Citation Nr: 21020712 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 18-18 972 DATE: April 8, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1961 through March 1953. The Veteran died in July 2017. The appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (BVA or Board) on appeal from December 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for the cause of the Veteran's death is remanded. The appellant contends that the Veteran’s service-connected post-traumatic stress disorder (PTSD) was the primary or contributory cause of the Veteran’s death. Specifically, the appellant contends that the continued stress from PTSD caused the Veteran to have a myocardial infraction, which ultimately resulted in the Veteran’s death. Alternatively, the appellant asserts that the shock therapy treatments that the Veteran received for his PTSD caused damage to the Veteran’s heart, which eventually lead to the Veteran’s death. Furthermore, the appellant has asserted that the Veteran’s PTSD led to dementia, and the medicine prescribed for treatment of the Veteran’s dementia caused him to suffer a myocardial infraction. The Board finds that the existing record is not sufficient to adjudicate the issue of cause of the Veteran’s death. First, the Veteran’s death certificate lists Raleigh General Hospital as the hospital where the Veteran was receiving treatment at the time of his death in July 2017. However, the existing record does not contain treatment notes from Raleigh General Hospital for this time period. Additionally, the current record indicates that the Veteran was receiving private treatment from a Dr. Harold Harvey as early as January 2017. However, the record does not contain detailed treatment notes from this physician. Lastly, the appellant has provided medical articles supporting a link between PTSD and cardiovascular events. She also provided an article supporting that medicine for the treatment of dementia can cause cardiovascular problems. However, no VA examiner has considered whether the Veteran’s cause of death was related to his service-connected PTSD or medications he was taking for his dementia. Considering the aforementioned, the Board finds that a remand is warranted for further development. The matters are REMANDED for the following action: 1. Obtain records of any inpatient treatment at Raleigh General Hospital in 2017. Additionally, obtain all relevant treatment notes from Dr. Harold Harvey dated in 2016 and 2017. Document all requests for information as well as all responses in the claims file. 2. Obtain a VA opinion from an appropriate clinician to determine the nature of the Veteran’s death. Specifically, the examiner is asked to address the following: a. Whether it is at least as likely as not that the Veteran’s myocardial infraction was caused or is aggravated by his service-connected PTSD including due to his treatment of PTSD due shock therapy. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. b. (i) whether the Veteran’s dementia was less likely or not caused or aggravated by his service-connected PTSD. (ii) If the examiner makes the determination that the Veteran’s dementia was caused or aggravated by the Veteran’s service-connected PTSD, the examiner should offer an opinion on whether medications for the dementia were the primary or contributory cause of the myocardial infraction suffered at the time of the Veteran’s death. In formulating the opinions, the examiner is asked to specifically address the medical articles submitted into the record that suggest a connection between PTSD and medications used for dementia and cardiovascular events. See VBMS document labeled Medical Treatment Record-Non-Governmental Facility, receipt date 7/28/2020, 21 pages and Medical Treatment Record-Non-Governmental Facility, receipt date 7/28/2020, 6 pages. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.B. Mmeje, 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.