Citation Nr: 20023028 Decision Date: 04/02/20 Archive Date: 04/02/20 DOCKET NO. 19-13 112 DATE: April 2, 2020 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Entitlement to dependency and indemnity compensation (DIC) under 38 U.S.C. § 1318 is remanded. Entitlement to survivor pension benefits is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1943 to February 1946. The Veteran died in August 2017 and the Appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 decision. The Appellant contends that the Veteran’s service-connected posttraumatic stress disorder (PTSD) hastened the Veteran’s death. Specifically, she contends that the Veteran’s PTSD caused and/or permanently aggravated his hypertension and that both PTSD and hypertension contributed to his stroke in 2000 and his continued decline until his death. The Board notes that the Veteran is service connected for PTSD and that atherosclerotic cardiovascular disease is listed as one of the contributory causes of death in the death certificate. The Board cannot make a fully informed decision on the issue of service connection for the cause of the Veteran’s death because no VA examiner has opined whether the Veteran’s service-connected PTSD was a contributory cause of death as alleged. 38 C.F.R. § 3.312(c)(4). Further, the Board acknowledges the Federal Register statement of June 28, 2005, 70 F.R. 37040, which notes that presumption of service connection was warranted for hypertensive vascular disease for prisoners of war (POW). It was reasoned that presumption of service connection was warranted on the basis that several medical studies found veterans with a long-term history of PTSD to have a high risk of developing cardiovascular disease and myocardial infarction, and since POWs have a relatively high rate of PTSD incurrence, they would presumably be at risk of cardiovascular disease to include hypertension. VA has therefore recognized that medical studies have shown that veterans with PTSD have a high risk of cardiovascular disease including hypertension and that a connection exists between PTSD and hypertension. This Federal Register statement and its findings regarding the connection between PTSD and hypertension should also be considered by the examiner in rendering a nexus opinion. The issue of entitlement to DIC benefits under 38 U.S.C. § 1318 is inextricably intertwined with the claim of entitlement to service connection for the cause of the Veteran’s death. The cause of death claim could therefore directly impact the claim for DIC benefits under 38 U.S.C. § 1318 and the matter must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Finally, there is not enough evidence in the file to decide the claim for survivor pension benefits. Further development must be undertaken to obtain updated income and expense information from the Appellant since it was last provided in April 2018. The matters are REMANDED for the following action: 1. Refer the matter of the cause of the Veteran’s death to a qualified VA medical professional, who must offer a well-reasoned opinion regarding the following question: whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s service-connected PTSD was a contributory cause of death from inanition due to or consequence of dysphagia, cerebral infraction and atherosclerotic cardiovascular disease. In answering this question, the examiner must state (a) whether the primary cause of death, by its very nature was so overwhelming that eventual death could be anticipated irrespective of coexisting conditions or (b) whether the service-connected PTSD was of such severity as to have a material influence in accelerating the Veteran’s death. The examiner is notified that in this situation, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature. 38 C.F.R. § 3.312(c)(4). In reaching this conclusion, the examiner must specifically address the Appellant’s contentions that the Veteran’s PTSD caused and/or permanently aggravated his hypertension and that both PTSD and hypertension contributed to his stroke in 2000 and his continued decline until his death. The examiner must take into consideration the Federal Register statement of June 28, 2007, 70 F.R. 37040 noted above and address findings therein. 2. After completing the above, first readjudicate the cause of death claim before considering the claim of entitlement to DIC benefits under 38 U.S.C. § 1318. 3. Obtain updated income and expense information from the Appellant since it was last provided in April 2018. Thereafter, the RO should review the expanded record and determine whether survivor pension benefits may be granted. The readjudication must clearly detail and explain how all monthly income and expenses, as well as annualized income and expenses, were calculated for each year of the appeal period. 4. If upon completion of the above action the claims remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. L. Wallin, 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.