Citation Nr: 21075462 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-36 794 DATE: December 20, 2021 ISSUES 1. Entitlement to service connection for the cause of the Veteran's death. 2. Dependency and indemnity compensation (DIC) benefits under 38 U.S.C. § 1318. REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. Dependency and indemnity compensation (DIC) benefits under 38 U.S.C. § 1318 is remanded. REASONS FOR REMAND The Veteran served from March 16, 1966 to April 29, 1966. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2016 by a Regional Office (RO) of the Department of Veterans Affairs (VA) which denied entitlement to entitlement to service connection for cause of the Veteran' death and entitlement to Dependency and Indemnity Compensation (DIC) under 38 U.S.C. § 1318. The Board notes that during the course of this appeal, the appellant changed her representation from the Marine Leagues Corp to Disabled American Veterans (DAV). See July 9, 2021 VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative. The Board also notes that after issuance of the Statement of the Case (SOC), the appellant's representative submitted an Appellant's Brief with citation to a medical journal article/treatise and research study, which included a waiver of AOJ consideration of additional evidence. See December 9, 2021, Appellant's Brief, pg.1. Therefore, the Board may properly consider such newly received evidence. Entitlement to service connection for the cause of the Veteran's death is remanded. To establish service connection for the cause of a veteran's death, the evidence must show that disability incurred in or aggravated by service either caused or contributed substantially or materially to the cause of death. For a service-connected disability to be the cause of death, it must singly or with some other condition be the immediate or underlying cause or be etiologically related thereto. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death but rather it must be shown that there was a causal connection. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. The Veteran's death certificate lists his cause of death as end stage dementia. At the time of his death, the Veteran was service connected for bipolar disorder with recurrent episodes of depression and mania. The appellant contends that the Veteran's service-connected bipolar disorder caused his dementia, which ultimately caused his death. As referenced in the introduction of this Board remand, the appellant's representative has submitted citations to a medical journal article/treatise and research study, which support an association between bipolar disorder and dementia. See, History of Bipolar disorder and the risk of dementia: a systematic review and meta-analysis, American Journal of Geriatric Psychiatry (2017); Dementia and bipolar disorder on the borderline of old age, PubMed.gov (nih.gov); See also, December 9, 2021, Appellant's Brief, pgs. 2-3. The Board observes that there is no medical opinion of record with regard to the Veteran's cause of death. The Board finds that prior to adjudication of this claim, a VA medical opinion should be obtained as to the nature and etiology of the Veteran's cause of death with consideration of the specific facts of this Veteran's bipolar disorder, with recurrent episodes of depression and mania. When forming his/her rationale, the examiner should review and discuss the medical journal article/treatise and research study submitted by the appellant's representative. The Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discussed generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated medical opinion. Sack v. West, 11 Vet. App. 314 (1998); see also 38 C.F.R. § 3.159(a)(1). Dependency and indemnity compensation (DIC) benefits under 38 U.S.C. § 1318. DIC benefits under 38U.S.C. § 1318 is inextricably intertwined with service connection for the cause of the Veteran's death, and thus also is remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Accordingly, these matters are REMANDED for the following action: 1. Obtain a VA medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's cause of death. The examiner must opine whether the Veteran's service-connected bipolar disorder, with recurrent episodes of depression and mania, at least as likely as not, contributed to his end stage dementia, which caused or contributed to his cause of death. The examiner must discuss the medical journal article/treatise and research study submitted by the appellant's representative. See December 9, 2021 Appellant's Brief re: History of Bipolar disorder and the risk of dementia: a systematic review and meta-analysis, American Journal of Geriatric Psychiatry (2017); Dementia and bipolar disorder on the borderline of old age, PubMed.gov (nih.gov). A detailed rationale is required to support each opinion. This means that relevant medical principles and/or medical literature (including those submitted by the appellant's representative) should be discussed as it relates to facts specific to the Veteran, as shown by the medical and lay (non-medical) evidence. If an opinion cannot be provided without resorting to speculation, a complete explanation for why this is so is required. 2. If the benefit sought is not granted, the AOJ should furnish the appellant and her representative a Supplemental Statement of the Case (SSOC) and a reasonable opportunity to respond before returning the record to the Board for further review. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Little, 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.