Citation Nr: 21011671 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-25 354 DATE: March 2, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND Prior to discussing the appeal at hand, the Board would be remiss if it did not recognize the Veteran’s outstanding service. The Veteran served on active duty in the United States Navy from January 1951 to May 1952. He was clearly a credit to the Navy and to his family, and his service to his country is greatly appreciated. He died in May 2007. The appellant is the Veteran’s surviving spouse. In October 2019, the appellant presented sworn testimony during a Travel Board hearing in Pittsburgh, Pennsylvania. A transcript of the hearing has been associated with the claims file. The Board previously remanded this claim in July 2020. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The appellant’s representative argues that the Veteran’s death from septic shock and renal failure may have been caused by his service-connected shrapnel injury of the hip. Representative brief, February 2021. He cites articles that apparently correlate embedded shrapnel and systemic effects, including renal. Given this theory and the heightened duty to assist in cases, such as here, where there are missing records, the Board finds that remand for a medical opinion is appropriate. 38 C.F.R. § 3.159(c)(4). Additionally, as the claim is being remanded, the appellant should be once again invited to submit a copy of the Veteran’s death certificate and any other relevant documents or records. The matters are REMANDED for the following actions: 1. Ask the appellant to submit a copy of the Veteran’s death certificate and any other relevant treatment records or VA-related documents in her possession or to identify any such records or documents so that VA may assist her in obtaining them. 2. Thereafter, send the claims file to an appropriate clinician to determine the cause of the Veteran’s death. The examiner must opine whether it is at least as likely as not that the Veteran’s service-connected hip injury with embedded shrapnel was a principal (primary) or contributory (contributed materially or substantially) cause of his death. The examiner must specifically address the articles cited in the February 2021 representative brief and discuss whether the Veteran’s embedded shrapnel injury could have led to systemic renal effects. The term “at least as likely as not” does not mean “within the realm of medical possibility.” Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. 3. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. [CONTINUED ON THE NEXT PAGE] YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moore, 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.