Citation Nr: 21072667
Decision Date: 12/06/21	Archive Date: 12/06/21

DOCKET NO. 17-24 522
DATE: December 6, 2021

REMANDED

Entitlement to service connection for the Veteran's cause of death is remanded.

REASONS FOR REMAND

The Veteran had active service from October 1969 to November 1975.  He died in October 2015.  The Appellant is his surviving spouse.  She seeks entitlement to service connection for the Veteran's cause of death.

The Appellant appeared at a hearing before the undersigned in April 2021.  A transcript of the hearing is of record.

During the April 2021 hearing, the Appellant's representative asserted records submitted at the time of the hearing, i.e., October 2015 treatment records from St. Anthony's Medical Center, support a finding of ischemic heart disease in the Veteran's case; however, these records are duplicative of records previously submitted in January 2017 and were considered by a March 2017 examiner, who adequately explained the Veteran did not have ischemic heart disease just before his death in October 2015 but rather had bacterial endocarditis caused by strep viridans.  Yet, the March 2017 examiner did not explicitly address whether the cause of death noted of the Veteran's death certificate, "severe aortic stenosis", was a result of bacterial endocarditis or potentially some other condition.  The Board is not permitted to rely on its own unsubstantiated medical conclusions to close this gap in the evidentiary record.  See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991).  The Board acknowledges "severe aortic stenosis" does not appear to fall within the parameters of ischemic heart disease as contemplated by 38 C.F.R. § 3.309(e), but it notes the inability to establish service connection on a presumptive basis does not foreclose the possibility of service connection on a direct or secondary basis.  See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).  Thus, an addendum to the March 2017 opinion is necessary to ensure the decision on the Appellant's claim is fully informed.

The matter is REMANDED for the following action:

Obtain an addendum from the March 2017 examiner explicitly addressing whether the cause of death listed on the Veteran's death certificate, i.e., "severe aortic stenosis", is a result of or otherwise caused by the bacterial endocarditis diagnosed shortly before his death.

If not, the examiner must address whether the "severe aortic stenosis" was at least as likely as not (50 percent probability or greater) the result of an in-service disease or injury, to include, but not limited to his presumed exposure to herbicide agents; or proximately due to, or aggravated by, a service-connected disability or disabilities.

In the context of direct service, a rationale limited solely to a statement indicating "severe aortic stenosis" is not a disease presumed to be associated with herbicide agent exposure will be deemed inadequate to make an informed decision on the Appellant's claim standing alone; there must be a discussion of the underlying medical principles involved.

If the secondary service connection opinion is necessary because direct service connection is not established, it must address both causation and aggravation to be deemed adequate.  The examiner is advised aggravation means an increase in the severity of the underlying disability beyond its natural progression.  If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation.

If the March 2017 examiner is unavailable or cannot otherwise provide the requested addendum, it may be obtained from another examiner.

The addendum must include a complete rationale to support all conclusions contained therein.

 

 

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.