Citation Nr: 18122452 Decision Date: 07/30/18 Archive Date: 07/30/18 DOCKET NO. 16-57 259 DATE: July 30, 2018 ORDER Entitlement to service connection for the Veteran's cause of death is granted. FINDINGS OF FACT 1. The Veteran died in October 2015. His death certificate indicated that the immediate cause of death was intracerebral hemorrhage, with diabetes mellitus as a condition contributing to death but not related to intracerebral hemorrhage. 2. During the Veteran’s lifetime, service connection was in effect for anatomical loss of right eye; cataracts; acquired absence of right eye; bilateral hearing loss; right sided facial and lower neck scars; pleural cavity injury; paralysis of the right musculocutaneous nerve; residuals of a gunshot wound to the abdomen; skull defect; gunshot wound to the right chest; surgical scar of the right shoulder; traumatic brain injury (TBI) with headaches; residual numbness and weakness of the right facial nerve; residuals of a gunshot wound to the left arm; and scars of the right upper extremity. 3. The probative evidence of record shows that the severity of the Veteran’s service-connected TBI caused or materially contributed to his fatal intracerebral hemorrhage. CONCLUSIONS OF LAW The Veteran’s service-connected TBI caused or substantially or materially contributed to the Veteran’s cause of death. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 1318, 5103, 5103A, 5107; 38 C.F.R. §§ 3.5, 3.102, 3.159, 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1952 to April 1954. The Veteran died in October 2015. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. The matter is currently under the jurisdiction of the RO in Denver, Colorado. In June 2017, the appellant was afforded a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran’s electronic claims folder. 1. Entitlement to service connection for the Veteran's cause of death The appellant contends that the Veteran’s fatal stroke was caused by his service-connected TBI. See March 2016 Notice of Disagreement. For the reasons explained below, the Board finds that the preponderance of the evidence is in favor of a grant of service connection for the Veteran’s cause of death. Therefore, the claim is granted. Service connection for the cause of a Veteran’s death may be granted if a disability incurred in or aggravated by service was either the principal or contributory cause of death. See 38 C.F.R. § 3.312 (a). For a service-connected disability to be the principal cause of death, it must singly or with some other condition be the immediate or underlying cause of death, or be etiologically related. See 38 C.F.R. § 3.312 (b). For a service-connected disability to constitute a contributory cause, it must contribute substantially or materially to death. The Veteran died in October 2015. His death certificate indicated that the immediate cause of death was intracerebral hemorrhage, with diabetes mellitus as a condition contributing to death but not related to intracerebral hemorrhage. During the Veteran’s lifetime, service connection was in effect for anatomical loss of right eye; cataracts; acquired absence of right eye; bilateral hearing loss; right sided facial and lower neck scars; pleural cavity injury; paralysis of the right musculocutaneous nerve; residuals of a gunshot wound to the abdomen; skull defect; gunshot wound to the right chest; surgical scar of the right shoulder; traumatic brain injury (TBI) with headaches; residual numbness and weakness of the right facial nerve; residuals of a gunshot wound to the left arm; and scars of the right upper extremity. Since none of the Veteran’s service-connected disabilities were explicitly listed on the Veteran’s death certificate, the Board requested a medical opinion regarding whether the Veteran’s TBI or any other service-connected disability contributed to the Veteran’s intracerebral hemorrhage or whether the Veteran’s intracerebral hemorrhage was directly caused by events in service, specifically injuries from the June 1953 mortar attack. In February 2018, Dr. T.T., an endocrinologist, provided a negative nexus medical opinion. However, in May 2018, the Board requested an opinion from a neurologist, a specialist which the Board felt was most competent to address neurological medical questions. In July 2018, a specialist with the Veterans Health Administration (VHA) opined that it was at least as likely as not that the Veteran’s service connected TBI caused the fatal intracerebral hemorrhage which led to the Veteran’s death. The specialist explained that although the Veteran had many medical problems which likely also contributed to his death, it is impossible to separate them from the “medical risks for stroke from the long-term sequelae of the severe TBI the Veteran suffered, which resulted in enucleations, craniotomy, and a retained small metallic density fragment in the medial left orbit.” She cited to several medical treatises which supported her conclusion, which all detailed the risks of intracerebral hemorrhages in patients with TBI. Specifically, the studies discussed the increased risk of a hemorrhagic stroke for TBI patients. The Board finds the July 2018 positive medical opinion probative. It is provided by an expert who is competent to opine on the relationship between TBI and intracerebral hemorrhages. She reviewed the Veteran’s electronic claims folder and found that the Veteran’s severe TBI caused or substantially contributed to his fatal intracerebral hemorrhage. Although Dr. T.T. provided a negative nexus opinion in February 2018, the Board finds that he was only competent to provide an opinion on the issue of the etiology of the Veteran’s diabetes mellitus (another disability listed on the Veteran’s death certificate) and not his TBI, intracerebral hemorrhage or other neurological disorders. As such, the Board attaches minimal probative value to the negative nexus opinion. Conversely, the Board assigns significant weight to the July 2018 positive opinion. The Board finds that the July 2018 VHA opinion supports a finding that the Veteran’s service-connected TBI substantially or materially contributed to his fatal intracerebral hemorrhage and service connection for the Veteran’s cause of death must be granted. MICHAEL A PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Baskerville, Counsel