Citation Nr: 21065128 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 19-06 412 DATE: October 25, 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 August 1948 to September 1969. He died in June 2017 and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in July 2018 by a Department of Veterans Affairs (VA) Regional Office. In January 2021, the appellant testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In May 2021, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for the cause of the Veteran's death. The Veteran's certificate of death lists his causes of death as lobar pneumonia, chronic respiratory failure, and severe chronic obstructive pulmonary disease (COPD) without any other significant conditions. The appellant contends that his cause of death is related to exposure to herbicide agents while serving in Vietnam. Specifically, she has submitted evidence, to include an identification card, that the Veteran served in Vietnam under a different name. In this regard, her representative alleged in a September 2021 Written Brief Presentation that VA needs to "put their files right." Yet, to do so would require the removal of evidence from the record that was submitted by the appellant herself and not associated with the record by VA, which would appear to violate the representative's own client's due process rights. Moreover, part of the representative's argument relies on that evidence, as he contends such corroborates the Veteran's service in Vietnam. However, service treatment records (STRs) clearly document treatment for the deceased Veteran at a stateside facility during the time in which the other individual was serving in Vietnam. As such, the evidence establishes that the Veteran and the other individual were two separate service members, or the records for the other individual are fabricated. As the Veteran's service personnel records do not confirm his service in the Republic of Vietnam or otherwise show service in a location where VA acknowledges the use of herbicide agents, such alleged in-service exposure to herbicide agents has not been verified. Alternatively, the appellant's representative asserts that the Veteran's cause of death is related to in-service exposure to diesel exhaust, fumes, lead, and copper in connection with his duties as a tank (armor) crewman. In addition, he highlights a link between heart disease and hypertension and alleges the latter had its onset in service. In this regard, STRs reflect findings referable to upper respiratory infections, pharyngitis, and hypertension and, in a February 2018 letter, Dr. L.F. reported that the Veteran had a long history of ischemic heart disease and explained that older adults with ischemic heart disease have a greater risk of getting pneumonia due to a weakened immune system. The May 2021 Remand sought a medical opinion to determine whether the Veteran's fatal lobar pneumonia, chronic respiratory failure, and/or severe COPD were related to his military service or, in the alternative, whether a disability of service origin, to include hypertension, was a principal or contributory cause of his death. In response, a VA physician provided an unfavorable medical opinion in July 2021. Therein, he noted that the Veteran's STRs did not show any evidence of the diagnosis, treatment, or symptoms suggestive of respiratory failure, pneumonia, COPD, or hypertension, nor did they indicate that he met JNC criteria for hypertension while on active duty or within one year of separation from military service. Although the Veteran complained of acute, temporary upper respiratory symptoms (i.e., common cold, laryngitis, pharyngitis), the VA physician found such resolved with treatment and were unrelated to his lobar pneumonia, chronic respiratory failure, and COPD 48 years after his separation from service. Notably, the VA physician did not have the opportunity to address the appellant's representative's September 2021 assertions regarding a link between the Veteran's cause of death and in-service environmental exposures to diesel exhaust, fumes, lead, and copper or the cited medical literature. In addition, he does not appear to have considered a January 1969 STR reflecting a clinical impression of hypertension, or discuss the other STRs showing potentially elevated blood pressure readings. Consequently, the Board finds a remand is warranted to obtain an addendum opinion addressing such matters. The matter is REMANDED for the following action: Forward the record, to include a copy of this Remand, to the VA physician who provided the July 2021 opinion, or an appropriate substitute if unavailable, so as to obtain an opinion addressing the cause of the Veteran's death. Following a review of the record, the clinician should offer an opinion as to whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's fatal lobar pneumonia, chronic respiratory failure, and/or severe COPD had its onset in, or is otherwise related to his military service, to specifically include any environmental exposure to diesel exhaust, fumes, lead, and/or copper in connection with his duties as an armor crewman. The clinician should address the medical literature cited to in the appellant's representative's September 2021 Written Brief Presentation addressing a potential link between exposure to such environmental hazards and high blood pressure, heart disease, and respiratory disorders. If not, the clinician should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a disability of service origin, to include hypertension, was the immediate or underlying cause of the Veteran's death or etiologically related thereto, contributed substantially or materially to the cause of his death, combined to cause death, or aided or lent assistance to the production of death. The clinician must specifically address a January 1969 STR reflecting a clinical impression of hypertension, other STRs showing potentially elevated blood pressure readings, and Dr. L.F.'s February 2018 opinion regarding a link between hypertension, heart disease, and pneumonia. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. M. Celli, 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.