Citation Nr: 21007414 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-44 907 DATE: February 9, 2021 ORDER Service connection for the cause of the Veteran’s death for purposes of receiving Dependency and Indemnity Compensation (DIC) is denied. FINDINGS OF FACT 1. The Veteran died in July 1998. His death certificate indicates that the cause of death was cardiopulmonary arrest, with underlying causes of ischemic cardiomyopathy and coronary artery disease. 2. At the time of death, the Veteran was not service-connected for any disabilities. 3. Symptoms of cardiovascular disease were not chronic in service, continuous after service, or manifest to a degree of 10 percent within one year of service separation. 4. The Veteran’s terminal cardiovascular disease was not otherwise related to service, to include as due to an undiagnosed acquired psychiatric disorder. CONCLUSION OF LAW The criteria for establishing service connection for the cause of the Veteran’s death have not been met. 38 U.S.C. §§ 1110, 1310, 5107; 38 C.F.R. §§ 3.12, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Army from April 1944 to July 1946. His decorations included a Combat Infantry Badge and a World War II Victory Medal. The Veteran died in July 1998 and the Appellant is his surviving spouse. In August 2019, the Appellant, the Appellant’s daughter, and Appellant’s son testified at a Board hearing before the undersigned at the RO, and a transcript of that hearing is of record. In November 2019 and July 2020, the Board remanded the case for further development, including obtaining outstanding treatment records, records from the Social Security Administration (SSA), and VA medical opinions on the nature and etiology of the cause of the Veteran’s death. VA treatment records and SSA records have since been associated with the claims file, and four VA medical opinions were obtained in 2020. The Board therefore finds there has been substantial compliance with the remand directives. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for cause of death. 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) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b). 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). In this case, the Veteran’s July 1998 death certificate indicates that the immediate cause of the Veteran’s death was cardiopulmonary arrest, with underlying causes of ischemic cardiomyopathy and coronary artery disease. At the time of his death, the Veteran was not service-connected for any disability. The Appellant testified in the August 2019 Board hearing that the Veteran would have anxiety and panic attacks at night, walked back and forth in the house, and told her about having flashbacks of the war. The panic attacks caused stress on the heart and caused him to start smoking, which caused his heart condition. His first heart attack was in the 1970s and he had quintuple bypass surgery when he was in his 70s. When the Veteran went to VA to seek assistance, he was told that he was not entitled to anything except a GI home loan. The Appellant’s son indicated that the Veteran could not get a “normal job” because of his heart condition and that he would not go camping or fishing because he did not want to spend time in a tent. The Appellant’s daughter indicated that the Veteran should have been entitled to certain benefits as a highly decorated Veteran. The Board finds that the weight of the lay and medical evidence demonstrates that the Veteran’s cause of death, cardiopulmonary arrest with underlying causes of ischemic cardiomyopathy and coronary artery disease, was not incurred in service, and is not otherwise etiologically related to active service. In this regard, the Board finds that the preponderance of the evidence is against a finding that the Veteran had a heart injury, disease, or event during service, including as due to an undiagnosed psychiatric disorder, which could have subsequently resulted in terminal heart disease. Service treatment records (STRs) show no complaints of, treatment for, or diagnosis of heart disease or psychiatric disorder. In an April 1944 service entrance examination, the Veteran’s cardiovascular system was noted to be normal and he was noted to have no psychiatric or neurological symptoms. In a July 1946 service separation examination, the Veteran’s cardiovascular system was again noted to be normal and a chest x-ray was negative. He was also noted to be psychiatrically normal. The Board acknowledges that the Veteran was injured in combat; however, it was a right knee injury without any indication of a heart injury. The first post-service evidence of heart disease was in 1970, approximately 24 years after service separation. A 1980 VA treatment record indicates that the Veteran had a myocardial infarction (heart attack) in approximately 1970 and had a cardiac catheterization procedure in 1973. As such, the Board finds that the weight of the evidence shows that the Veteran was not diagnosed with and/or treated for any heart disease during service, did not have symptoms of any heart disease in service, and heart disease did not manifest to a compensable degree within one year of service separation. The Board next finds the weight of the evidence demonstrates that symptoms of heart disease were not continuous since service separation in July 1946. As noted above, the Veteran was not treated for, or diagnosed with, heart disease in service, and was first diagnosed with heart disease more than 20 years after separation from service. The approximately 24-year period between service and the onset of heart disease is one factor, along with other factors in this case, that weighs against a finding of service incurrence, including by continuous symptoms since service from which service incurrence would be presumed. See Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical complaint of a claimed disability is one factor to consider as evidence against a claim of service connection). Finally, the Board concludes that the weight of the evidence demonstrates that the Veteran’s heart disease was not otherwise related to his military service, to include as due to an undiagnosed acquired psychiatric disorder. In May 2020, a VA examination reviewed the Veteran’s claims file and concluded that it was less likely than not that the ischemic cardiomyopathy, cardiac arrest, and coronary artery disease were caused by, or secondary to, his military service. The rationale was that treatment records were silent for any in-service documentation of ischemic cardiomyopathy, cardiac arrest, or coronary artery disease, and the Veteran passed away in 1998, which was more than 50 years after separating from military service. The examiner also indicated that the record was silent for mention of any psychiatric condition, nor was there any documentation of “stress” related to or causing any undiagnosed illness or any cardiac conditions. In September 2020, another VA medical opinion was obtained. A VA psychologist reviewed the record and indicated that there was no symptoms or psychiatric history in the medical records; rather, in a May 1944 STR, the Veteran’s mental health was described as “normal.” The examiner also noted that the cardiovascular condition was documented as being incurred in service; however, the Regional Office (RO) noted that the examiner could have been confused and thought that a Purple Heart indicated a heart condition. As such, a clarification was requested. Subsequently, two additional VA medical opinions were obtained. In October 2020, a VA physician reviewed the record and concluded that the Veteran’s causes of death were conditions caused by atherosclerosis, which was a pathological process that had multiple contributing factors. Review of the STRs showed no evidence of a diagnosis, treatment, or symptoms suggestive of any heart disease including cardiopulmonary arrest, ischemic cardiomyopathy, or coronary artery disease. Moreover, mental health conditions (stress) have been studied with regard to coronary artery disease and there have been no conclusive results to show a mental health condition causes or permanently aggravates coronary artery disease beyond its natural progression. In November 2020, a different VA physician reviewed the claims file and determined that the Veteran’s cause of death was less likely than not causally related to his military service. The rationale was that although there was evidence that the Veteran injured his right knee in service, there was no documentation of any other condition or injury that occurred with the right knee injury, and the knee injury resolved without sequelae. Moreover, the Veteran’s heart condition developed 24 years after he separated from service, and the Veteran had a significant tobacco use history in the decades after service, which was a known strong risk factor for coronary artery disease. Furthermore, it was less likely than not that the Veteran’s heart condition was a result of stress from an undiagnosed psychiatric condition, as psychiatric conditions had no effect on whether plaques form in the coronary arteries, resulting in ischemia of the heart muscle. There was also no evidence that the Veteran had any manifestations of a psychiatric disorder prior to development of the heart condition. Specifically, the Veteran was evaluated for depression in 1979, but the record was silent for a known or suspected prolonged depression or other psychiatric condition prior to or after 1979. There was also no evidence of a psychiatric condition in service. The Board finds that the VA examiners’ opinions to be competent and credible, and as such, entitled to significant probative weight. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The opinions were rendered after reviewing the Veteran’s STRs and other medical records, and the examiners provided facts and rationale on which they based their opinion, including expressly discussing STRs and post-service medical records. See Prejean v. West, 13 Vet. App. 444 (2000) (factors for assessing the probative value of a medical opinion include the examiner’s access to the claims folder and the Veteran’s history, and the thoroughness and detail of the opinion). Furthermore, neither the Appellant nor her representative has produced a medical opinion to contradict the conclusion of the VA examiners. For these reasons, the Board finds that the preponderance of the evidence is against service connection for the Veteran’s cause of death. The Board is grateful for the Veteran’s service and is sympathetic to the Appellant’s beliefs regarding the Veteran’s cause of death; however, the preponderance of the competent evidence is against the claim, and the benefit-of-the-doubt doctrine does not apply. Service connection for the Veteran’s cause of death is not warranted, and the claim for DIC is denied. 38 U.S.C. § 5107(b). H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Nelson 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.