Citation Nr: 20029282 Decision Date: 04/27/20 Archive Date: 04/27/20 DOCKET NO. 10-38 089 DATE: April 27, 2020 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from August 1976 to July 2003. He passed away in March 2009. The Appellant is his surviving spouse. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The Veteran’s death certificate lists his cause of death as acute cardiac arrythmia secondary to rupture of the mid circumflex artery with other significant conditions contributing to death listed as hypertension and dilated cardiomyopathy. The Appellant contends that the Veteran developed hypertension during active service or alternatively that he developed a blood clot during surgical procedures in service that led to his death. VA most recently obtained a medical opinion on the cause of the Veteran’s death in April 2016. However, subsequent to that opinion and on the direction of the Court of Appeals for Veterans Claims, new service treatment records were associated with the claims file. The service treatment records contain multiple prehypertensive readings. See, e.g., Feb. 2020 STR pp. 57, 64, 95, 139, 162, 167, 183, 325, 352, 357, 409, 411, 424; Dorland’s Illustrated Medical Dictionary 1510 (32nd ed. 2012) (defining “prehypertension” as “moderately increased blood pressure, defined as a systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89”). The April 2016 medical expert was unable to review this evidence when rendering an opinion. Thus, an additional opinion is needed as to whether hypertension manifest in service or is otherwise related to service. Additionally, the VA examiners in April 2016 and October 2010 provided negative opinions essentially finding that the Veteran did not have hypertension in service or after. Nevertheless, the examiners did not suggest an alternative etiology for the Veteran’s death. If hypertension was not a contributing cause of the Veteran’s death as identified by the death certificate, the Board finds a medical opinion would be helpful identifying the more likely etiology for the cardiac arrythmia secondary to rupture of the mid circumflex artery that caused his death. Such opinion should also address whether the cause of death is at least as likely as not related to the claimed possibility of blood clot developed at the time of in-service surgical procedures, abnormal results of ECG noted as probable inferior subepicardial injury in June 2001, slight ectasia in the descending aorta noted after two chest views were taken in February 2003, and borderline abnormal EKG results in February 2003 assessed as Bradycardia. An addendum opinion is needed. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). The matters are REMANDED for the following action: 1. Obtain a medical opinion on the cause of the Veteran’s death. The medical expert should review the claims file and address the following: (a.) Was the Veteran’s hypertension (listed as a contributory cause of death on his death certificate) at least as likely as not (50 percent probability or more) related to his active service? The examiner must specifically address hypertensive and prehypertensive blood pressure readings recorded during service. See, e.g., Feb. 2020 STR pp. 57, 64, 95, 139, 162, 167, 183, 325, 352, 357, 409, 411, 424; July 2015 STR pp. 4, 9, 10, 12, 16, 56; Dec. 2003 STR pp. 7, 8. (b.) Was the cardiac arrythmia secondary to rupture of the mid circumflex artery that caused the Veteran’s death at least as likely as not related to abnormal results of ECG noted as probable inferior subepicardial injury in June 2001, slight ectasia in the descending aorta noted after two chest views were taken in February 2003, and borderline abnormal EKG results in February 2003 assessed as Bradycardia during service? (Continued on the next page)   (c.) Was the cardiac arrythmia secondary to rupture of the mid circumflex artery that caused the Veteran’s death at least as likely as not caused by an undetected blood clot that occurred during knee and intestinal surgeries during service? In providing opinions, please identify and explain what factors, other than hypertension, more likely contributed to the Veteran’s death. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.P. Armstrong, 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.