Citation Nr: 21013700 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-47 205 DATE: March 10, 2021 ORDER Entitlement to service connection for inguinal hernia is granted. Entitlement to service connection for myeloma is denied. Entitlement to service connection for a lumbar spine condition, to include as secondary to myeloma is denied. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as secondary to myeloma is denied. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to myeloma is denied. Entitlement to service connection for right lower extremity radiculopathy, to include as secondary to myeloma is denied. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is denied. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to inguinal hernia and/or myeloma is denied. Entitlement to a total disability rating based on individual unemployability (TDIU) due to a service-connected disability is denied. Entitlement to service-connected cause of death is denied. Entitlement to service-connected burial benefits is denied. Entitlement to nonservice-connected burial benefits is granted. FINDINGS OF FACT 1. Resolving any doubt in favor of the Veteran, the Board finds that the Veteran’s inguinal hernia was incurred in and aggravated by his military service. 2. There is no evidence of record to support a finding that the Veteran’s myeloma was incurred coincident with service. 3. There is no evidence of record to support a finding that the Veteran’s back condition was incurred coincident with service. 4. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with left lower extremity peripheral neuropathy prior to the Veteran’s diagnosis of myeloma. 5. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with left upper extremity peripheral neuropathy prior to the Veteran’s diagnosis of myeloma. 6. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with right lower extremity radiculopathy prior to the Veteran’s diagnosis of myeloma. 7. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with hearing loss prior to the Veteran’s diagnosis of myeloma. 8. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with tinnitus prior to the Veteran’s diagnosis of myeloma. 9. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with an acquired psychiatric disorder prior to the Veteran’s diagnosis of myeloma. 10. There is no evidence of record to suggest that the Veteran was unable to follow a substantial gainful occupation due to his service-connected inguinal hernia.. 11. The preponderance of the most probative evidence supports a denial of a service-connected cause of death. 12. The Veteran’s death was not due to a service-connected disability and/or otherwise attributable to his military service. 13. The Veteran had a claim of service connection for inguinal hernia pending at the time of his death, which was awarded in this decision, the appellant qualifies for non-service connected burial benefits. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for inguinal hernia have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.3. 2. The criteria for entitlement to service connection for myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for a lumbar spine condition, to include as secondary to myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 4. The criteria for entitlement to service connection for left lower extremity peripheral neuropathy, to include as secondary to myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 5. The criteria for entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 6. The criteria for entitlement to service connection for right lower extremity radiculopathy, to include as secondary to myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 7. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 8. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 9. The criteria for entitlement to service connection for an acquired psychiatric disorder, to include as hernia and/or myeloma have not been met. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 10. The criteria for entitlement to a TDIU have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.3, 4.15, 4.16, 4.18, 4.19, 4.25. 11. The criteria for entitlement to service-connected cause of death have not been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. 12. The criteria for entitlement to service-connected burial benefits have not been met. 38 U.S.C. §§ 2302, 2303; 38 C.F.R. §§ 3.1700-1713. 13. The criteria for entitlement to nonservice-connected burial benefits have not been met. 38 U.S.C. §§ 2302, 2303; 38 C.F.R. §§ 3.1700-1713. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service with the United States Army from August 1981 to August 1983. He was enlisted in the United States Army Reserve from August 1983 to February 1994, with active duty training in 1989. The Veteran passed away on March 14, 2017. The appellant is his surviving spouse and was recognized as a valid substitute claimant in January 2018. This matter is before the Board of Veterans’ Appeals (Board) on appeal from the October 2014, April 2016, and August 2017 rating decisions issued by a Department of Veterans Affairs (VA). The October 2014 rating decision denied service connection for a back condition. The April 2016 rating decision denied the reopening of the claim for service connection for left inguinal hernia; entitlement to individual unemployability; and service connection for bilateral hearing loss, tinnitus, depression and anxiety, post-traumatic stress disorder, myeloma, left upper and lower extremity peripheral neuropathy, and right lower extremity radiculopathy. The August 2017 rating decision denied service connection for the cause of the Veteran’s death. In August 2018, these matters were before the Board. The claim for service connection for inguinal hernia was reopened and all issues were remanded for further development and to obtain any outstanding military personnel records and service treatment records. A review of the record reflects substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter has been returned to the Board for further appellate proceedings. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). Duty to Notify and Assist VA has a duty to notify and assist Veterans in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). In September 2016, the Veteran requested C&P examinations be conducted to assist in development of his claims. See Form 9, September 2016. In a claim for disability compensation, VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4). A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; establishes that the veteran suffered an event, injury or disease in service, or has a disease or symptoms manifesting during an applicable presumptive period provided the claimant has the required service or triggering event to qualify for that presumption; AND indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. Id. The Board notes, other than service connection for inguinal hernia, the evidence of record before the RO during the April 2016 rating decision did not suggest that the Veteran’s claims for bilateral hearing loss, tinnitus, depression and anxiety, post-traumatic stress disorder, myeloma, left upper and lower extremity peripheral neuropathy, and right lower extremity radiculopathy manifested during an applicable presumptive period or were associated with any established event, injury, or disease reported by the Veteran. Therefore, a VA examination or medical opinion was not necessary to decide those claims. As for the inguinal hernia, the June 1988 rating decision denying the claim was final and had not been reopened. Therefore, a VA examination or medical opinion was not necessary to decide that claim. Service Connection 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 incurred or aggravated during service.” Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009). In each case where a veteran is seeking service-connection for any disability due consideration shall be given to the places, types, and circumstances of such veteran’s service as shown by such veteran’s service record, the official history of each organization in which such veteran served, such veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether the preponderance of the evidence is against the claim. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for inguinal hernia Prior to the Veteran’s death he asserted that service connection was warranted for his inguinal hernia, which he claimed had its onset in service. Procedurally, in March 1988, the Veteran submitted a claim for hernia. See VA 21-526, March 1988. In June 1988, the Veteran was afforded a VA examination. The Veteran reported that, during service, he lifted heavy boxes as a supply clerk and developed a right inguinal hernia. See VA Examination, June 1988. The Veteran reported having surgery in 1981. The examiner noted no current hernia; however, well-healed bilateral inguinal scars were observed. In December 1988, the Veteran was notified that his claim was disallowed because the RO did not receive the Reserve or National Unit that the Veteran was assigned to during service. See Notification Letter, December 1988. In August 2000, the Veteran submitted another claim for service connection for hernia; stating, “[d]o not know what happened with my original claim to San Juan P.R. for this hernia condition” and “I do not recall ever hearing from VA at all after I made my original claim.” See VA 21-526, August 2000. An August 2000 VA progress note reflects that the Veteran was seen in urgent care with complaints of recurrent left inguinal hernia, which was getting larger and painful over the past several weeks. See Medical Treatment Record-Government Facility, August 2000. The Veteran reported undergoing hernia repair during service without issue until recently. He described working 50 to 60 hours at a plastic molding plant. In January 2001, the Veteran was afforded a VA hernia examination. The Veteran reported that in 1981, he incurred a lifting injury resulting in a left inguinal hernia for which he had surgery; then in 1986, he began having pain on the right side and subsequently had a right inguinal herniorrhaphy. See VA Examination, January 2001. The Veteran reported having pain for one year in the groin and feeling a lump on the left side. Examination revealed bilateral herniorrhaphy scars; described as hyperpigmented and slightly raised. The Veteran was diagnosed with bilateral inguinal hernias. In a February 2001 addendum, the examiner stated that the Veteran’s bilateral hernias were reducible; noted the absence of ventra hernai and diastasis recti; and noted that the abdominal wall muscles and fascia surrounding the hernias were not effective. Id. at p.5 of 5. In September 2001, the Veteran was notified that his service treatment records were needed in order to evaluate his claim. See Notification Letter, September 2001. In July 2002, the Veteran was notified that no decision had been rendered because additional evidence was still pending to establish his claim. See Third Party Correspondence, July 2002. In April 2003, the Veteran was notified that his claim was denied because he failed to provide the dates or periods he served as an Army reservist, along with complete unit and address. See MAP-D Development Letter, April 2003. In a January 2004 statement, the Veteran requested that his claim be processed; stating that almost 14 months had passed without any action on the part of VA. See VA 21-4138, January 2004. In January 2004, the Veteran was notified that VA was working on his claim for a hernia condition. See VCAA/DTA Letter, January 2004. In a February 2004 statement, the Veteran reported that his first hernia surgery was in 1981 during basic training; second surgery was in 1988; and the third was in 2003. See VA 21-4138, February 2004. In a March 2004 correspondence, the Veteran was notified that VA was working on his claim for service connection for hernia condition, and asked to submit additional information and evidence. See MAP-D Development Letter, March 2004. In March 2004, the Veteran submitted a completed ‘request for information needed to reconstruct medical data’ form. See Third Party Correspondence, March 2004. In December 2004, the Veteran was notified of the formal finding of unavailable of service treatment records for the Veteran’s period of active service. See VA Memo, December 2004. In January 2005, additional VA treatment records were associated with the Veteran’s claims file which contained an April 2002 VA surgical note reflecting that the Veteran reported frequent tenderness and reducible mass of left inguinal area. See Capri, January 2005. Examination revealed tender mass at both inguinal areas. The Veteran underwent repair of left inguinal hernia. Id. at p.8 of 9. The Veteran was diagnosed with recurrent direct left inguinal hernia. Id. at p.9 of 9. A May 2002 VA surgery note reflects that the Veteran was seen for a hematoma that developed after the Veteran underwent herniorrhaphy. Id. at p.7 of 9. A January 2005 rating decision denied reopening of the claim for service connection for inguinal hernia, herniorrhaphy because no new and material evidence was received; noting that service medical records necessary to prove that condition was incurred or aggravated as a result of military service were not available. In September 2005, the Veteran submitted an informal notice of disagreement. See Third Party Correspondence, September 2005. A November 2005 statement of the case (SOC) denied service connection for left inguinal hernia, status post herniorrhaphy because no service records were available to show the condition was acquired during service. See SOC, November 2005. The Veteran was advised that his claim would be reconsidered if the medical records are located at a later date. In December 2013, the Veteran submitted a request to reopen his claim for service connection for hernia. See VA 21-526b, December 2013. In August 2014, the Veteran requested status of his pending claims because he was informed that he had bone cancer. See VA 21-4138, August 2014. An October 2014 report of general information reflecting that the Veteran was called to clarify what he was claiming and because no document was found. See VA 21-0820, October 2014. The Veteran stated that he was claiming service connection only for his back. In an October 2014 NOD, the Veteran requested DRO review of his pending claims. See VA 21-4138, October 2014. In July 2015, private treatment records were associated with the Veteran’s claims file, which contained a January 1988 medical note stating that the Veteran had surgery on January 27 for inguinal hernia. See Medical Treatment Record-Non-Government Facility, July 2015. Additionally, in July 2015, military personnel records were added to the Veteran’s claims file. The records reflected that in February 1988, the Veteran enlisted in the Army Reserve and was honorably discharged in February 1994. See Military Personnel Record, July 2015 at p.25, 32 of 33. In January 2016, the Veteran submitted a request to reopen claim for service connection for hernia. See VA 21-526EZ, January 2016. An April 2016 rating decision denied reopening of the claim for service connection for left inguinal hernia, herniorrhaphy because of no new and material evidence. An August 2016 SOC confirmed and continued the denial. In March 2017, VA was notified of the Veteran’s death. See VA 27-0820a, March 2017. A March 2017 Board decision dismissed the pending claim for service connection for left inguinal hernia, herniorrhaphy due to the Veteran’s passing. In August 2017, photographs of the Veteran during service were added to the Veteran’s claims file. One of the photographs show surgical sutures on the right lower abdominal area. See Photographs, August 2017. In January 2018, the Veteran’s spouse was determined to be a proper substitute claimant for the Veteran’s pending claims. See Appeal Substitution Review, January 2018; Appeal Substitution Review, January 2018. An August 2018 Board decision found that new and material evidence was received to reopen the claim of entitlement to service connection for inguinal hernia, and remanded the claim for further development. A July 2020 supplement statement of the case (SSOC) denied service connection for inguinal hernia, noting no new evidence had been received to support service connection for inguinal hernia. The Board notes that the evidence reviewed does not include the August 2017 photographs. In this case, prior to the Veteran’s death, he consistently reported that he incurred an inguinal hernia caused by lifting heavy boxes, resulting in surgery during his military service. Private treatment records reflect that the Veteran had left inguinal hernia surgery in January 1988. See Medical Treatment Record-Non-Government Facility, July 2015. As previously noted, military personnel records show that the Veteran enlisted in the Army Reserves from February 1988 to February 1994. Additionally, a March 1989 letter of appreciation reflect that the Veteran participated in annual training in 1989. See Military Personnel Record, July 2015. Further, the medical evidence of record reflect that the Veteran was diagnosed and treated several times for bilateral inguinal hernias, as additional herniorrhaphies after discharge. Additionally, VA examinations revealed bilateral inguinal scars. Service connection has been continual denied because there was no evidence of an inservice occurrence or aggravation. As previous noted, one of the photographs added in August 2017 show that the Veteran did have surgery during his military service. The Board finds that the photograph, as well as the June 1988 VA examiners notation of a right inguinal surgery during service and well-healed inguinal scars, support a finding that the Veteran’s right inguinal hernia had its onset in service. Additionally, resolving any doubt in favor of the Veteran, the Board finds that the Veteran’s inguinal hernia was incurred in and aggravated by his military service. As the criteria service connection has been met, service connection for inguinal hernia is granted. 2. Entitlement to service connection for myeloma 3. Entitlement to service connection for a lumbar spine condition, to include as secondary to myeloma In a May 2016 correspondence, the Veteran reported that, as a consequence of his multiple myeloma, he has suffered back pain, cramps in both legs, movement limitations, and pain in bones and joints; for which he believed service connection was warranted. See Correspondence, January 2017 at p.23 of 160. In November 2013, magnetic resonance imaging (MRI) of the Veteran’s lumbar spine revealed a lesion on the L1 vertebral body that corresponded to a lytic lesion compatible with an aggressive neoplastic lesion. See Medical Treatment Record-Non-Government Facility, December 2013. The MRI also revealed “a diffuse pattern of abnormal signal” in the bone marrow with enhancement and hyperintensity in the STIR images, focal lesion in the anterior and superior margin of the L5 vertebral body; and straightening of the lumbar lordosis. A December 2013 private clinical note reflects a diagnosis of multiple myeloma. Id. at p.3 of 4. In December 2013, the Veteran submitted a claim for service connection for multiple myeloma. See VA 21-526b, December 2013. In October 2014, the Veteran was called to clarify what he was claiming and reported that he was claiming service connection for a back condition. See VA 21-0820, October 2014. An October 2014 rating decision denied service connection for a back condition. In July 2015, military personnel records were added to the Veteran’s claims file, which revealed that he was treated for a paravertebral condition in May 1989, which was not related to work. See Military Personnel Record, July 2015. The additional records reflect that the Veteran missed active duty training during in 1990. There is no evidence of record to suggest that the Veteran participated in active duty training from 1990 until his discharge in 1994. In August 2015, Social Security Administration (SSA) records were added to the Veteran’s claims file. A December 2013 computerized tomography (CT) scan of the lumbar spine revealed diffuse osteopenia, ill-defined lytic lesion concerning the L1 vertebral body, multiple patchy lytic lesions in the vertebral bodies from T12 through L5, inferior displacement of the superior endplate of T12 vertebral body suggestive of a compression fracture of uncertain age, deformity of the superior and inferior endplates of L1 vertebral body, and straightening of the lumbar spine secondary to muscle spasm. See Medical Treatment Records-Furnished by SSA, August 2015 at p.29 of 104. In November 2015, private treatment records were added to the Veteran’s claims file that revealed a pain management summary of care reflecting that he presented to the private clinic on November 2013 following the recent diagnosis of multiple myeloma and mild back pain associated with a large lytic lesion on L1. See Medical Treatment Record-Non-Government Facility at p.30 of 71. It is noted that on December 2013, the Veteran presented to the clinic with increased pain after a fall resulting in an L1 vertebral compression fracture. An April 2014 bone survey revealed mild lateral compression fracture deformities involving L1 and L2, slight loss of vertebral body heights, and demineralization of the spine. A November 2015 private opinion stated that the Veteran’s severe musculoskeletal and neoplastic disease are more probable than not secondary to his military service performance. Id. at p.6 of 71. However, the examiner did not provide a basis for this conclusion; nor is there evidence to support this finding. As such, the very low probative value is given to the private opinion. Although the Veteran was treated for a back condition while he was a member of the Army Reserve, there is no evidence to suggest that he participated in active duty training after that treatment. Additionally, the evidence of record suggests that the Veteran’s back pain was associated with the lytic lesions on his lumbar spine. Further, there is no evidence of record to support a finding that the Veteran’s myeloma or back condition was incurred coincident with service. See 38 C.F.R. § 3.303(a). Therefore, the claims for service connection for myeloma and service connection for a lumbar spine condition, to include as secondary to myeloma are denied. 4. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as secondary to myeloma 5. Entitlement to service connection for left upper extremity peripheral neuropathy, to include as secondary to myeloma 6. Entitlement to service connection for right lower extremity radiculopathy, to include as secondary to myeloma A review of the evidence of record revealed a May 2014 private treatment note, which reflects that the Veteran was seen by physical therapy for evaluation of his lower extremity weakness and was given a four-wheel walker. See Medical Treatment Record-Non-Government Facility, November 2015 at p.45 of 57. The examiner noted that the etiology of the Veteran’s peripheral motor neuropathy was secondary to his underlying myeloma. Id. at p.56 of 57. As both service connection myeloma and a lumbar spine condition have been denied in this decision, service connection for left upper and lower extremity peripheral neuropathy, and right lower extremity radiculopathy on a secondary basis must also be denied. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with peripheral neuropathy or radiculopathy prior to the Veteran’s post-service diagnosis of myeloma. As such, service connection on a direct basis is also denied. 7. Entitlement to service connection for bilateral hearing loss 8. Entitlement to service connection for tinnitus In the May 2016 correspondence, the Veteran reported that, as a consequence of his multiple myeloma, he has suffered hearing loss for which he believed service connection was warranted. See Correspondence, January 2017 at p.23 of 160. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with hearing loss or tinnitus prior to the Veteran’s diagnosis of myeloma. Additionally, there is no evidence that the Veteran was exposed to hazardous noise during service. However, the evidence reflects that the Veteran worked as a molding technician in a plant from 1990 to 2013. As such, service connection for bilateral hearing loss and tinnitus are denied. 9. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected hernia and/or nonservice-connected myeloma. In the May 2016 correspondence, the Veteran reported that, as a consequence of his multiple myeloma, he has suffered depression, anxiety, difficulty handling stressful situations, insomnia, memory loss, hearing loss, lack of tolerance, and frequent mood changes for which he believed service connection was warranted. See Correspondence, January 2017 at p.23 of 160. There is no medical evidence of record reflecting treatment for, diagnosis of, or complaints of symptoms associated with an acquired psychiatric disorder prior to the Veteran’s post-service diagnosis of myeloma. As such, service connection on a direct basis is denied. 10. Entitlement to a TDIU. Prior to and at the time of the Veteran’s death, he was not service connected for any disability. In this decision, the Veteran was granted service connection for inguinal hernia. However, there is no evidence of record to suggest that the Veteran was unable to follow a substantial gainful occupation due to his service-connected inguinal hernia, nor did he so contend. See 38 C.F.R. § 3.340. Moreover, the appellant has not asserted that the Veteran was unable to obtain or maintain gainful employment due solely to his now service-connected inguinal hernia. Notably, SSA records reflect that the Veteran was found to be disabled due to his myeloma. See Medical Treatment Records-Furnished by SSA, February 2017 at p.11 of 250. Based on the above, entitlement to a TDIU due to a service-connected disability is denied. 11. Entitlement to service connection for cause of death To establish service connection for the cause of the Veteran’s death, the evidence must show that a disability that was incurred in or aggravated by service, or which was proximately due to or the result of a service-connected condition, was either a principal or contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(a). For a service-connected disability to be the principal cause of death, it must singularly or jointly with some other condition be the immediate or underlying cause of death, or be etiologically related to the cause of death. 38 C.F.R. § 3.312(b). For a service-connected disability to be a contributory cause of death, it must be shown that it contributed substantially or materially, that it combined to cause death, or aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c). Determinations as to whether service connection may be granted for a disability that caused or contributed to a veteran’s death is based on the same statutory and regulatory provisions that generally govern determinations of service connection. See 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. In this case, the Veteran passed away on March 14, 2017. His cause of death is recorded as: cardiorespiratory arrest, due to pancytopenia, due to terminal multiple myeloma. In this decision, the Veteran was awarded service connection for inguinal hernia. Additionally, the Board has determined that the Veteran’s myeloma was not incurred coincident with his military service. To this end, there is no indication or contention that symptoms of the Veteran’s cardiorespiratory arrest, due to pancytopenia, due to terminal multiple myeloma was first experienced by the Veteran in service or that his fatal disabilities were otherwise directly related to service. Moreover, there is no evidence that the Veteran’s now service-connected inguinal hernia caused or contributed to his death. Significantly, no medical professional has suggested that the Veteran’s fatal cardiorespiratory arrest due to pancytopenia due to terminal multiple myeloma was incurred in his military service, and neither has the appellant presented, identified, or even alluded to the existence of any such medical evidence or opinion. See 38 C.F.R. § 3.159(c)(4)(i); cf. Duenas v. Principi, 18 Vet. App. 512, 517 (2004), citing Paralyzed Veterans of Am. v. Sec'y of Veterans Affairs, 345 F.3d 1334, 1355-57 (Fed. Cir. 2003) (noting that a medical examination conducted in connection with claim development could not aid in substantiating a claim when the record does not already contain evidence of an in-service event, injury, or disease). The appellant has been afforded ample opportunity to present competent medical evidence in support of her claim; however, she has failed to do so. See 38 U.S.C. § 5107(a) (it is the claimant's responsibility to support a claim for VA benefits). The Court has held that "[t]he duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the appellant's claim of entitlement to service connection for the cause of the Veteran’s death, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Accordingly, the claim is denied. 12. Entitlement to service-connected burial benefits 13. Entitlement to nonservice connected burial benefits Where, as here, a veteran's death is not service-connected, a burial allowance to cover the burial and funeral expenses, as well as the expense of transporting the body to the place of burial may be payable under certain circumstances. 38 U.S.C. § 2302(a); 38 C.F.R. § 3.1705. Specifically, if the cause of a veteran's death is not service-connected, entitlement is based upon the following conditions: at the time of death, the veteran was in receipt of pension or compensation (or but for the receipt of military retirement pay would have been in receipt of compensation); or, the veteran had an original claim for either benefit pending at the time of his death for which there was evidence available on the date of death to support the award for compensation or pension or, in the case of a reopened claim, there was sufficient prima facie evidence of record on the date of death to show entitlement; or, the deceased was a veteran of any war or was discharged or released from active military, naval, or air service for a disability incurred or aggravated in line of duty, and there is no next of kin and the veteran's estate funds are insufficient to cover expenses. See 38 C.F.R. §§ 3.1705(b), (e), 3.1708(b), (c). The Veteran’s death was not due to a service-connected disability and/or otherwise attributable to his military service. It is noted, at the outset, that claims for a burial allowance may be advanced only by “[t]he individual whose personal funds were used to pay burial, funeral, and transportation expenses.” at 38 C.F.R. § 3.1702(b)(3). In order to award service-connected burial benefits, service connection for the cause of the Veteran’s death must be in effect. See 38 C.F.R. § 3.1700. Here, the appellant has not been granted service connection for the cause of the Veteran’s death. As such, service-connected burial benefits may not be awarded. However, the Board recognizes that the appellant incurred the cost of the Veteran’s burial expense. Moreover, as the Veteran had a claim of service connection for inguinal hernia pending at the time of his death, which was awarded in this decision, the appellant qualifies for nonservice connected burial benefits. Based on the above, the entitlement to nonservice connected burial benefits is granted. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Camille NeSmith, 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.