Citation Nr: 21074110 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-52 212 DATE: December 14, 2021 ORDER Entitlement to service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The Veteran died in May 2016; the cause of death was listed as coronary artery disease, a history of pulmonary embolism and diverticulitis, hypertension, hyperlipidemia and atrial fibrillation. 2. At the time of his death, the Veteran was service-connected for a right knee disability, a left knee disability, a right hip disability, a left hip disability, a low back disability, tinnitus, hearing loss and radiculopathy of the right and left lower extremities. 3. The Veteran's service-connected disabilities did not cause or substantially or materially contribute to his death. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1110, 1154, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310, 3.312 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1970 to April 1974. He died in May 2016. The appellant is the Veteran's surviving spouse. This matter comes to the Board of Veterans' Appeals (Board) from a February 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In her substantive appeal (VA Form 9), the appellant requested a Board hearing before a Veterans Law Judge. She subsequently withdrew her hearing request. The Board also acknowledges that the issues of entitlement to a rating in excess of 30 percent for a left hip replacement, entitlement to a rating in excess of 30 percent for a right hip replacement, entitlement to a rating in excess of 10 percent for a lumbar spine disability, entitlement to a rating in excess of 10 percent for radiculopathy of the right lower extremity, entitlement to a rating in excess of 10 percent for radiculopathy of the left lower extremity, entitlement to a total disability rating based on individual unemployability (TDIU) and entitlement to an earlier effective date than November 18, 2010 for the grants of service connection for a left hip disability, a right hip disability, a lumbar spine disability, right lower extremity radiculopathy and left lower extremity radiculopathy have been perfected, but not yet certified to the Board. The Board's review of the claims file reveals that the agency of original jurisdiction (AOJ) is still clearly taking action on these issues and they have not been certified for appeal. As such, the Board will not accept jurisdiction over them at this time, but they will be the subject of a subsequent Board decision, if otherwise in order. Laws and Regulations Service connection may be granted for a disorder resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disorder; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the present disorder and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection for the cause of a Veteran's death may be granted if a disability incurred in or aggravated by service was either the principal or contributory cause of death. See 38 C.F.R. § 3.312(a) (2019). For a service-connected disability to be the principal cause of death, it must singly or with some other condition be the immediate or underlying cause of death, or be etiologically related. See 38 C.F.R. § 3.312(b) (2019). For a service-connected disability to constitute a contributory cause, it must contribute substantially or materially to death. It is not sufficient to show that it casually shared in producing death; rather it must be shown that there was a causal connection. See 38 C.F.R. § 3.312(c) (2019). In order to be a contributory cause of death, it must be shown that there were "debilitating effects" due to a service-connected disability that made the Veteran "materially less capable" of resisting the effects of the fatal disease or that a service-connected disability had "material influence in accelerating death," thereby contributing substantially or materially to the cause of death. See 38 C.F.R. § 3.312(c) (1) (2019); Lathan v. Brown, 7 Vet. App. 359 (1995). Factual Background and Analysis The Veteran passed away on May 10, 2016. On his death certificate, the immediate cause of death was listed as "natural causes" noted to be coronary artery disease, a history of pulmonary embolism and diverticulitis, hypertension, hyperlipidemia and atrial fibrillation. A June 2016 autopsy report noted that the Veteran had a sudden collapse due to his atherosclerotic and hypertensive cardiovascular disease which resulted in a terminal impact to the right rear aspect of the Veteran's head which corroborated the sudden likely cardiac event. The cause of death was listed as atherosclerotic and hypertensive cardiovascular disease and the manner of death was natural. The autopsy report noted that the sudden event and terminal cause of death was of exclusive cardiac origin (probably ventricular fibrillation due to the combined atherosclerotic and hypertensive cardiovascular disease) with a sudden collapse which was typical of the sudden fall backwards and head impact and failure to attempt to break the fall. The Veteran was service connected for a right knee disability, a left knee disability, a right hip disability, a left hip disability, a low back disability, tinnitus, hearing loss and radiculopathy of the right and left lower extremities prior to his death. Based on the above, the Board finds that the most competent and credible evidence of record is against a finding of service connection for the cause of the Veteran's death. The competent and persuasive evidence of record does not show that the Veteran's eventual cause of death for heart condition was related to or proximately caused by his service or by his service-connected orthopedic and audio disabilities. It is undisputed that the Veteran's death was caused by natural causes including disabilities related to the heart. As noted above, the June 2016 autopsy reported indicated that the sudden event and terminal cause of death was of exclusive cardiac origin. However, service connection for cause of death requires more than just a showing that the Veteran died of heart related disabilities. Rather, it must be shown that his heart related were either directly or presumptively linked to his time in active service. Here, the evidence of record fails to establish as such. The Veteran service treatment records are silent for any complaints, diagnosis, or treatment indicative of a heart disability and there is no indication that the Veteran developed a heart disability within one year of service. Post service private treatment records showed that he was diagnosed and treated for several conditions such as coronary artery disease, a history of pulmonary embolism and diverticulitis, hypertension, hyperlipidemia and atrial fibrillation several years after service. Notably, the record is negative for evidence that shows that the Veteran developed a heart disability as a result of his service, nor does it show that his heart disabilities manifested within one year of service. Additionally, the evidence shows that the Veteran's service-connected orthopedic and audio disabilities did not progress to a point where they were considered a contributory factor or proximate cause of his death. The Veteran's death certificate does not list the Veteran's orthopedic and audio disabilities as factors or causes of his death. The Veteran is not service connected for the death certificate's listed causes of death including coronary artery disease, a history of pulmonary embolism and diverticulitis, hypertension, hyperlipidemia and atrial fibrillation. There has been no showing that the Veteran's service-connected disability contributed to his death. As a result, there is no competent evidence or opinion even suggesting that there exists a medical nexus between the Veteran's service or his service-connected disabilities and the Veteran's death and the appellant has not presented or identified any such existing medical evidence or opinion. The Board recognizes that VA has not obtained a medical opinion and has considered whether such development is warranted. However, VA need not obtain a medical opinion with respect to the claim on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claim. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is no credible evidence that the exists a relationship between the Veteran's service or his service-connected disabilities and his death. Thus, remand for a medical opinion is not necessary. The Board acknowledges the appellant's statements asserting the Veteran's service-connected conditions relating to his cause of death. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, determining the etiology of the Veteran's cause of death, falls outside the realm of common knowledge of a lay person because it involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. In this regard, an opinion regarding the nature and etiology of the Veteran's disabilities requires medical expertise that the appellant has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). Thus, the appellant's lay statements as to the relationship between the Veteran's service-connected disabilities and his cause of death are given no probative weight. The Board thus finds that the weight of the competent and probative evidence is against a finding of service connection for the cause of the Veteran's death. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.