Citation Nr: 20021049 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 16-35 482A DATE: March 24, 2020 REMANDED Entitlement to dependency and indemnity compensation (DIC) based upon service connection for the Veteran’s cause of death is remanded. Introduction The Veteran served honorably on active duty in the United States Army during the Vietnam Era, from March 1970 to November 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from October 2014, March 2015, and May 2015 Rating Decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. When this case was previously before the Board in October 2018, the above-referenced issue was denied. Thereafter, the matter was appealed to the United States Court of Appeals for Veterans Claims (Court) which, in August 2019, vacated and remanded the case for readjudication. Although the Board sincerely regrets further delay, remand is again necessary to ensure compliance with the previous remand directives and proper development. See Stegall v. West, 11 Vet. App. 268, 271 (1998). REASONS FOR REMAND Upon appealing this matter to the Court, the Appellant argued in her February 2019 Informal Brief that, among other things, certain relevant treatment records were not considered by the Board. Ultimately, in June 2019 the Secretary acknowledged that “the record does not contain VA treatment records from the Salisbury VA medical center (VAMC)” which pre-date the Board’s decision and that “may be determinative.” As a result, in August 2019 the Court agreed with the parties “that the Board failed to consider relevant treatment records” and, therefore, vacated the Board’s October 2018 decision and remanded the matter for re-adjudication. After further review, the Board finds that this matter must be remanded to the RO for two reasons. First, although the Appellant attached copies of certain treatment records generated by the Salisbury VAMC to her Informal Brief, it is unclear whether these copies comprise some or all of the relevant records from that facility. Thus, on remand the RO must endeavor to obtain any and all treatment records from the Salisbury VAMC and associate them with the claims file prior to re-adjudication. Next, the service treatment records (STRs) indicate the Veteran experienced symptomology and exhibited objective findings during military service that may or may not be etiologically related to the conditions from which he ultimately passed away. On the Veteran’s June 2014 Certificate of Death, the cause(s) of death are reported as acute respiratory failure, cerebral edema, and cerebral ischemic infarction. The STRs reference issues such as dizziness, syncope, frequent or severe headaches, elevated blood pressure, heart palpitations, left sided chest pain, bilateral foot edema, and chest pressure. For example, the Veteran’s blood pressure was 140/90 in March 1970 and 140/92 in September 1971. Due to a history of palpitations and left-sided chest pain, he underwent an EKG in September 1971 which was reportedly within normal limits. A Report of Medical History dated September 1971 noted chest pain or pressure, heart palpitations or pounding, dizziness or fainting spells, and frequent or severe headaches. The Veteran presented in November 1971 complaining of swollen feet, headache, and general malaise. On remand, after the Salisbury VAMC treatment records are procured, the RO must obtain a medical opinion addressing the possibility of an etiological relationship between the Veteran’s in-service symptoms and objective findings, and the acute respiratory failure, cerebral edema, or cerebral ischemic infarction that ultimately resulted in his death. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file the Veteran’s treatment records from the Salisbury VAMC. 2. After the Salisbury VAMC treatment records are procured and associated with the claims file, obtain a records review and medical opinion from a physician possessing suitable expertise to render an opinion regarding the etiological relationship, if any, between the Veteran’s symptoms and objective findings during military service and the cause(s) of his death, specifically, acute respiratory failure, cerebral edema, and cerebral ischemic infarction. All pertinent evidence of record (to include the Salisbury VAMC treatment records) must first be made available to and reviewed by the examiner. Following a complete review of the Veteran’s electronic file, the examiner must provide an opinion as to: (a.) Whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s cause(s) of death (i.e., acute respiratory failure, cerebral edema, and/or cerebral ischemic infarction) is/are due to, related to, or otherwise etiologically associated with an in-service event, injury, or disease. (b.) Whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s hypertension, or any other medical condition(s), manifested during military service or within one year of discharge. (c.) If the answer to (b.) above is yes, whether it is at least as likely as not (i.e., 50 percent probability or greater) that there is an etiological relationship with the Veteran’s cause(s) of death (i.e., acute respiratory failure, cerebral edema, and/or cerebral ischemic infarction). In offering the above opinion(s), the examiner must consider and discuss as necessary the Veteran’s STRs that reference issues with dizziness, syncope, frequent or severe headaches, elevated blood pressure, heart palpitations, left sided chest pain, bilateral foot edema, and chest pressure; as well as, the cardiology consultation note of Dr. B.R.L. dated June 2014, the medical opinion of Dr. D.C.A. dated September 2014, and the medical opinion of Dr. D.L.E. dated April 2015. A complete rationale for any opinion expressed must be provided. If it is not possible to provide the above-requested opinion(s) without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts), a deficiency in the record (i.e., additional facts are required), or the examiner (i.e., does not have the knowledge or training). (Continued on next page) T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Worsham, 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.