Citation Nr: 21069848 Decision Date: 11/20/21 Archive Date: 11/20/21 DOCKET NO. 17-33 329 DATE: November 20, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND VA has a duty to ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). Although not previously directed, the Agency of Original Jurisdiction (AOJ) elected to obtain an opinion regarding the Appellant's claim after this matter was remanded by the Board of Veterans' Appeals (Board) in February 2020. See 38 U.S.C. § 5103A(a); Wood v. Peake, 520 F.3d 1345, 1347-48 (Fed. Cir. 2008). Unfortunately, the August 2021 opinion obtained by the AOJ is inadequate to address the theories of entitlement the Appellant has raised to support her claim. First, the Appellant has asserted the Veteran's service-connected post-traumatic stress disorder (PTSD) exacerbated the conditions that led to his death and/or was a contributory cause of his death. The sole rationale the August 2021 VA examiner provided to address this theory is that "PTSD is not an etiological risk factor for cardiopulmonary or rheumatoid pathologies." This rationale appears to solely address whether PTSD caused the conditions listed on the Veteran's death certificate as his immediate cause of death without adequately addressing the material issue of whether PTSD contributed substantially or materially to death, combined to cause death, or aided or lent assistance to the production of death, as well as the Appellant's explicit assertion that the Veteran's PTSD exacerbated the conditions that led to his death. See 38 C.F.R. § 3.310(b). Additionally, after the Board's February 2020 remand, the Appellant submitted a copy of the remaining excerpts of the Veteran's service treatment records (STRs) that were not destroyed in a 1973 fire at the National Personnel Records Center with a statement asserting notations regarding heart issues in the STRs relate to her claim for service connection for the Veteran's cause of death, essentially raising a theory of direct service connection that was also not addressed in the previously obtained August 2021 opinion. The Board notes "apical systolic murmur function precordium" was noted on the Veteran's induction examination and therefore can only serve as predicate disability for the Appellant's claim for service connection for the Veteran's cause of death if there is a finding that the condition was aggravated during service. Yet, an October 1954 radiographic report notes lung markings appearing to be slightly accentuated throughout the chest, especially in both pericardiac regions, with the Veteran reporting chest pain for at least last five months at that time. Thus, there is some evidence in the available STRs that should be addressed by an expert in light of the Appellant's most recent assertion to ensure the decision on her claim is fully informed. The matter is REMANDED for the following action: Obtain a new opinion regarding the issue of service connection for the Veteran's cause of death that addresses both theories of entitlement raised by the Appellant. It is asked that the selected expert respond directly to the questions below rather than write a summary opinion. Specifically, the selected expert must address the following two theories raised by the Appellant, as enumerated below: 1.) Was there any increase in severity of the apical systolic murmur function precordium (noted on the Veteran's induction examination) during service, and, if so, whether it is clear and unmistakable that such increase was due to the natural progression of the disease? In this regard, please discuss the relevance, if any, of the October 1954 radiographic report that shows lung marking appearing to be slightly accentuated throughout the chest, especially in both pericardiac regions, with the Veteran reporting chest pain for at least last five months at that time. If there was an increase in the apical systolic murmur function precordium that was not clearly and unmistakably due to the natural progression of the disease, is it at least as likely as not (50 percent probability or greater) that any of the conditions listed as the Veteran's immediate cause of death (cardiopulmonary arrest, rheumatoid vasculitis, or rheumatoid arthritis) were proximately due to, or aggravated by, the apical systolic murmur function precordium (or a residual thereof). The secondary service connection aspect of the opinion must explicitly address both causation and aggravation to be deemed adequate. It must be noted aggravation means an increase in the severity of the underlying disability beyond its natural progression. 2.) Were any of the conditions listed as the Veteran's immediate cause of death (cardiopulmonary arrest, rheumatoid vasculitis, or rheumatoid arthritis) at least as likely as not (50 percent probability or greater) proximately due to, or aggravated by, his service-connected PTSD; or did PTSD at least as likely as not (50 percent probability or greater) contribute substantially or materially to death, combined to cause death, or aided or lent assistance to the production of death in the Veteran's case? The initial secondary service connection aspect of the opinion must explicitly address both causation and aggravation to be deemed adequate. It must be noted aggravation means an increase in the severity of the underlying disability beyond its natural progression. The expert's report must include a complete rationale for all conclusions reached in the requested opinion. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. S. Kyle, 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.