Citation Nr: 21070383 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 18-39 089 DATE: November 23, 2021 REMANDED Service connection for cause of death is remanded. REASONS FOR REMAND The Veteran had active service in the Marines from April 1969 to January 1976. He died in September 2016. The Appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a February 2018 rating decision. The Appellant seeks to establish that the Veteran's esophageal cancer was connected to his exposure to contaminated water at Camp Lejeune. The Veteran's death certificate shows that the primary causes of death were failure to thrive and dementia. A contributory cause of death is listed as esophageal cancer. 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 service either caused or contributed substantially or materially to death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (a). A service-connected disability will be considered the principal cause of death when the disability singly or jointly with some other condition was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312 (b). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially, that it combined to cause death, or that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown there was a causal connection. 38 C.F.R. § 3.312 (c). The Appellant testified before the Board in August 2021. During this hearing, the Appellant's representative raised an additional theory of entitlement, namely that the Veteran's service-connected ischemic heart disease contributed to his death, specifically his failure to thrive. Specifically, the Appellant's representative requested that a medical opinion be obtained on this issue. Under 38 U.S.C. § 5103A(a), VA must provide a medical opinion where (1) the claimant requests assistance in obtaining a medical opinion, (2) the provision of a medical opinion is necessary to substantiate the claim for benefits, and (3) there exists a reasonable possibility that such assistance would in fact aid in substantiating the claim. See Wood v. Peake, 520 F.3d 1345, 1348 (Fed. Cir. 2008); DeLaRosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008) (holding that the Secretary may have a duty to provide a medical opinion in connection with a DIC claim under section 5103A(a) as part of his duty to assist). Given that one of the Veteran's causes of death was listed as failure to thrive and given that his service-connected ischemic heart disease affects a vital organ, the Board finds that this argument meets the low threshold to provide a VA examination in cause of death cases. The matter is REMANDED for the following action: 1. Obtain a medical opinion to address the cause of the Veteran's death. The examiner should answer the following question: Is it at least as likely as not (50 percent or greater) that the Veteran's service-connected ischemic heart disease, was either the principal or a contributory cause of his death? Why or why not? The examiner is informed that a service-connected disability will be considered the principal cause of death when the disability singly or jointly with some other condition was the immediate or underlying cause of death or was etiologically related thereto. A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially, that it combined to cause death, or that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown there was a causal connection. Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. There are primary causes of death which by their very nature are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, but, even in such cases, there is for consideration whether there may be a reasonable basis for holding that a service-connected condition was of such severity as to have a material influence in accelerating death. In this situation, however, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jennifer M. Narvaez, 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.