Citation Nr: 21070020 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 18-49 573 DATE: November 22, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1948 to November 1951. He died in November 2015. The Appellant is the Veteran's surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision dated in June 2018 of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). A November 2019 Board decision denying the claim was vacated by the United States Court of Appeals for Veterans Claims (CAVC) in May 2021. The case has been remanded to the Board, and, as explained below, must be remanded to the AOJ for additional development. 1. Entitlement to service connection for the Veteran's cause of death is remanded. The record reflects that the AOJ obtained three opinions regarding the Veteran's cause of death. The Board recognizes that the Court noted that there were only two distinct opinions in the claims file; the AOJ sought clarification from the September 2018 VA examiner, and on October 22, 2018, he provided an opinion in which he cut and pasted his previous response. The third opinion is dated October 11, 2018. Regardless of whether the opinions in the file are counted as two or three separate opinions, the Court's memorandum decision found that the opinions of record are inadequate to decide the Appellant's claim. First, the September 2018 (and, thus, the October 22, 2018) opinion indicated that the Veteran's death was not caused by his dementia or Alzheimer's disease. However, the Veteran's Certificate of Death lists dementia as a direct cause of death. Therefore, the opinion is inadequate because it is based on an incorrect premise. Second, the Appellant has contended that the Veteran's Alzheimer's disease or dementia should have been service connected because it was aggravated by his service-connected hearing loss. In support of her contention, she has submitted two articles. The VA examination reports of record addressed the articles, and found that they showed a theoretical link, but not a causal link, between hearing loss and dementia. However, in considering secondary service connection, an aggravation opinion was not provided. Finally, service connection for cause of death is warranted if a service-connected disability either caused or contributed substantially or materially to the Veteran's death. A contributory cause of death must contribute substantially or materially, or aid or lend assistance to the production of death. The VA examinations of record only address causation and do not address whether the Veteran's hearing loss was a contributory cause of death, or specifically whether it contributed substantially or materially, or aided or lent assistance to the production of death. As such, the Appellant's claim for service connection for the Veteran's cause of death must be remanded for adequate opinions. The matters are REMANDED for the following action: 1. Obtain a supplemental opinion from a qualified VA examiner regarding the Veteran's cause of death. The entire claims file and a copy of this remand should be made available to the examiner for review. The examiner is asked to address the following: (a.) The examiner should directly address the articles submitted by the Appellant in January 2018 and July 2018, which purport a link between Alzheimer's and hearing loss. (b.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran's cardiac arrest or dementia was proximately caused by his service-connected hearing loss. (c.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran's cardiac arrest or dementia was aggravated by his service-connected hearing loss. (d.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran's service-connected hearing loss contributed substantially or materially, or aid or lend assistance to, the production of death. A complete rationale must be provided for all expressed opinions. A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Smith, 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.