Citation Nr: 21011443 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 16-21 620 DATE: March 1, 2021 ORDER Entitlement to service connection for the Veteran's cause of death is granted. FINDINGS OF FACT 1. The Veteran died in December 2013. The death certificate lists cardiopulmonary arrest, myocardial infarction, and coronary artery disease as the cause of death. 2. At the time of his death, the Veteran was service-connected for the following disabilities: loss of use of left hand, to include left shoulder, elbow, and wrist impairment, status post left shoulder hemiarthroplasty and open reduction and internal fixation of glenoid fracture associated with residuals of gunshot wound below right knee; residuals of gunshot wound below right knee; arthritis of right knee with inflammation of motion; tender scars, right knee and leg, and residuals of right ankle fracture. 3. The evidence is in equipoise as to whether the Veteran’s service-connected disabilities contributed to the Veteran’s death. CONCLUSION OF LAW Resolving all reasonable doubt in the appellant’s favor, the criteria for service connection for the Veteran’s cause of death have been met. 38 U.S.C. §§ 1210, 5107; 38 C.F.R. §§ 3.102, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1950 to May 1953. He died in December 2013. The appellant is his surviving spouse. This matter is on appeal from a September 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). DIC benefits are payable to the surviving spouse of a veteran if the Veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. A veteran’s death will be considered as being due to a service-connected disability when the evidence establishes that the service-connected disability was either the principal or a contributory cause of death. The issue involved will be determined by exercise of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including, particularly, autopsy reports. 38 C.F.R. § 3.312(a). The service-connected disability will be considered as the principal (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 one which contributes substantially or materially to death or aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c). Service-connected disabilities or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there was resulting debilitating effects and general impairment of health to the extent that would render the person less capable of resisting the effects of either disease or injury primarily causing death. 38 C.F.R. § 3.312(c)(3). There are primary causes of death which by their very nature are so overwhelming that eventual death can be anticipated irrespective of co-existing conditions, but, even in such cases, there is for consideration whether there may be reasonable basis for holding that a service-connected condition was of such severity as to have a material influence in accelerating death. 38 C.F.R. § 3.312(c)(4). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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 in or aggravated during service. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Turning to the facts of the case, the Veteran passed away in December 2013. His death certificate identifies his immediate cause of death as cardiopulmonary arrest, fatal myocardial infarction, coronary artery disease, with significant contributing conditions of coronary artery disease recent surgery. At the time of his death, the Veteran was service-connected for the following: loss of use of left hand, to include left shoulder, elbow, and wrist impairment, status post left shoulder hemiarthroplasty and open reduction and internal fixation of glenoid fracture associated with residuals of gunshot wound below right knee; residuals of gunshot wound below right knee; arthritis of right knee with limitation of motion; tender scars, right knee and leg, and residuals of right ankle fracture. The appellant’s main contention is that the many surgeries for the Veteran’s service-connected right leg condition caused a blood clot that caused the Veteran’s heart to fail, resulting in his death. A December 2013 discharge summary describes the events leading to the death of the Veteran, who was described as having a significant cardiac history, including congestive heart failure, peripheral vascular disease, two coronary artery bypass graft surgeries, and nine coronary stents. On November 29, 2013, the Veteran underwent an aortofemoral arteriogram with right leg runoff and a right femoral-to-below knee popliteal polytetrafluoroethylene bypass graft. On the day after the surgery, a nurse noted that the Veteran’s pacemaker was not functioning properly at times. Two days after the surgery, while the Veteran was being assisted out of bed, he complained of sudden shortness of breath followed by chest pain and then was unresponsive. Advanced cardiovascular life support activities were initiated but the Veteran ultimately passed away. In a February 2017 letter, the Veteran’s treating physician acknowledged the Veteran’s in-service gunshot wound to his right leg and noted that based on his medical history, the Veteran’s in-service wound had “an incomplete recovery.” In relevant part, the physician noted that the blood clot and embolism, which caused the Veteran’s death, resulted from the preceding vascular surgery. Moreover, the physician found that there is a “reasonable medical probability” that the Veteran’s gunshot wound to the right leg contributed to the progression of his vascular disease. Notably, this evidence was not before the Board in the prior decision. Upon review of the record, the Board finds that the evidence is evenly balanced as to whether the Veteran’s cause of death is proximately due to or the result of his service-connected right leg gunshot wound. By law, the resulting reasonable doubt is resolved in the appellant’s favor. See 38 U.S.C. § 5107(b); Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’..., the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits”). In this respect, the coroner has identified the cause of the Veteran’s death as being due to cardiac arrest, myocardial infarction, and his long history of coronary artery disease. The Veteran’s treating physician opined that the Veteran’s documented history of right leg gunshot wound contributed to his vascular disease, leading to the surgery in November 2013. As the opinion is probative as it considers the specific facts of the Veteran’s medical history applied to sound medical principles, and there is no medical opinion to the contrary, the Board finds that the evidence for and against the claim is evenly balanced. Accordingly, service connection for the Veteran’s cause of death is granted. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Orie, 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.