Citation Nr: 21065764 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 18-41 894 DATE: October 27, 2021 ORDER Entitlement to service connection for the cause of the Veteran's death is granted. FINDINGS OF FACT 1. The Veteran died in June 2016. His immediate cause of death was a self-inflicted gunshot to the head. 2. Symptoms of a trauma-related disorder began during service and continued after service separation. 3. The trauma-related disorder contributed substantially and materially to the cause of the Veteran's fatal self-inflicted gunshot wound. CONCLUSION OF LAW The criteria to establish service connection for the cause of the Veteran's death are met. 38 U.S.C. §§ 1110, 1116, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1984 to August 2006. Unfortunately, the Veteran died in June 2016. The appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the October 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for the Veteran's cause of death. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Service Connection for the Cause of the Veteran's Death In a Dependency and Indemnity Compensation (DIC) claim based on cause of death, the current disability element will always have been met (the current disability being the one that caused the Veteran to die). Carbino v. Gober, 10 Vet. App. 507, 509 (1997), aff'd sub nom. Carbino v. West, 168 F.3d 32 (Fed. Cir. 1999). DIC benefits are payable to the surviving spouse of a Veteran if the Veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5(a)(1). In order to establish service connection for the cause of a Veteran's death, the evidence must show that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 C.F.R. § 3.312 (a). To constitute the principal cause of death, the service-connected disability must be one of the immediate or underlying causes of death or be etiologically related to the cause of death. 38 C.F.R. § 3.312 (b). To constitute a contributory cause of death, it must be shown that the service-connected disability contributed substantially or materially; that it combined to cause death, or that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c)(1). The June 2016 death certificate establishes that the immediate cause of the Veteran's death was self-inflicted single gunshot with pistol. See June 2016 Certificate of Death issued by the South Dakota Department of Health. During his lifetime, the Veteran was service connected for obstructive sleep apnea rated as 50 percent disabling; patellofemoral pain syndrome right knee rated as 10 percent disabling; patellofemoral pain syndrome left knee rated as 10 percent disabling; residuals right shoulder sprain rated as 10 percent disabling; Morton's neuroma left foot rated as 10 percent disabling; residuals right hand contusion rated as noncompensable; right hip strain rated as noncompensable; and hypertension rated as noncompensable; he was not service connected for any psychiatric disorder. Turning to the record, the appellant asserts, in part, that the Veteran's death was related to posttraumatic stress disorder (PTSD). See October 2017 Notice of Disagreement. At the January 2021 Board hearing, the appellant testified that prior to the Veteran's death, his PTSD symptoms impacted his quality of life. She reported witnessing the Veteran have symptoms of paranoia, sleep disturbance, and social altercations, including issues at work. She acknowledged that the Veteran's death certificate stated that his cause of death was due self-inflicted gunshot but contended that he committed suicide due to PTSD symptoms. See January 2021 Hearing Transcript, pages 4, 6, 7; January 2018 DRO Hearing Transcript, page 12. Based on the evidence, both lay and medical, the, the Board finds that the evidence is at least in equipoise with regard to the question of whether there was an onset of psychiatric symptoms in service and since service separation, i.e., whether a psychiatric disorder was directly "incurred in" service. As an initial matter, the Veteran was diagnosed with trauma-related disorder by a neuropsychologist in a November 2018 VA medical opinion after conducting a file review. The Board notes this is the only diagnosis of a psychiatric disorder in the claims file. Although the Veteran's VA and private medical records are negative for any mental health treatment, the lack of treatment was explained by the appellant, stating that she several times implored the Veteran to get help, but he refused. See January 2021 Hearing Transcript, page 6. In short, although a diagnosis of PTSD was not confirmed, a trauma-related disorder was diagnosed. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board finds that the Veteran witnessed traumatic events in service, including negotiating with a barricaded suicidal solider who ultimately took his own life; transferring passengers from one convoy vehicle to another during an emergency halt in a high direct area of operations, where he heard gunfire; discovering the body of an airman who had committed suicide whom the Veteran had worked with closely on work and medical issues; and that the Veteran transported bodies down to the morgue while stationed in Hot Springs. The events are supported by lay and buddy statements from the appellant, the daughter of the Veteran, and family friends of the Veteran, in addition to the Veteran's military personnel records including performance evaluations, and service treatment records (STRs). See April 1993 Performance Assessment; September 2016 Buddy Statements; March 2006 Chronological Record of Medical Care; January 2018 Decision Review Officer Hearing Transcript, page 6. The appellant also stated that the second suicide, "put him [the Veteran] over the edge," and his behavior was not good when he returned from Kuwait. See January 2021 Hearing Transcript, page 4. The Board next finds that the evidence is at least in equipoise as to whether the Veteran's trauma-related disorder substantially or materially contributed to the cause of his death, suicide via gunshot wound. In this regard, a November 2018 VA neuropsychologist had an opportunity to review the Veteran's claim file and opined that symptoms of trauma resulting from his military experiences more likely caused the Veteran's death by gunshot wound. The examiner noted the appellant described a history of behavior which she related to traumatic experiences which occurred during military service which began shortly after the Veteran's time in the military and persisted throughout his life, and such behavior was consistent with a trauma-related disorder. The Board construes the opinion to relate the trauma-related disorder to the experiences in service, and the underlying cause of his death. The Board finds the opinion to be of probative value as it is based on a review of the record, to include lay statements from the appellant and STRs, and contained rationale to support the conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, given the credible evidence showing that the Veteran had witnessed traumatic events in service, the credible evidence that the Veteran's symptoms began in service and continued after service and were later diagnosed as a trauma related disorder, and the probative medical evidence that the in-service trauma symptoms more likely than not led to committing suicide, the Board resolves reasonable doubt to find that the Veteran's trauma related disorder, which began during service, contributed substantially and materially to the cause of the Veteran's death, suicide. As the reasonable doubt created by the relative equipoise in the evidence must be resolved in favor of the appellant, the criteria to establish service connection for the cause of the Veteran's death are met, and the claim is granted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.312. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moldawer, Associate 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.