Citation Nr: 21021693 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 17-31 992 DATE: April 13, 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 in the United States Navy from February 1948 to January 1952, to include service in Korea. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in June 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). The Appellant appeared for a hearing before the undersigned Veterans Law Judge in March 2021. A transcript of the hearing is of record. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. The Appellant asserts that the cause of the Veteran’s death is related to his active service due to the Veteran’s in-service asbestos exposure. In order to establish service connection for the cause of the Veteran's death, applicable law requires that the evidence show that a disability incurred in or aggravated by service either caused or contributed substantially or materially to death. For a service-connected disability to be the cause of death it must singly, or with some other condition, be the immediate or underlying cause, or else be etiologically related. For a service-connected disability to constitute a contributory cause, 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 U.S.C. § 1310; 38 C.F.R. § 3.312. In the alternative, service connection for the cause of death may be warranted where the evidence indicates that the cause of the Veteran’s death should have been service-connected. That is to say that, to establish service connection for a particular disability found to have caused his death, the evidence must show that the disability resulted from disease or injury which was incurred in or aggravated by service or, in the alternative, is secondary to another service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.304. The Veteran’s death certificate reflects that he died in March 2015. The underlying condition causing death is listed as coronary artery disease. Other significant conditions listed on the death certificate are COPD (chronic obstructive pulmonary disorder) and osteoarthritis. At the time of his death, the Veteran was service-connected for two disabilities – bilateral hearing loss, rated at 30 percent; and residuals of a traumatic amputation of the left ring finger, rated as noncompensably disabling. Again, the appellant does not contend that the Veteran’s service-connected disabilities caused his death. Instead, she contends that the Veteran’s in-service exposure to asbestos resulted in the conditions that led to his death. Given the Veteran’s dates of service and his service in the Navy, VA has already found it highly probable that the Veteran was exposed to asbestos during his active service. In January 2016, the Veteran’s private treating physician submitted a letter in support of the Appellant’s claim. In the letter, the physician stated that the Veteran was diagnosed with chronic pulmonary fibrosis which was consistent with asbestos exposure. The physician also stated that the Veteran’s pulmonary fibrosis had many flare-ups which led to acute infections and pneumonia that required hospitalization. In a March 2016 VA medical opinion, the VA examiner opined that the Veteran’s asbestos exposure did not complicate the Veteran’s COPD because there was no evidence of his asbestosis being restrictive to his pulmonary functions and thus, there was no ill effects from asbestos exposure. In a June 2016 VA medical opinion, the same VA examiner opined that the Veteran’s asbestos exposure did not decrease his lung function and thus did not aggravate his COPD or heart disease. Given this evidence, the Board finds that an additional opinion is necessary. That is not to say that the March and June 2016 opinions are inadequate for rating purposes; indeed, they are clear and contain a sufficient rationale for the opinions provided. Instead, the Board seeks clarification as to one point raised by the Veteran’s treating physician that has not yet been addressed. Namely, that physician noted that the Veteran’s pulmonary fibrosis resulting in flare-ups that led to acute infections and pneumonia, requiring hospitalization. Whether such flare-ups are indeed attributable to the Veteran’s pulmonary fibrosis, and whether such associated conditions such as pneumonia or other infections had any relationship to his eventual causes of death has not yet been explored. An additional opinion is therefore required. The matters are REMANDED for the following action: 1. With any necessary assistance from the appellant, obtain any outstanding treatment records regarding the Veteran’s treatment and potential hospitalizations for his pulmonary fibrosis. 2. After the above ordered development has been completed, obtain an addendum opinion from an appropriate examiner as to whether the Veteran’s pulmonary fibrosis and any complications thereof contributed to the Veteran’s death. A complete copy of the Veteran’s claims file must be available to and reviewed by the examiner. After reviewing the claims file, the examiner is to state whether there is evidence of the Veteran’s pulmonary fibrosis leading to infections (to include pneumonia) and/or hospitalizations. If so, then the examiner is to state whether it is at least as likely as not that the Veteran’s pulmonary fibrosis and any associated complications and infections contributed to the Veteran’s death from COPD or coronary artery disease. A complete rationale must be provided. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. K. Hall, 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.