Citation Nr: 20008339 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 14-12 383 DATE: January 31, 2020 ORDER Service connection for the cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died in March 2012. The immediate cause of death listed on his death certificate was probable cardiac arrest, with no other significant conditions listed that contributing to death, but not resulting in the underlying cause. 2. At the time of his death, the Veteran was service-connected for schizophrenia and hypertension conditions. 3. The probative evidence of record does not demonstrate that the Veteran’s probable cardiac arrest is medically related to his service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death are not met. 38 U.S.C. §§ 1131, 1310, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had honorable active duty service from September 1975 to April 1983. He died in March 2012, and the Appellant is his surviving spouse. In July 2016, the Veteran testified before the undersigned Veteran’s Law Judge (VLJ). A transcript of this hearing has been associated with the claims file. The Appellant previously appointed the Guam Veterans Affairs Office as her representative; however, as noted during the July 2016 hearing with the undersigned Veterans Law Judge, she is no longer represented for this appeal. In September 2018, the Board remanded the Appellant’s claims to the agency of original jurisdiction (AOJ) to obtain the Veteran’s updated medical records and to obtain a medical opinion of the Appellant’s claim. This development has been completed and the Appellant’s case has returned to the Board for adjudication. Service Connection for Cause of Death 1. Service connection for the cause of the Veteran’s death is denied The Veteran died in March 2012. The immediate cause of death listed on his death certificate was probable cardiac arrest, with no other significant conditions listed that contributing to death, but not resulting in the underlying cause. At the time of his death, the Veteran was service-connected for schizophrenia and hypertension conditions. The Appellant asserts that the Veteran’s prescription for his service-connected schizophrenia, Olanzapine, caused or materially contributed to his death because the side-effects of the medication could cause cardiac arrest. Law The death of a veteran will be considered to have been due to a service-connected disability where the evidence establishes that a disability was either the principal or the contributory cause of death. 38 C.F.R. § 3.312 (a). A principal cause of death is one which, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312 (b). A contributory cause of death is one which contributed substantially or materially to cause death; or aided or lent assistance to the production of death. See 38 C.F.R. § 3.312 (c). In determining whether a service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; or that it aided or lent assistance to the production of death. 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 C.F.R. § 3.312 (c)(1). The debilitating effects of a service-connected disability must have made the veteran materially less capable of resisting the fatal disease or must have had a material influence in accelerating death. See Lathan v. Brown, 7 Vet. App. 359 (1995). In order to establish service connection for the cause of death, there must be (1) evidence of death; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and death. Hickson v. West, 12 Vet. App. 247, 253 (1999). In determining whether the disability that resulted in the death of the Veteran was the result of active service, the laws and regulations generally applicable to compensation for service-connected disability apply. 38 U.S.C. § 1310. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303 (d). Certain chronic diseases, such as cardiovascular diseases, will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Finally, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Analysis Turning to the evidence for direct service connection, it is significant that the service treatment records are negative for complaints or treatment cardiovascular disease. At discharge, the Veteran had diagnoses of hypertension and schizophrenia. Direct service connection requires an in-service event or incurrence. In this case, the record does not support such a finding. Therefore, the Board finds that service connection is not warranted for cardiovascular disease. Presumptive service connection requires that heart disease manifest within one year of separation of service. In this case, the Veteran separated in 1983 and there is no evidence of a diagnosis of heart disease within one year. Thus, presumptive service connection is not warranted. Turning to the question as to whether the Veteran’s service-connected conditions, to include his medication for schizophrenia, substantially or materially contributed to his death, a March 2012 private treatment record noted that the Veteran died from cardiac arrest, and that his Type 2 diabetes for more than 10 years, hypertension, tobacco abuse, and hyperlipidemia all increased his risk for heart attack. The claims file also includes copies of the potential side effects for Olanzapine. One of these sheets reflects that the drug may infrequently make the blood sugar level rise, which can cause or worsen diabetes. It also states that the drug may cause significant weight gain and a rise in blood cholesterol levels, and that these effects along with diabetes may increase the patient’s risk for developing heart disease. In October 2012, a VA examiner gave the opinion that there was no evidence that Olanzapine is a medication which is known to cause heart disease. Further, there was no evidence to support that the Veteran had complications of heart disease based on his history of hypertension. Rather, the Veteran had more significant risk factors for heart disease including tobacco abuse, hyperlipemia, alcohol abuse, and diabetes. As noted in the September 2018 Board remand, this opinion did not sufficiently address the side-effects of Olanzapine. Thus, an additional medical opinion was obtained. In October 2019, a medical opinion was returned. The medical professional noted the Veteran’s longstanding hypertension, obesity, diabetes mellitus, and hyperlipemia existed prior to starting Olanzapine in December 2010. Further, the medical records revealed that the Veteran lost weight while on Olanzapine and had longstanding, strong risk factors for cardiac arrest including tobacco use and diabetes. The medical professional gave the opinion that it was less likely than not that the Veteran’s treatment with Olanzapine caused or contributed substantially or materially to the Veteran’s death; combined to cause the Veteran’s death; or aided or lent assistance to the production of his death by cardiac arrest. In support thereof, the medical professional explained that the mechanism by which Olanzapine causes and/or aggravates hypertension, diabetes, hyperlipidemia and/or cardiac disorders is by causing weight gain with related adverse metabolic effects. In the Veteran’s case, this clearly did not happen, as the Veteran actually lost weight on Olanzapine. The well-documented weight loss after starting Olanzapine is strong evidence that the Veteran did not develop a metabolic disorder on Olanzapine which might worsen diabetes and/or hypertension and/or hyperlipidemia and/or cardiac disorder. The professional went on to explain that it is far more likely that other factors lead to the Veteran’s cardiac arrest than his Olanzapine use. The medical literature indicates that factors such as tobacco use and diabetes are very strongly implicated in leading to cardiac arrest/sudden cardiac death. By contrast, the risk of Olanzapine causing cardiac arrest/sudden cardiac death is far less. In this particular case, no evidence was found that Olanzapine caused or in any way aided or contributed to the veteran’s death. There was no evidence of Olanzapine causing EKG abnormalities and/or arrhythmia signs/symptoms was for example. However, the medical records repeatedly documented that the Veteran was a tobacco user and had suboptimal diabetes control (citing December 2010 and January 2011 records for example). Thus, these factors would be far more likely to lead to the Veteran’s cardiac arrest than Olanzapine use. The Board gives the opinion great probative weight because of its thoroughness, the fact that it is based on a review of the pertinent records, and that it was offered by a competent medical professional. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Given this, the Board finds that the Veteran’s cardiac arrest was not related to his service-connected conditions or treatment thereof; therefore, the criteria for service connection for cause of death have not been met. Moreover, although the Board acknowledges the Appellant’s sincere belief that the Veteran’s cause of death is related to his military service, to include his prescription of Olanzapine, the Board notes that, as a layperson, she is not shown to have medical training or expertise, and is therefore not competent to render an opinion as to the etiology of the Veteran’s primary and contributory causes of death. Accordingly, the claim of entitlement to service connection for the cause of the Veteran’s death is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, at 49. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.