Citation Nr: 21069658 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 15-41 214A DATE: November 19, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran had active military service from November 1976 to December 1996. He died in August 2013. The appellant is the Veteran's surviving spouse. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the appellant testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is included in the claims file. The appellant was afforded a 90 day period of time following the hearing to submit additional evidence. The Board finds that additional development is required before the appellant's claim on appeal is decided. Entitlement to Service Connection for Cause of the Veteran's Death The Veteran's death certificate lists the immediate cause of his death as acute coronary insufficiency, with diabetes, hypertension, and chronic obstructive pulmonary disease (COPD) listed as other significant conditions contributing to death but not resulting in the underlying cause of death. The appellant asserts that the Veteran's death was due to service. Specifically, the appellant contends that the Veteran used prescription medication and alcohol to alleviate pain associated with his service-connected lumbar spine degenerative joint disease, which in turn resulted in impairment to health which contributed to his death. At the time of the Veteran's death, the Veteran was service-connected for lumbar spine degenerative joint disease, left lower extremity radiculopathy, left eye retina inflammation, left ear hearing loss, left ear perforated ear drum and a deviated septum. To date, no medical opinion has been obtained as to the likelihood that the cause of the Veteran's death is related to service. As the Board cannot conclude that there is no reasonable possibility that obtaining such an opinion would aid in substantiating the appellant's claim, further development is required. See 38 U.S.C. § 5103A(a); DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008); Wood v. Peake, 520 F.3d 1345 (Fed. Cir. 2008). The matters are REMANDED for the following action: Forward the Veteran's claims file to a VA medical examiner with sufficient expertise to provide opinions regarding the etiology of diabetes and the cause of the Veteran's death. The examiner must review the claims file and must note that review in the report. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is it at least as likely as not (50 percent or better) that the Veteran's service-connected lumbar spine degenerative joint disease, left lower extremity radiculopathy, left eye retina inflammation, left ear hearing loss, left ear perforated ear drum and/or deviated septum contributed substantially or materially to his death? (B) Is it at least as likely as not (50 percent or better) that the Veteran's diabetes mellitus type II was caused or aggravated by his service-connected disabilities, to specifically include his lumbar spine degenerative joint disease? In forming the opinion, the examiner must specifically address the appellant's assertion that medication and alcohol the Veteran used for treatment of service-connected disabilities caused or aggravated his diabetes. (C) If the answer to (b) is yes, is it at least as likely as not (50 percent or better) that the Veteran's diabetes mellitus type II contributed substantially or materially to his death? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.