Citation Nr: 21005710 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 18-43 882 DATE: February 2, 2021 REMANDED Service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1957 to January 1959. His DD 214 reveals that he had no foreign service, but states that his last major command was at Army Post Office code 301, which corresponds to Korea. The Veteran passed away in July 2009. The appellant is the Veteran’s surviving spouse. The Board wishes to thank the Veteran’s family for his service. Service connection for the cause of the Veteran's death is remanded. This claim is remanded for additional development. The Veteran's certificate of death reveals that he died in July 2009. The immediate cause of death was hypoglycemia, due to (or as a consequence of) cardiac arrhythmia, due to (or as a consequence of) chronic ischemic cardiomyopathy, due to (or as a consequence of) chronic kidney disease, end stage, dialysis. Diabetes mellitus, type 2, was identified as a significant condition contributing to death but not resulting in the underlying cause. At the time of the Veteran's death, he was not service-connected for any disability. A final April 1960 rating decision denied service connection for intestinal trouble diagnosed as schistosomiasis. A final November 2004 rating decision denied service connection for a kidney condition as secondary to schistosomiasis, and held that new and material evidence had not been received to reopen a claim for service connection for schistosomiasis. Evidence indicates that there may be outstanding relevant VA treatment records. The Veteran’s eFolder does not contain records of VA treatment identified by the appellant. During a January 2021 hearing before the undersigned Veterans Law Judge, the appellant testified that the Veteran had relevant VA treatment at the Oklahoma City VA Medical Center (VAMC) in the early 1970s; the Bonham, Texas VA Hospital in the late 1970s and 1980s; and the Dallas VAMC in the early 1980s and 1990s. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. During the hearing, the appellant also testified that the Veteran had relevant private treatment at Memorial Hospital in Dallas in the 1970s, and Medical City/Denton Regional in Denton, Texas from the 1980s to his death. On remand, the appellant should be given the opportunity to authorize VA to obtain any relevant private treatment records. The appellant testified during the hearing that the Veteran was infected with a parasite in Korea which later perforated his intestines and got into his heart muscles. This in turn caused the Veteran to develop other problems, such as diabetes mellitus and the need for several heart operations. On remand, VA should obtain a medical opinion regarding whether the Veteran had an intestinal parasite during active duty and, if yes, whether there was a nexus between the residuals of the intestinal parasite and the cause of the Veteran's death. In this regard, service treatment records dated in July 1958 note that the Veteran had undergone a 20 pound weight loss in a two month period. His appetite had gone, and he had had diarrhea for the past 2 weeks that had stopped. A stool sample showed cysts of enolamoeba (sic) [entamoeba?] coli. In a September 1995 statement the Veteran related that his separation medical examination revealed a significant weight loss of 30 pounds. After separation from active duty in January 1959, he experienced continuous nausea and diarrhea. He was tested for tuberculosis and the test was negative. In December 1959, a private doctor, Dr. Baldwin, took a stool specimen and the lab results returned with a diagnosis of Schistosomiasis Japonicum. Dr. Baldwin recommended that the Veteran go to the Veteran's Hospital since the disease was a result of contaminants the Veteran had acquired while serving in Korea. Knowing that it might take some time to get admitted to the Veteran's Hospital, Dr. Baldwin began treatment immediately. A December 1959 examination report from Dr. Baldwin relates that a first stool specimen showed pin worms (Enterobius Vermicularis) and a second specimen showed schistosomiasis. A March 1960 Final Summary of a VA hospitalization relates that the Veteran was hospitalized from January to March 1960. He gave a history of having been stationed in Korea from July 1957 to October 1958. At one time, he was swimming in Osan Reservoir. Shortly thereafter, the reservoir was quarantined. The Veteran had diarrhea intermittently, but none particularly related to swimming in the reservoir. During the hospitalization, 14 stool specimens were examined for schistosomiasis and were negative. A gastroenterologist examined the Veteran and found no abnormalities at the time of the examination. The gastroenterologist found it difficult to conceive of a patient having schistosomiasis causing an enlarged liver one month earlier and a normal appearing liver at present. In addition, information was obtained from the Acting Chief Communicable Disease Branch, Preventative Medicine Division, Surgeon General’s Office, who said that to his knowledge no schistosomiasis had been reported in Korea. The final diagnoses were rectal polyp, treated by excision; essential hypertension, mild, labile – untreated, unchanged; schistosomiasis – not found; thyroid adenoma, probably functioning – untreated, unchanged; and prostatic hypertrophy, benign – untreated, unchanged. The matters are REMANDED for the following action: 1. Obtain the Veteran’s outstanding VA treatment records, to include but not limited to records of treatment at the Oklahoma City VAMC in the early 1970s; the Bonham, Texas VA Hospital in the late 1970s and 1980s; and the Dallas VAMC in the early 1980s and 1990s. 2. Ask the appellant to complete a VA Form 21-4142 for records of the Veteran's treatment at Memorial Hospital in Dallas in the 1970s, and Medical City/Denton Regional in Denton, Texas from the 1980s to his death in July 2009. Make two requests for the authorized records from these facilities, unless it is clear after the first request that a second request would be futile. 3. Then, after additional records have been obtained pursuant to paragraphs 1 and 2, obtain a medical opinion from an appropriate clinician, based on a review of the Veteran's eFolder, addressing the following questions: (a) is it at least as likely as not that the Veteran had an intestinal parasite during active duty and, if so; is it at least as likely as not that residuals of the intestinal parasite (i) caused or (ii) contributed substantially or materially to cause the Veteran’s death (the residuals of the intestinal parasite involved an active process affecting vital organs such that there was a resulting general impairment of health to an extent that rendered the Veteran materially less capable of resisting the effects of other disease or injury primarily causing death)? In providing the medical opinion, the clinician is requested to specifically consider and address the Veteran’s service treatment records, the December 1959 private examination report, and the March 1960 Final Summary of a VA hospitalization. The clinician should note the following regulatory guidance: A principal cause of death means that a medical condition was the immediate or underlying cause of death or was etiologically related thereto. A contributory cause of death means that a medical condition, not related to the principal cause of death, combined to cause death; that it aided or lent assistance to the production of death. 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. Generally, minor disabilities, particularly those of a static nature or not materially affecting a vital organ, would not be held to have contributed to death primarily due to unrelated disability, which would include disease or injuries of a quiescent or static nature involving muscular or skeletal functions and not materially affecting other vital body functions.   A complete rationale must be provided for any opinion expressed. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Davitian, 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.