Citation Nr: 21061459 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 17-11 807 DATE: October 4, 2021 ORDER Entitlement to service connection for cause of death is granted. FINDING OF FACT The Veteran's posttraumatic stress disorder (PTSD), a disability of service origin, contributed substantially or materially to the Veteran's cause of death. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have been met. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army during World War II from July 1943 to March 1946, including in the Pacific Theater. The appellant is his surviving spouse. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2016 decision of the Regional Office (RO). In December 2019, the Appellant testified at a hearing held before the undersigned. The matter was previously remanded in April 2020 and March 2021. 1. Entitlement to service connection for cause of death The Appellant seeks service connection for the cause of the Veteran's death. Such benefits are payable to the surviving spouse, child, or parents of a veteran if the veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. To establish service connection for the cause of the veteran's death, the service-connected disability must be either the principal or a contributory cause of death. 38 C.F.R. § 3.312(a). A disability is the principal cause of death if it was the immediate or underlying cause of death or was etiologically related to the death. 38 C.F.R. § 3.312(b). A disability is a contributory cause of death if it contributed substantially or materially to the cause of death, combined to cause death, aided, or lent assistance to producing death, for example when a causal (not just a casual) connection is shown. 38 C.F.R. § 3.312(c). The Veteran died in June 2015, at which point service connection was not in effect for any disabilities. His death certificate lists metastatic prostate cancer as the immediate cause of death. At the December 2019 hearing, the Appellant reported that the Veteran suffered from PTSD, which caused panic and involved avoidance of medical care providers. She asserts that this avoidance prevented him from seeking earlier treatment for prostate cancer. She further reported that during a PTSD-related panic incident, the Veteran fell and broke his hip, which hastened his death. The Board finds these statements to be credible and accepts that because of PTSD the Veteran avoided cancer treatment and experienced panic that resulted in his fall. In April 2020, the Board held that the Veteran suffered from PTSD related to his military service and assumed that this disorder was a disability of service origin for the purpose of adjudicating the Appellant's cause of death claim. The Board remanded for two opinions: 1) Whether it is at least as likely as not that the Veteran's psychiatric condition had an impact on his ability to make decisions regarding his medical care; and 2) Whether it is at least as likely as not that the Veteran's panic-induced hip injury materially contributed to his death. In March 2021, the Board remanded for addendum opinions. In doing so it re-worded its first opinion request as follows: Assuming as true that it is at least as likely as not that the Veteran's 2015 hip injury was the result of an episode of panic related to the Veteran's psychiatric condition, please opine as to whether the Veteran's hip injury caused, contributed substantially or materially, or hastened the Veteran's death. A May 2021 VA medical opinion by Dr. C.R. concludes that "[i]t cannot be determined whether the Veteran's [PTSD] had an impact on the Veteran's ability to make decisions regarding his medical care." The examiner notes that the Veteran displayed "memory deficits" and avoidance of social situations shortly before his death. At the same time, there was no evidence of medical avoidance in his treatment records, and the Veteran "continued to attend medical appointments after his diagnosis of prostate cancer." When a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 3.102. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. Id. There is a medical conclusion that the origin of the Veteran's death is uncertain. The Board will resolve this doubt in favor of the Appellant. As such, the Board finds that PTSD contributed substantially or materially to the Veteran's cause of death. The Appellant's claim is granted. The Board notes that an April 2021 VA medical opinion by Dr. R.A. concludes that the Veteran's "hip injury did not cause, contribute substantially or materially, or hasten the Veteran's death." Even taken as true, this opinion does not weigh against entitlement to service connection for cause of death of the basis that PTSD contributed substantially or materially to the Veteran's cause of death. Thus, the April 2021 opinion does not by itself disturb the Board's decision to grant the Appellant's claim. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.