Citation Nr: 21001057 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 14-07 618 DATE: January 6, 2021 REMANDED Entitlement to service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1983 to September 2004. He died in February 2011 and the appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office and Pension Management Center (RO & PMC) in Milwaukee, Wisconsin. In a January 2018 decision, the Board denied service connection for the cause of the Veteran’s death. The appellant appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In August 2018, the Court granted a Joint Motion for Remand (JMR), vacating and remanding the claim to the Board for further action. In June 2019, the Board remanded the appeal for further development. The appeal has now returned to the Board for adjudication. Although the Board regrets the additional delay, the appeal must be remanded for additional development. In the June 2019 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain a medical opinion addressing whether there was any relationship between the Veteran’s death and his service. The appellant has contended that the Veteran had high cholesterol during his period of active service, and that his cholesterol resulted in a heart attack causing his death. The Veteran’s immediate cause of death listed on his death certificate was cardiopulmonary arrest. In a November 2020 VA medical opinion, the examiner indicated that there was insufficient evidence to support a finding that cardiopulmonary arrest had onset during service or was otherwise causally related to the Veteran’s active service, to include reported elevated cholesterol. The examiner also indicated that cardiopulmonary arrest was a mechanism of death, and not a medical condition causing death, and that based on the record, she would have to resort to speculation to determine the medical condition that caused the cardiopulmonary arrest. The examiner also opined that there was insufficient evidence to support that the Veteran had a diagnosis of a cardiovascular condition. In support of her opinion, the examiner referenced VA treatment records from 2006 through 2009 which did not show any cardiovascular condition. However, she also referenced a January 2009 VA treatment record that noted an electrocardiogram (EKG) was done, but was not associated with the record. The Board finds that the November 2020 opinion is inadequate for several reasons. The examiner indicates that there is insufficient evidence to support a finding that the Veteran’s cardiopulmonary arrest is related to service, including his high cholesterol, but does not provide a rationale for this opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“most of the probative value of a medical opinion comes from its reasoning”). In addition, while the examiner concluded that the Veteran’s cardiopulmonary arrest was unrelated to service, she also later stated that it would be speculative to determine the medical condition that caused the cardiopulmonary arrest, which is contradictory. Thus, a remand is necessary to obtain an additional opinion. The Board also notes that the examiner referenced a January 2009 EKG which was not associated with the file. A January 13, 2009 VA treatment note references a scanned VISTA imaging document, however that record has not been associated with the claims file. Thus, on remand, this record should be located and associated with the file. The Board notes that the appellant has not responded to VA’s request to assist VA in obtaining relevant treatment records. In light of the VA examiner’s opinion regarding insufficient information to determine the cause of the cardiopulmonary arrest, the appellant is hereby advised that her assistance in obtaining complete medical records from Jackson Hospital and Clinic and Maxwell Air Force Base is crucial for an appropriate medical opinion. The matter is REMANDED for the following action: 1. Associate with the claims folder all medical records separately stored in VISTA imaging, including any records of a January 2009 EKG. See, e.g., Montgomery VA Medical Center Note, dated January 13, 2009 (reporting document scanned into VISTA). 2. Assist the appellant in obtaining complete treatment records from Jackson Hospital and Clinic and Maxwell Air Force Base since the Veteran’s discharge from service. 3. After the above development is completed, obtain a medical opinion from an appropriate clinician addressing whether there is any relationship between the Veteran’s death and his service. The examiner should address the following: A) Is it at least as likely as not (a probability of 50 percent or greater) that cardiopulmonary arrest, listed as the immediate cause of death on the Veteran’s death certificate, had its onset during service or is otherwise causally related to the Veteran’s active service, to include the reported elevated cholesterol? If the examiner determines that cardiopulmonary arrest is a mechanism of death, and not the medical condition causing death, he or she should specify the medical condition that caused the Veteran’s cardiopulmonary arrest and whether it onset during service or is otherwise causally related to the Veteran’s active service, to include the reported elevated cholesterol. B) Is it at least as likely as not (a probability of 50 percent or greater) that any of the Veteran’s service-connected disabilities currently in effect, alone or in combination, caused or contributed substantially or materially to the Veteran’s death? The examiner should also address whether the Veteran had a cardiovascular disease during or related to service. In doing so, the examiner should discuss the reports of elevated cholesterol during service. A clearly stated rationale for any opinion offered should be provided. In this regard, a discussion of the relevant facts and medical principles involved would be of considerable assistance to the Board. If the examiner is unable to provide any requested opinion without resort to speculation, the examiner should explain whether the inability to provide the needed opinion is due to the limits of the examiner’s medical knowledge; the limits of the knowledge of the medical profession in general; or whether there is specific additional evidence, which if obtained, would enable the examiner to provide the needed opinion. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Saikh, 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.