apparent, manifest, or otherwise had its onset during INACDUTRA service. The matter is REMANDED for the following action: 1. Ask the appellant to identify any outstanding relevant treatment records, private and government-held, regarding the Veteran’s hypertensive and arteriosclerotic cardiovascular disease. The AOJ should undertake appropriate development to obtain all outstanding pertinent private treatment records, to include those from January 2007 treatment at Community Hospital. The appellant’s assistance should be requested as needed. All obtained records should be associated with the evidentiary record. 2. Verify all periods of the Veteran’s active service, ACDUTRA and/or INACDUTRA and obtain outstanding service treatment records and personnel records. Of particular importance is the type of service the Veteran was on (active duty, ACDUTRA, or INACDUTRA) from 2006 to 2007 and personnel records from August 2009. 3. After obtaining any outstanding records, forward the Veteran’s claims folder to an appropriate clinician for review and for an opinion on the cause of the Veteran’s death. The medical professional must be provided with and review the dates of the Veteran’s ACDUTRA and INACDUTRA service, as well as all pertinent evidence of record. After reviewing the claims file, the examiner should respond to the following: (a) Is it at least as likely as not that the Veteran’s hypertension, hypertensive disease, and/or arteriosclerotic cardiovascular disease began in, is etiologically related to, or was permanently worsened by any period ACDUTRA? In answering the above question, the examiner is advised of the National Guard STRs showing diagnoses/treatment for hypertension in 2006 and 2007, as well as the September 2007 private treatment record from Dr. S.D.T., noting an increase in the Veteran’s blood pressure from the stress of National Guard service. (b) Is it at least as likely as not that the Veteran’s myocardial infarction OR cardiac arrest was clinically apparent, manifest, or otherwise had its onset during INACDUTRA service on August 16, 2009? In answering the above question, the examiner is advised that the appellant has reported that the Veteran left his National Guard duty/drill early on August 16, 2009 (i.e., a period of ACDUTRA) due to complaints of not feeling well with symptoms of stomach pain and an excruciating headache. The rationale for all opinions expressed must be provided. If the medical professional is unable to provide any required opinion, he or she should explain why. 4. After completing all indicated development, the appellant’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought on appeal is not granted, the appellant and her representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Hoeft, Counsel