Citation Nr: 21007257 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 18-37 792 DATE: February 9, 2021 ORDER Entitlement to service connection for the Veteran’s cause of death is granted. FINDING OF FACT 1. The Veteran died in March 2011 due to multiple myeloma; the Appellant is the Veteran’s surviving spouse. 2. It is at least as likely as not that the Veteran’s multiple myeloma was incurred in or caused by his active duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for the Veteran’s cause of death are met. 38 U.S.C. §§ 1110, 1131, 1310, 5107(b); 38 C.F.R. §§ 3.303, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1961 to November 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Appellant attended a hearing before the undersigned Veterans Law Judge in October 2020. A transcript of the hearing is of record. Entitlement to service connection for the Veteran’s cause of death The Veteran died in March 2011. The Veteran’s death certificate states that he died from multiple myeloma. The Appellant, who is the Veteran’s surviving spouse, claims entitlement to VA death benefits. Dependency and Indemnity Compensation (DIC) benefits are payable to the surviving spouse of a Veteran if the Veteran died from service-connected disability. 38 C.F.R. § 3.5. Service connection for the cause of a Veteran’s death is warranted if a service-connected disability either caused or contributed substantially or materially to the cause of the Veteran’s death. 38 C.F.R. § 3.312. Generally, to establish service connection a veteran must show: “(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.” Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). The death of a Veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. 38 C.F.R. § 3.312 (a). A service-connected disability will be considered as the principal, or primary, cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312 (b). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; or 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. 38 C.F.R. § 3.312 (c)(1); see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994). As noted above, the Veteran’s death certificate states that the Veteran died from multiple myeloma. Furthermore, service treatment records from September 1976 note a small focus of sclerotic bone in the femoral neck superiorly, bilaterally. At the October 2020 Board hearing, the Appellant and her representative testified that the September 1976 note is significant because that is where the Veteran’s multiple myeloma began. What remains to be established is whether there is a nexus between the diagnosed multiple myeloma and his in-service disease or injury. In a January 2021 private medical opinion, Dr. T.S. opined that the Veteran’s multiple myeloma was at least as likely as not directly related to military service. Dr. T.S. noted that the Veteran had symptoms of the condition while on active duty. Specifically, Dr. T.S. referenced an X-ray report from September 1976, which noted “a small focus of sclerotic bone in the femur neck superiorly, bilaterally, more marked on the right”. Dr. T.S. noted that the Veteran did not have multiple myeloma prior to service. Dr. T.S. stated that multiple myeloma is a malignancy of the plasma cells found in the bone marrow and is characterized by disarray of the bone remodeling process. Dr. T.S. noted that a hallmark of multiple myeloma is osteolytic bone lesions. Dr. T.S. further noted that multiple myeloma is a slow growing condition. Dr. T.S. concluded that, based on the Veteran’s symptoms, history, and medical records, the Veteran’s multiple myeloma is at least as likely as not directly related to service. The Board finds that the probative evidence of record indicates that the Veteran’s multiple myeloma was incurred in or caused by his active duty service. The Board finds the January 2021 private opinion from Dr. T.S. to be highly probative because Dr. T.S. provided an adequate opinion based on the pertinent evidence of record and the appropriate medical literature. As a result, the Board finds that a positive nexus between the Veteran’s multiple myeloma and his active duty service has been established. Furthermore, the evidence of record indicates that the Veteran’s multiple myeloma caused his death since it was listed as a direct cause of death on his death certificate. Accordingly, the Appellant is entitled to service connection for the Veteran’s cause of death. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David M. Sebstead, 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.