Citation Nr: 20021046 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 16-09 781 DATE: March 24, 2020 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1968 to March 1970. He died in November 1987. The Appellant is the Veteran’s surviving spouse. This matter comes before the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board) on appeal from an Agency of Original Jurisdiction (AOJ) rating decision dated in August 2017. 1. Entitlement to service connection for the Veteran's cause of death is remanded. The Veteran’s primary cause of death was alcoholic liver disease with terminal gastrointestinal hemorrhage. The Appellant contends that the Veteran’s alcohol abuse was secondary to posttraumatic stress disorder (PTSD). The Veteran was not service connected for PTSD at the time of his death. The Board notes that direct service connection for a substance use disorder is barred as a matter of law, though it may be granted if there is clear medical evidence establishing that the alcohol abuse disability was caused by or aggravated by a service-connected disorder. 38 U.S.C. §§ 105, 1131; 38 C.F.R. § 3.310; Allen v. Principi, 237 F.3d at 1376 (Fed. Cir. 2001). Thus, the Appellant’s claim hinges on whether the Veteran had PTSD for which he should have been service connected. Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and a stressor event in-service; and credible supporting evidence that the claimed stressor event in-service occurred. 38 C.F.R. § 3.304 (f). Where the evidence establishes that the Veteran engaged in combat and the claimed stressor is related to that combat, lay testimony alone may establish the occurrence of the stressor if a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms that the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service. 38 C.F.R. § 3.304 (f)(2). The Veteran’s military personnel records reflect that he “participated in combat operations” and “counter-insurgency Operation’s [sic]” in Vietnam. The records also reflect that the Veteran had violations of the Uniform Code of Military Justice (UCMJ) for threating or harassing behavior. In April 2012, the Appellant submitted a statement indicating that the Veteran was wounded in Vietnam. The Appellant testified at before a Decision Review Officer in July 2015 that she believes the Veteran had PTSD, and his drinking was related thereto. She testified that the Veteran lost his temper, was physically abusive, had nightmares, sleep-walked, and experienced night sweats. She also testified at a Board hearing in April 2019 that he got into fights, and that his nightmares occurred every night. The Veteran’s daughter also testified in April 2019, and she explained that her father would drink when he got home from work to help him fall asleep, and he would wake up screaming in the middle of the night. Based on the evidence, the Board concludes that a medical opinion is necessary to determine whether the Veteran had PTSD related to combat. The Appellant also testified that the Veteran received treatment at a VA facility in San Jose between 1970 and 1971. Therefore, on remand, the AOJ must attempt to procure these records. The matters are REMANDED for the following action: 1. Obtain treatment records regarding the Veteran from the San Jose VAMC, and supplement the claims file. 2. After any additional records are associated with the claims file, obtain a supplemental opinion from an appropriate VA clinician to address the following: (a.) The examiner should consider and address: the Veteran’s personnel records showing combat activities and violations of the UCMJ; the Appellant’s July 2015 and April 2019 testimony regarding the Veteran’s symptoms; and the Veteran’s daughter’s April 2019 testimony. (b.) The examiner must opine whether it is at least as likely as not (50 percent or greater) that the Veteran had PTSD related to combat in Vietnam; (c.) If so, the examiner must opine whether it is at least as likely as not (50 percent or greater) that the Veteran’s PTSD proximately caused his alcoholic liver disease. An explanation for all opinions expressed must be provided. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, Associate Counsel 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.