Citation Nr: 21077402 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 15-43 395 DATE: December 29, 2021 ORDER 1. A special monthly pension (SMP) based on the need for aid and attendance is denied. 2. Service connection for a liver disorder is denied. 3. Service connection for a heart disorder is denied. 4. Service connection for hypertension is denied. 5. Service connection for diabetes mellitus, type 2, is denied. 6. Service connection for a right lower extremity disorder is denied. 7. Service connection for a left lower extremity disorder is denied. 8. Service connection for a kidney disorder is denied. 9. Service connection for chronic obstructive pulmonary disease (COPD) is denied. 10. Service connection for the Veteran's cause of death is denied. 11. Death and indemnity compensation (DIC) pursuant to 38 U.S.C. § 1318 is denied. 12. A death pension is denied. FINDINGS OF FACT 1. The Veteran's countable income has exceeded the applicable maximum annual pension rate (MAPR) throughout the appeal period. 2. The Veteran did not have a liver disorder that had its onset during active service, within one year of discharge from service, or that is causally or etiologically related to any disease, injury, or incident during service. 3. The Veteran did not have a heart disorder that had its onset during active service, within one year of discharge from service, or that is causally or etiologically related to any disease, injury, or incident during service. 4. The Veteran did not have hypertension that had its onset during active service, within one year of discharge from service, or that is causally or etiologically related to any disease, injury, or incident during service. 5. The Veteran did not have diabetes mellitus, type 2, that had its onset during active service, within one year of discharge from service, or that is causally or etiologically related to any disease, injury, or incident during service. 6. The Veteran did not have a right lower extremity disorder that had its onset during active service or within one year of discharge from service, that is causally or etiologically related to any disease, injury, or incident during service, or is caused or aggravated by a service-connected disability. 7. The Veteran did not have a left lower extremity disorder that had its onset during active service or within one year of discharge from service, that is causally or etiologically related to any disease, injury, or incident during service, or is caused or aggravated by a service-connected disability. 8. The Veteran did not have a kidney disorder that had its onset during active service that is causally or etiologically related to any disease, injury, or incident during service or is caused or aggravated by a service-connected disability. 9. The Veteran did not have COPD that had its onset during active service or that is causally or etiologically related to any disease, injury, or incident during service. 10. The Veteran died in September 2014 of an immediate cause of end stage liver disease from nonalcoholic steatohepatitis (NASH) with a condition leading to the cause of death of end stage renal disease (ESRD). 11. At the time of his death, the Veteran was not service connected for any conditions. 12. The Veteran's cause of death is not related to service. 13. At the time of his death, the Veteran was not in receipt of, or entitled to receive, compensation for service-connected disabilities continuously rated totally disabling for a period of 10 years immediately preceding his death. 14. The appellant's countable income exceeds the applicable MAPR. CONCLUSIONS OF LAW 1. The criteria for an SMP for accrued benefit purposes are not met. 38 U.S.C. §§ 1503, 1541; 38 C.F.R. §§ 3.3, 3.23, 3.271, 3.272, 3.278. 2. The criteria for service connection for a liver disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a heart disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for diabetes mellitus, type 2, are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for a right lower extremity disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 7. The criteria for service connection for a left lower extremity disorder are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 8. The criteria for service connection for a kidney disorder are not met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 9. The criteria for service connection for COPD are not met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 10. The criteria for service connection for the Veteran's cause of death are not met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. 11. The criteria for entitlement to DIC benefits pursuant to 38 U.S.C. § 1318 are not met. 38 U.S.C. § 1318; 38 C.F.R. § 3.22. 12. The criteria for a death pension are not met. 38 U.S.C. §§ 1503, 1541, 5107; 38 C.F.R. §§ 3.21, 3.23, 3.102, 3.271, 3.272. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1965 to February 1969. He died in September 2014 and the appellant is his surviving spouse. The case is on appeal from October 2014 rating decisions. The appellant submitted additional evidence after a May 2017 supplemental statement of the case and a June 2017 statement of the case in regard to the claims decided herein. Waiver of RO consideration of the additional evidence is presumed given the date of the substantive appeal. See 38 U.S.C. § 7105(e). The appellant requested a Board hearing in an August 2017 VA Form 9. However, in a February 2018 statement, the appellant requested that the hearing be cancelled. Therefore, the hearing request is considered withdrawn. See 38 C.F.R. § 20.704(e). The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). I. SMP 1. A SMP based on the need for aid and attendance. Legal Criteria Basic entitlement to pension exists if, among other things, the claimant's income is not in excess of the MAPR specified in 38 C.F.R. § 3.23. 38 U.S.C. § 1521; 38 C.F.R. § 3.3(a)(3). The MAPR is given the same force and effect as if published in VA regulations. 38 C.F.R. § 3.21. The MAPR is revised every December 1st and is applicable for the following 12-month period. The MAPR shall be reduced by the amount of the countable household annual income. 38 U.S.C. §§ 1503, 1521; 38 C.F.R. §§ 3.3, 3.23(b). In determining annual income, all payments of any kind or from any source (including salary, retirement or annuity payments, or similar income, which has been waived) shall be included during the 12-month annualization period in which received, except for listed exclusions. 38 U.S.C. § 1503(a); 38 C.F.R. § 3.271(a). Income from the Social Security Administration (SSA) is not specifically excluded under 38 C.F.R. § 3.272 and is therefore included as countable income. For purposes of calculating pension benefits, total income may be reduced by amounts equal to amounts paid by a claimant for unreimbursed medical expenses that were "in excess of 5 percent of the applicable maximum annual pension rate or rates...as in effect during the 12-month annualization period in which the medical expenses were paid." 38 C.F.R. § 3.272(g)(1)(iii). In order to be excluded from income, these medical expenses must be paid during the time period at issue, regardless of when they were incurred. In addition, they must be out-of-pocket expenses, for which the veteran received no reimbursement, such as through an insurance company. However, the medical insurance premiums themselves, as well as the Medicare deduction, may be applied to reduce countable income. Analysis In February 2011, the Veteran filed a claim for an SMP based on the need for aid and attendance. He reported monthly SSA income of $1,766 for himself and $1,007 for his wife. He also reported a monthly pension of $359 and monthly long term disability payments of $370.80 that were to expire in September 2012. In a June 2011 rating decision, the RO found that the Veteran required aid and attendance and granted an SMP pending evaluation of the household income and medical expenses. In a decision later in June 2011, the RO found that the Veteran's income after medical expenses was in excess of the applicable MAPR. In December 2015, the appellant submitted unreimbursed household medical expenses from February 2011 until the Veteran's death in September 2014. In April 2017, updated SSA information was associated with the file showing monthly income for the appellant. The appellant received monthly SSA income of $1,061 in January 2012 and January 2013 and received $1,076.90 in January 2014. The Board finds that the annualized income was in excess of the applicable MAPR for the entire appeal period. In this regard, in February 2011, the annualized household income was $42,033.60. The appellant reported unreimbursed medical expenses for 2011 of $11,349. After reducing the unreimbursed medical expenses by $1,169.80 (5 percent of the applicable MAPR), the household income minus medical expenses was $31,854.40. The income minus medical expenses was in excess of the applicable MAPR for a Veteran requiring aid and attendance with one dependent in February 2011 of $23,396. For January 2012, the annualized household income was $38,232 when excluding the disability benefits that ended in September 2012. The appellant reported unreimbursed medical expenses for 2012 of $13,091.90. After reducing the unreimbursed medical expenses by $1,211.90 (5 percent of the applicable MAPR), the household income minus medical expenses was $26,352. The income minus medical expenses was in excess of the applicable MAPR for a Veteran requiring aid and attendance with one dependent in January 2012 of $24,239. For January 2013, the annualized household income was $38,232. The appellant reported unreimbursed medical expenses for 2012 of $9,576.30. After reducing the unreimbursed medical expenses by $1,232.60 (5 percent of the applicable MAPR), the household income minus medical expenses was $29,888.30. The income minus medical expenses was in excess of the applicable MAPR for a Veteran requiring aid and attendance with one dependent in January 2013 of $24,652. For January 2014, the annualized income was $38,422.80. The appellant reported unreimbursed medical expenses for 2014 of $8,223.84. After reducing the unreimbursed medical expenses by $1,251.10 (5 percent of the applicable MAPR), the household income minus medical expenses was $31,450.06. The income minus medical expenses was in excess of the applicable MAPR for a Veteran requiring aid and attendance with one dependent in January 2014 of $25,022. The preponderance of the evidence shows that the Veteran's countable income exceeded the applicable MAPR throughout the appeal period. Therefore, an SMP for accrued benefit purposes is not warranted. II. Service Connection 2. Service connection for a liver disorder. 3. Service connection for a heart disorder. 4. Service connection for hypertension. 5. Service connection for diabetes mellitus, type 2. 6. Service connection for a right lower extremity disorder. 7. Service connection for a left lower extremity disorder. 8. Service connection for a kidney disorder. 9. Service connection for COPD. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Certain chronic diseases are presumed to be incurred in or aggravated by service if manifest to a compensable degree within one year of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015). For veterans exposed to an herbicide agent, such as Agent Orange, during active service, certain diseases shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). VA laws and regulations provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Analysis The appellant contends that the Veteran should have been granted service connection for diabetes, hypertension, COPD, and liver, heart, kidney, and lower extremity disorders. In an August 2007 correspondence, the Veteran claimed that his kidney failure could be due to diabetes medication or other medications he used over the years. In an April 2014 statement, the Veteran reported that he unloaded, cleaned, and repaired radio equipment returning from Vietnam while stationed at Lockbourne Air Force Base (AFB) in Columbus, Ohio. He stated that the equipment was covered with dirt and dust from Vietnam. He also stated that the equipment contained Agent Orange and that this exposure caused him to develop diabetes, heart failure, renal failure, liver failure, and hypertension. In a May 2017 statement, the appellant reported that the Veteran experienced respiratory problems, colds, and sinus symptoms while serving at Lockbourne AFB. She also reported that one doctor diagnosed the Veteran with COPD, but also that another doctor did not agree that a COPD diagnosis had been established. She indicated that the condition was related to exposure to radio equipment that had returned "covered in junk from Vietnam." In an August 2017 statement, the appellant claimed that the Veteran was exposed to Agent Orange on cargo planes, C-123 planes, and radio equipment. She stated that the Veteran would eat while opening up the radio equipment resulting in ingesting Agent Orange. She also stated that a VA letter addressing Agent Orange exposure noted that the exposure potential in cargo planes and C-123 planes was extremely low and, therefore, the risk of long-term health effects is minimal. The appellant noted that "minimal' is not the same as nonexistent. The Veteran's service personnel records (SPRs) show that he served as a radio equipment repairman and was stationed at Lockbourne AFB from October 1966 to February 1969. His service treatment records (STRs) show that he was treated for a cold in November 1966 and strep throat in March 1967. In a January 1969 report of medical history completed at separation from service, the Veteran marked "yes" for a history of several symptoms to include cramps in his legs, but marked "no" for sinusitis, hay fever, chronic or severe colds, high or low blood pressure, asthma, tuberculosis, shortness of breath, pain or pressure in chest, chronic cough, stomach, liver, or intestinal trouble, jaundice, frequent or painful urination, and kidney stone or blood in urine. The Veteran's January 1969 separation examination was marked "normal" for his lungs and chest, abdomen, lower extremities, vascular system, and heart. His blood pressure was reported as 138 over 78. The examiner did not report the presence of any relevant symptoms or conditions, despite noting several in-service conditions and injuries. In July 2014, the RO made a formal finding that there was insufficient information to corroborate the Veteran's claimed exposure to herbicides. The finding noted that the Veteran did not serve outside the United States and based the claim solely on exposure during service at Lockbourne AFB. In June 2017, a United States Army and Joint Services Records Research Center (JSRRC) memorandum from May 2009 was associated with the file. The memorandum states that numerous official military documents were reviewed in regard to the use of tactical herbicide agents, such as Agent Orange, during the Vietnam Era. The memorandum reported that the JSRRC has found no evidence that veterans were exposed to tactical herbicides based on contact with aircraft that flew over Vietnam or equipment that was used in Vietnam. The Board finds that the Veteran was not exposed to herbicides, including Agent Orange, during service. In this regard, in July 2014 the RO found that there was insufficient information to corroborate the Veteran's claim of being exposed to herbicides. In addition, in June 2017 a JSRRC memorandum from May 2009 was associated with the file indicating that there is no evidence that veterans were exposed to herbicides due to contact with aircraft or equipment that traveled to Vietnam. The Board notes that the Veteran claimed, and the appellant believes that he was exposed to Agent Orange while repairing radio equipment that returned from Vietnam. The Veteran is competent to establish facts that can be observed by the use of a person's five senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). As such, the Veteran is competent to report the events that occurred in service, including the locations of such service and events that occurred during service. However, in rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The Board does not find that the Veteran has established the competency to distinguish herbicides from other material on or inside radio equipment he repaired during service. In this regard, in weighing credibility, VA may consider bias and self-interest in weighing the credibility of evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995). Therefore, his claims are outweighed by the contrary evidence of record. In addition, the appellant claims that the Veteran was exposed to Agent Orange on cargo planes and C-123 planes. However, the Veteran never reported traveling on planes that he believed traveled to Vietnam or that transported Agent Orange. In addition, the evidence does not show that the Veteran traveled on or was near planes that traveled to Vietnam or that transported Agent Orange. The appellant was not present during the Veteran's service and did not indicate why she believes he was exposed to Agent Orange in that manner. Therefore, the Board finds she is not competent to report such exposure. In sum, exposure to herbicide agents, such as Agent Orange, is not presumed as the Veteran did not serve in Vietnam and the preponderance of the evidence does not establish actual exposure to herbicide agents. Without establishing in-service exposure to herbicide agents, the nexus element of the service connection claims is not presumed. In addition, the evidence of record does not show, and neither the Veteran nor the appellant has contended that he had the onset of diabetes, hypertension, liver, heart, kidney, or lower extremity disorders during service or within one year of discharge. They have also not asserted any other potential relationship between service and these conditions other than the claimed exposure to Agent Orange. Furthermore, while the appellant claims that the Veteran had COPD that had its onset during service, the medical evidence does not show that he was diagnosed with this condition. In this regard, the Veteran's VA treatment records do not include a diagnosis of COPD. The appellant states that one doctor diagnosed him with COPD, but she also states that another doctor disagreed with the diagnosis. In addition, the appellant did not provide a statement explaining the doctor's rationale for diagnosing the Veteran with COPD. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Thus, as the evidence does not show that the Veteran was diagnosed with COPD, service connection for this condition on a direct basis is not indicated. See Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Finally, to the extent that secondary service connection is raised in regard to the kidney and lower extremity claims, service connection is not warranted because the Veteran is not service-connected for any conditions and secondary service connection presupposes the existence of an underlying service-connected disability. See 38 C.F.R. § 3.310. While an examination or medical opinion has not been obtained in regard to these claims, a mere conclusory claim that a current condition is related to service is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010) (distinguishing cases where only a conclusory generalized statement is provided by the veteran and rejecting the theory that medical examinations are to be routinely and virtually automatically provided to all veterans in disability cases involving nexus issues). Therefore, the Board finds that a VA examination or opinion is not warranted for these claims. Accordingly, the preponderance of the evidence is against the claims. Therefore, the benefit-of-the-doubt doctrine is not applicable and service connection for the claimed conditions is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. III. Cause of Death 10. Service connection for the Veteran's cause of death. Legal Criteria To establish service connection for the cause of a veteran's death, the evidence must show that a disability incurred in or aggravated by active service was either (1) the principal (primary) cause of death or (2) a contributory cause of death. To be considered a principal (primary) cause of death, a service-connected disability must have been singly or jointly with some other condition the immediate or underlying cause of death or have been etiologically related to the cause of death. 38 C.F.R. § 3.312(b). For a service-connected disability to be a contributing cause, it must have substantially or materially contributed to the veteran's death; it is not sufficient to show that it casually shared in producing death, but rather there must be a causal connection. A contributory cause of death is inherently one not related to the principal cause. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Analysis The appellant is seeking service connection for the Veteran's cause of death. The Veteran's death certificate shows that he died in September 2014 of an immediate cause of end stage liver disease from NASH with a condition leading to the cause of ESRD. At the time of his death, the Veteran was not service connected for any conditions. In addition, the Veteran's service connection claims pending at his death are denied herein. The Board notes that aside from the appellant's own statements, the evidence of record does not contain any evidence suggesting a link between the Veteran's service and his cause of death. Therefore, the Board finds that the service connection for the cause of the Veteran's death is not warranted. The Veteran was not service connected for any conditions at the time of his death. In addition, as explained above, service connection is not warranted for any of the claims pending at the time of the Veteran's death, including for liver or kidney disorders. Thus, the nexus element for service connection for the cause of death is not met. Accordingly, the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable, and service connection for the Veteran's cause of death is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. IV. DIC 11. DIC pursuant to 38 U.S.C. § 1318. Legal Criteria Pursuant to 38 U.S.C. § 1318, DIC benefits are also payable to the surviving spouse of a deceased veteran, in the same manner as if the death were service connected, if such veteran died not as the result of his own willful misconduct and was, at the time of his or her death, either in receipt of or entitled to receive compensation for a service-connected disability rated totally disabling if: (1) the disability was continuously rated totally disabling for a period of 10 or more years immediately preceding death; or (2) the disability was continuously rated totally disabling for a period of not less than five years from the date of such veteran's discharge or other release from active duty; or (3) the veteran was a former prisoner of war who died after September 30, 1999, and the disability was continuously rated totally disabling for a period of not less than one year immediately preceding death. 38 U.S.C. § 1318; 38 C.F.R. § 3.22. Analysis At the time of his death, the Veteran was not service connected for any disabilities. In addition, the service connection claims pending at his death are denied herein. The Board finds that the Veteran was not rated as totally disabled as the result of a service-connected disability for a period of ten years or more or for a period of five years from the date of his separation from active duty. Additionally, the Veteran was not a former prisoner of war. Under these undisputed facts, the legal criteria for entitlement to DIC pursuant to 38 U.S.C. § 1318 are not met. Accordingly, the claim must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (where the law, not the evidence, is dispositive, the appeal should be terminated for lack of legal merit or entitlement). V. Death Pension 12. Death pension. Legal Criteria Basic entitlement to a survivor pension exists if, among other things, the claimant's income is not in excess of the MAPR specified in 38 C.F.R. § 3.23. 38 U.S.C. § 1541; 38 C.F.R. § 3.3(a)(3). The MAPR is given the same force and effect as if published in VA regulations. 38 C.F.R. § 3.21. The MAPR is revised every December 1st and is applicable for the following 12-month period. The MAPR shall be reduced by the amount of the countable annual income of the surviving spouse. 38 U.S.C. §§ 1503, 1541; 38 C.F.R. §§ 3.3, 3.23(b). In determining annual income, all payments of any kind or from any source (including salary, retirement or annuity payments, or similar income, which has been waived) shall be included during the 12-month annualization period in which received, except for listed exclusions. 38 U.S.C. § 1503(a); 38 C.F.R. § 3.271(a). Income from the Social Security Administration (SSA) is not specifically excluded under 38 C.F.R. § 3.272 and is therefore included as countable income. For purposes of calculating pension benefits, total income may be reduced by amounts equal to amounts paid by a claimant for unreimbursed medical expenses that were "in excess of 5 percent of the applicable maximum annual pension rate or rates...as in effect during the 12-month annualization period in which the medical expenses were paid." 38 C.F.R. § 3.272(g)(1)(iii). In order to be excluded from income, these medical expenses must be paid during the time period at issue, regardless of when they were incurred, and must be out-of-pocket expenses for which the claimant received no reimbursement, such as through an insurance company. However, the medical insurance premiums themselves, as well as the Medicare deduction, may be applied to reduce countable income. Analysis The appellant filed a claim for a death pension in September 2014. She reported receiving income from the SSA and an additional $360 monthly in retirement. She also reported paying a monthly Medicare premium of $104.90. The appellant has not reported any decreases in income or increases in medical expenses since September 2014. In October 2014, an SSA income and Medicare payment statement for the appellant was associated with the file. The statement shows that the appellant received monthly SSA income of $1,888.90 and paid $104.90 monthly in Medicare premiums as of September 2014. The Board finds that the appellant's countable income exceeds the applicable MAPR. The applicable MAPR for a surviving spouse without a dependent was $8,485 in September 2014. The appellant's annualized income was $26,986.80. The appellant claimed unreimbursed medical expenses of $1,258.80. After reducing the medical expenses by $424 (5 percent of the applicable MAPR), her total medical expense deduction is $834.80. The appellant's annual income reduced by eligible unreimbursed medical expenses leaves the $26,562.80 in countable income, which is in excess of the applicable MAPR. The preponderance of the evidence shows that the appellant's countable income exceeds the applicable MAPR. Therefore, a death pension is not warranted. S. Morrad Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Jimerfield 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.