Citation Nr: 21064744 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 16-63 948 DATE: October 21, 2021 ORDER Entitlement to service connection for cause of death is denied. FINDINGS OF FACT 1. The Veteran died in June 2015. The death certificate lists the immediate cause of death as gastrointestinal bleed and metastatic small cell lung cancer. 2. The most probative evidence of record does not demonstrate that service-connected fractured cervical spine caused or 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 are not met. 38 U.S.C. § 5107; 38 C.F.R.; § 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served honorably in the United States Army from November 1965 to May 1968. The Veteran died in June 2015. The appellant in the present appeal is his surviving widow. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A copy of the transcript has been associated with the claims file. The Board previously remanded the appeal in February 2020, and the matter has been returned for appellate consideration. The development ordered by the Board having been completed (obtaining any additional private treatment records and a VA opinion), the Board finds substantial compliance with its remand instructions. Entitlement to service connection for cause of death. The Appellant is seeking service connection for the Veteran's cause of death. Service connection for the cause of a Veteran's death is warranted if a service-connected disability either caused or contributed substantially or materially to the cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In determining whether a service-connected disability contributed substantially or materially to death, the evidence must show that it combined to cause death or that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1); see also, Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). The Veteran's cause of death on his death certificate is listed as shock due to or as a consequence of a gastrointestinal bleed, due to or a consequence of metastatic small cell lung cancer. Other contributing factors are listed as chronic obstructive pulmonary disease (COPD) and hypertension. During his lifetime, the Veteran was service connected for 6 disabilities, to include residuals from a fractured cervical spine. The appellant contends a bone spur in his throat developed due to his service-connected fractured cervical spine. She believes that this bone spur development may have contributed to the gastrointestinal bleeding. The question for the Board is thus whether the Veteran's service-connected fractured cervical spine resulted in the development of a bone spur in the throat, and if so, whether it then led to his death. The August 2017 VA examination report attempted to address whether the Veteran service-connected fractured cervical spine contributed to his death. The VA examiner found that Veteran's service-connected fractured cervical spine was not related to the Veteran's death. However, the February 2020 Board decision remanded the claim because the August 2017 VA examination report was found to be inadequate for rating purposes due to the failure to fully consider the Veteran's full service and VA treatment records. To that end, an August 2020 VA medical opinion was proffered to address the question as to whether the Veteran's service-connected fractured cervical spine resulted in the development of a bone spur in the throat, and if so, whether it then led to his death. First, the VA examiner did find that the Veteran's cervical spine surgery resulted in kyphosis, which caused pressure on the esophagus from the vertebral bodies of C6 and C7. The VA examiner, however, opined that the resulting bone spur did not contributed to the Veteran's death. He highlighted that from the Veteran's cause of death was a result of a major upper gastrointestinal bleed and hemodynamic instability, in which began three days prior to hospital admission. The findings of the abdominal CT scan were highly suggestive of a duodenal focus for acute bleeding, which could be the result of metastasis of the duodenum from his small cell carcinoma of the lung that eventually eroded into a blood vessel in the duodenal wall. The VA examiner noted that the fact that the Veteran's liver showed signs of metastasis as support for his medical reasoning. As such, the VA examiner stated that, "it defies credulity to attempt to link his upper GI bleed with cervical spine kyphosis and C 6/7 pressure on the esophagus." The examiner noted that kyphosis was noted not to result in structural damage to the esophagus to the extent that it would produce an ulceration and lead to bleeding. Moreover, the site of the bleeding was not the esophagus. The VA examiner emphasized that the type of bleeding exhibited by the Veteran was indicative of duodenal bleeding in that melena preceded the development of hematemesis by several days. Although the VA examiner found that the Veteran cervical spine resulted in C6/7 pressure on the esophagus, he did not find any evidence that the C6/7 abnormality played any role whatsoever in the Veteran's death from massive upper GI bleeding and shock. In this case, as to the issue of whether the Veteran's service-connected fractured cervical spine caused or contributed substantially or materially to the Veteran's cause of death, the Board finds that the August 2020 VA addendum opinion is both adequate and the most probative evidence of record as it was definitive, based upon a complete review of the Veteran's entire claims file, in consideration of the Veteran's reported history, and pursuant to the Board's remand instructions. Furthermore, the August 2020 VA examiner provided a complete and thorough rationale in support of his opinion. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges the statements provided by the appellant regarding the symptomology surrounding the Veteran's service-connected cervical spine disability and his cause of death, as the appellant is competent to address such. However, she is not competent to opine as to whether the Veteran's service-connected fractured cervical spine caused or contributed substantially or materially to the Veteran's cause of death. As the appellant's statements are not competent as to the question of nexus, they are assigned no probative weight. Therefore, the issue of whether the Veteran's service-connected fractured cervical spine caused or contributed substantially or materially to the Veteran's cause of death must be decided based on the medical evidence of record. Therefore, the Board finds that the preponderance of the probative evidence is against a grant of entitlement to service connection for the cause of the Veteran's death. In reaching the above conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the appellant's claim, that doctrine is not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Higgins 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.