Citation Nr: 21075499 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 14-16 624 DATE: December 20, 2021 ORDER Entitlement to service connection for cause of the Veteran's death is denied. FINDING OF FACT The evidence of record shows that a service-connected disability did not cause or contribute substantially or materially to the Veteran's 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. §§ 1101, 1110, 1112, 1113, 1116, 1310, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.203, 3.303, 3.304, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1977 to March 2007. The Veteran passed away in December 2011, and the appellant is his surviving spouse. This appeal comes before the Board of Veterans' Appeals (Board) from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for cause of the Veteran's death The appellant asserts that the Veteran's cardiopulmonary failure was caused or aggravated by the Veteran's service-connected diabetes mellitus, type II. Alternatively, the appellant has argued that the Veteran had signs and symptoms of a cardiac condition in service which caused or contributed to the noted cardiopulmonary failure. Unfortunately, the Board finds the preponderance of the evidence is against the claim, for the reasons set forth below. To establish service connection for the cause of the Veteran's death, the evidence must show that a disability, which was incurred in or aggravated by active-duty service, either caused or contributed substantially or materially to death. In this regard, it can be either the immediate or underlying cause, or else be etiologically related. 38U.S.C. §1310; 38C.F.R. §3.312. In order to constitute the principal cause of death, the service-connected disability must be medically determined to have been one of the immediate or underlying causes of death or be etiologically related to the cause of death. 38C.F.R. §3.312 (b). A contributory cause of death is one not inherently related to the principal cause, but that it contributed substantially or materially, combined to cause death, or assisted in the production of death. Significantly, it is not sufficient to show that a service-connected disability casually shared in producing death, but rather it must be shown that there was a causal connection between the disability and death. See 38C.F.R. §3.312 (c)(1). Service-connected diseases or injuries involving active processes affecting vital organs are given careful consideration as a contributory cause of death, despite being unrelated to the primary cause, due to debilitating effects and general impairment of health that such processes may cause. 38C.F.R. §3.312 (c)(3). In all cases, VA must consider whether the evidence indicates that a service-connected condition was of such severity as to have a material influence in accelerating death. Furthermore, in cases where the Veteran was not already service-connected for the condition that caused death, service connection for the condition may still be warranted where the evidence of record establishes that the particular injury or disease resulting in death was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38U.S.C. §1110; 38C.F.R. §3.303. The Veteran's death certificate listed the immediate cause of death as cardiopulmonary failure. The contributory causes were listed as sepsis and acute myeloid leukemia. At the time of the Veteran's death, he was not service connected for any of the immediate or contributory causes of death. At the time of his death, the Veteran was service connected for sleep apnea, diabetes mellitus, type II, degenerative arthritis of the thoracolumbar spine, a left knee disability, gastroesophageal reflux disease (GERD), a right knee disability, bilateral pes planus with a left heel spur, allergic rhinitis, and a left knee scar. The Veteran's service treatment records note he was seen for an episode of peripheral edema and underwent an electrocardiogram which showed a mild left atrium enlargement. The Veteran's service treatment records, including his separation examination, are silent for any complaints, findings, treatment, or diagnoses related to cardiopulmonary failure, sepsis, or acute myeloid leukemia. A VA medical opinion was obtained in April 2020. The VA examiner provided negative nexus opinions stating it was less likely than not that the Veteran's service-connected diabetes mellitus caused, contributed to, or materially hastened the Veteran's death; and that it was less likely than not that the Veteran had a heart condition that arose in service or was otherwise related to service. The Board gives probative weight to the VA opinion regarding the etiology of the Veteran's cause of death. The VA opinion was supported by compelling rationale; thorough review of the Veteran's record and relevant history; and review and citation of current medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The record does not contain evidence that the Veteran had symptoms of a heart condition during the final months of his life, including during terminal hospitalization that caused or contributed to his noted cardiopulmonary failure. The record also does not contain evidence that the Veteran's treating providers reported this condition as an active problem during the final months of his life. The record also does not contain evidence that the Veteran's diabetes aggravated or caused the Veteran's death. The death summary from the Veteran's terminal hospitalization does not mention diabetes at all, providing some evidence against this claim. Therefore, the preponderance of the evidence does not show that the Veteran's cardiopulmonary failure was caused or aggravated by the Veteran's service-connected diabetes mellitus or that the Veteran had a cardiac condition in service which caused or contributed to the noted cardiopulmonary failure. The Board acknowledges the appellant's statements that the Veteran's death was related to a service-connected disability or disability that was due to service. Although the appellant is competent to report the Veteran's symptoms which she observed, she is not competent to provide a nexus opinion regarding the nature and etiology of his cause of death and related disabilities. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the diagnosis and etiology of the Veteran's disabilities falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). It is important for the appellant to understand that the medical findings provide highly probative evidence against the claim that the Board cannot, unfortunately, ignore. The Board recognizes that the Veteran suffered from serious medical conditions; however, the competent medical evidence of record does not support a finding of service connection for the Veteran's cause of death. The Board cannot ignore the medical opinion obtained. Accordingly, the Board finds that the preponderance of the evidence is against a finding that the Veteran's causes of death manifested in service or are otherwise related to service. Based on the foregoing, the Board finds that the requirements for service connection for the Veteran's cause of death have not been met. 38 U.S.C. §§ 1110, 1116, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.313. As the preponderance of the evidence is against the appellant's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). Accordingly, service connection for the Veteran's cause of death is not warranted. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Holcombe, 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.