Citation Nr: 21072224 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-23 092 DATE: December 2, 2021 ORDER Entitlement to service connection for cause of death is denied. FINDINGS OF FACT 1. The Veteran died in January 2014. 2. The Veteran's death certificate lists the immediate causes of death as mediastinal mass presumed cancer and pericardial effusion. 3. At the time of his death, the Veteran had no service-connected disabilities. 4. The preponderance of the evidence is against finding the Veteran's causes of death, mediastinal mass and pericardial effusion, were related to the Veteran's period of service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1131, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from April 1951 to December 1953. The Veteran died in January 2014. The appellant is his surviving spouse. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Board remanded the claim for further development that included obtaining a VA medical opinion (VAMO). Entitlement to service connection for cause of death The appellant contends entitlement to service connection for the cause of the Veteran's death because the disabilities that led to his death began in service. See NOD (September 2015). As explained below, the Board concludes the preponderance of the evidence weighs against finding that the Veteran's death is related to his active service. The law provides that a surviving spouse of a qualifying veteran who dies as a result of a service-connected disability is entitled to receive dependency and indemnity compensation (DIC). 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Compensation may be awarded for the cause of a veteran's death where the evidence shows that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(a). In order 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). In the case of contributory cause of death, it must be shown that a service-connected disability contributed substantially or materially to cause death, combined to cause death, or aided or lent assistance to producing death - e.g., when a causal (not just a casual) connection is shown. 38 C.F.R. § 3.312(c). In short, the appellant is entitled to DIC benefits if the principal or contributory cause of the veteran's death was (1) an already service-connected disability that caused or aggravated another disability, directly leading to the veteran's death; or (2) a previously nonservice-connected disability that was in fact incurred or is otherwise etiologically related to service. 38 U.S.C. § 1310; 38 C.F.R. §§ 3.303(a), 3.310, 3.312. Turning first to the matter of whether the Veteran's original causes of death were service connected, the Veteran passed away on January 2, 2014, more than 60 years after service discharge. The death certificate recorded the Veteran's primary cause of death as mediastinal mass presumed cancer and pericardial effusion. The Veteran had no service-connected disabilities at the time of death. As such, the question that remains before the Board is whether a previously non-service-connected disability, one of the Veteran's causes of death, mediastinal mass or pericardial effusion, was in fact incurred in or is otherwise etiologically related service. The Board concludes the preponderance of the evidence is against finding the Veteran's causes of death were caused by or are etiologically related to his active military service. The probative evidence does not show the conditions were related to the Veteran's active military service, or that any of these conditions were chronic disabilities incurred in service. The conditions were not found within one year of separation or shortly thereafter. Rather, the Veteran's mediastinal mass and pericardial effusion were not shown until many years after service discharge. Service treatment records (STRs) show the Veteran complained of chest pains and wheezing while in service. On one occasion, the Veteran was diagnosed with an upper respiratory infection with wheezing in chest, cough, sore throat, malaise, myalgia, fever, and chilly sensation. However, it was noted that the Veteran did not have a chronic cough or weight loss. He was diagnosed with acute pharyngitis. October 1951 STRs show the Veteran sought treatment for daily headaches and frequent pain across his chest. It was also noted that cerumen (wax) was coming out of his ears. Chest x-rays were ordered, but the results of which were not associated with his file. January 1953 STRs show the Veteran sought treatment for severe pain that had lasted for months as well as cough and chills. He complained of headaches around eyes, pain across his chest, weakness, drowsiness, and slight sore throat. X-ray of his chest was conducted and resulted in negative findings. November 1953 STRs show the Veteran sought treatment for cold and sore throat with slight non-productive cough and chest pain. The examiner concluded the Veteran had wheezing rhonchi sore throat and diagnosed him with acute pharyngitis. A subsequent chest x-ray showed the Veteran's heart and lungs were within normal limits. Neither of the Veteran's causes of death were mentioned on the December 1953 separation examination reports. It was silent for any chest, heart, or lung complaints. Post-service, May 1965 private treatment records show the Veteran was admitted in November 1964 and December 1963 for complaints of shortness of breath, acute chest pain, hypertension, and fever. Cardiac catheterization showed hypoplastic left pulmonary artery, patent foramen ovale and normal intracardiac pressures. Pulmonary ventilation studies showed his vital capacity was moderately reduced and indicated a moderate loss of aerated lung tissue, which was due, in part, to airway obstruction. Electrocardiograms showed only minor wave segment changes. He was diagnosed with pneumococcus. While hospitalized, he had one episode of acute bronchopneumonia where he became extremely ill, however, he made a successful recovery and was discharged in December 1964. He was readmitted several days later in January 1965 and a left pneumonectomy was performed. The tissue showed classical bronchiectasis (saccular and old) involving all segmental bronchi of the left lung and mild emphysema of the lingula and left lower lobe. Physicians surmised that the initial abnormality was congenital hyperplasia of the left pulmonary artery allowing the lower lung to become more susceptible to infection, which produced bronchiectasis and the abnormal growth of the lung. However, it was not possible to determine the process. He was discharged later in January 1965, feeling well with a clear chest although his left side had not completely filled post-operation. He was readmitted the same day for an acute asthmatic episode, was treated conservatively, and discharged two days later. The physician noted he had seen the Veteran on several occasions since then and treated him for slight wheezes on his right side. Chest x-ray revealed a completely normal right side with some compensatory emphysema. Otherwise, chest was clear and chest x-ray was within normal limits. VA medical records (VAMRs) dated December 1984 through July 2016 show the Veteran sought treatment complaining of asthma, persistent cough, blackouts, emphysema, shortness of breath, elevated blood pressure, and bronchiectasis. See VA-101 Forms (March 2013). March 2008 VAMRs include a report that the Veteran underwent a fine needle aspiration of the right and left thyroid. Results showed degenerated follicular cells. July 2012 VAMRs show the Veteran was diagnosed with small to moderate pericardial effusion, most marked around right atrium. January 2014 VA MTRs show the Veteran died with a cause of death of mediastinal mass/pericardial effusion. In April 2020, VA obtained a medical opinion (VAMO) to address whether the Veteran's causes of death were etiologically related to service. The April 2020 VAMO shows that examiner conducted a thorough review of all materials in the claims file, including STRs and VAMRs. The examiner opined it is less likely as not that the Veteran's mediastinal mass and pericardial effusion are etiologically related to service. The rationale was that the conditions were not shown in service or related to service to include in-service respiratory complaints, noting among other things that there were no abnormalities of the respiratory system on service separation and negative x-ray findings. The mediastinal mass was present for years and was shown to originate in the thyroid. His lung abnormality was due to a 'congenital hyperplasia of the left pulmonary artery' leading ultimately to bronchiectasis, according to the Veteran's doctor who treated him 1964 and 1965. The Veteran's primary health issues in his last months of life were severe chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). It was further noted that pericardial effusion noted by CT scan in February 2013 appeared to be related to the Veteran's CHF; and the mediastinal mass was a "goiter," which is a benign thyroid tumor that results in hypothyroidism. Based on all the above evidence, the Board concludes the Veteran's death was less likely than not caused by or etiologically related to his active service. There is no evidence that the medical conditions that caused or contributed to the Veteran's death, including mediastinal mass and pericardial effusion, had their onset during service or within one year after separation from service. Additionally, the April 2020 VA medical examiner concluded the Veteran's death, mediastinal mass and pericardial effusion, was less likely than not etiologically related to service. The examiner explained the Veteran was not diagnosed with pericardial effusion until February 2013 and the mediastinal mass, according to the available evidence, was a goiter, which is a benign thyroid tumor that results in hypothyroidism. STRs were silent for the conditions, any condition of the thyroid, and there was no evidence of a chronic condition at separation from service. Multiple chest x-rays showed no abnormalities other than those known. The Board appreciates that the appellant sincerely believes her late husband's death was related to service; however, the appellant has not demonstrated that she has any medical knowledge or training in determining the cause of person's death. In other words, she is a layperson, not a medical expert. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Consequently, the Board gives greater weight to the April 2020 VAMO. The opinion was prepared by a trained medical professional after review of the relevant medical history and is supported by a complete rationale. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25. See also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (Also, "[a] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two."). On balance, the weight of the evidence is against the claim. The evidence in this case is not so evenly balanced so as to allow application of the benefit-of- the-doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the claim is denied. TESS WINKLER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Pendleton, N. 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.