Citation Nr: 21022231 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 15-20 653 DATE: April 15, 2021 ORDER Service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The Veteran died in August 2012, and his death certificate lists the cause of death as arteriosclerotic cardiovascular disease. 2. At the time of his death, the Veteran did not have any service-connected disabilities. 3. The preponderance of the evidence is against the finding that the Veteran had undiagnosed posttraumatic stress disorder (PTSD) that caused his arteriosclerotic cardiovascular disease or contributed to his death. 4. The preponderance of the evidence shows that the Veteran’s arteriosclerotic cardiovascular disease did not have its onset in service, did not manifest to a compensable degree within one year of discharge, and is not otherwise causally related to service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have not been met. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from July 1988 to November 1988 and from November 1990 to May 1991. The Veteran died in August 2012 and the Appellant is his surviving spouse. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from the March 2013 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The rating decision denied service connection for the cause of the Veteran’s death. The Appellant’s Notice of Disagreement (NOD) was received in November 2013. The Statement of the Case (SOC) was issued in April 2015, and the Appellant’s VA form 9, substantive appeal to the Board was received in June 2015. In January 2020, the Appellant and her representative appeared before the undersigned Veterans Law Judge (VLJ) for a Board videoconference hearing. The transcript is of record. The claim was remanded for further development and adjudication pursuant to a March 2020 Board decision. Entitlement to service connection for the cause of the Veteran's death. At the January 2020 hearing, the Appellant testified that the Veteran was suffering from undiagnosed PTSD and that his PTSD is related to service. She contended that the Veteran’s PTSD was the cause of his heart problems. She indicated that the Veteran died at the age of 42 from a heart attack, with no family history of heart disease, no previous heart problems, and no hypertension. The Appellant testified that she observed the Veteran display signs of sleep disturbance, hypervigilance, flattened emption, isolation, nightmares, flashbacks, and hyper-alertness around large crowds, which she believed to be symptoms of untreated PTSD. The Appellant contended that the Veteran suffered from PTSD as a result of his service, and that his PTSD caused his cardiovascular disease. VA death 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, 3.312.  To establish service connection for the cause of a veteran’s death, the evidence must show that a disability incurred in or aggravated by active service was the principal or contributory cause of death. 38 C.F.R. § 3.312.  To be considered a principal cause of death, a service-connected disability must have been singly or jointly with some other condition the immediate or underlying cause of death or have been etiologically related to the cause of death.  For a service-connected disability to be a contributing cause, it must have substantially or materially contributed to a veteran’s death; it is not sufficient to show that it casually shared in producing death, but rather there must be a causal connection.  A contributory cause of death is inherently one not related to the principal cause. 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (b), (c).  Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, 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 or injury incurred or aggravated during service’ the so-called nexus’ requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).  The Veteran’s service treatment records (STRs) do not contain any complaints or treatments for any psychiatric or cardiovascular disabilities. The Veteran was not treated at the VA and his private treatment records are unavailable as they have been destroyed by his provider following his death. In March 2020, the VA obtained a medical opinion. The VA examiner reviewed the Appellant’s file, including her hearing testimony, and concluded that it is less likely than not that the Veteran suffered from PTSD. The VA examiner indicated that the existing evidence does not support a PTSD diagnosis. With respect to the Veteran’s claimed symptoms, the VA examiner indicated that many of the symptoms are attributed to other illnesses. The VA examiner provided an example of this, indicating that the Veteran’s sleep symptoms open up a possibility of sleep apnea, a disability not related to PTSD. The VA examiner concluded that overall, the evidence is too vague and insufficient to make a credible PTSD diagnosis. The VA examiner also noted that research shows that over 80 percent of combat veterans do not show any significant long-lasting psychiatric symptoms or a diagnosis of PTSD and that there was no objective evidence of the Veteran suffering from PTSD symptoms. In her March 2021 written brief presentation, the Appellant indicated that the Veteran’s death was a sudden event where there was no diagnosis or medical history showing causation. Based on a review of the entire record, the preponderance of the evidence is against the claim. The evidence shows that the Veteran did not have undiagnosed PTSD that contributed to his death. The evidence likewise shows that the Veteran’s arteriosclerotic cardiovascular disease did not have its onset until many years after service and is not related to service. As such, service connection for the cause of the Veteran’s death is not warranted. In a DIC claim based on cause of death, the first requirement for service connection, evidence of a current disability, will always have been met (the current disability being the condition that caused the Veteran to die). Carbino v. Gober, 10 Vet. App. 507, 509 (1997), aff’d sub nom. Carbino v. West, 168 F.3d 32 (Fed. Cir. 1999). The Veteran’s Death Certificate lists his cause of death as arteriosclerotic cardiovascular disease. The cause of death is listed as “pending” with a notation that it was amended on November 7, 2012. Under approximate interval between onset and death, the Death Certificate states “unknown.” In this case, the Veteran’s arteriosclerotic cardiovascular disease did not have its onset in service and did not manifest to a compensable degree until many years after service. Indeed, the Appellant does not contend otherwise. The Veteran’s STRs do not contain complaints or treatments for a cardiovascular disability, and the Appellant’s March 2021 written brief presentation indicates that the Veteran’s death was sudden and unexpected. During the January 2020 Board hearing, the Appellant testified that the Veteran was not exhibiting any heart problems prior to his death and was going in annually for regular physical exams. She also testified that to her knowledge, the Veteran did not have hypertension. Thus, the remaining question is whether the Veteran’s arteriosclerotic cardiovascular disease is related to service. With respect to a nexus, the Appellant argues that the Veteran suffered from undiagnosed PTSD as she observed him to have symptoms. She argues that the Veteran’s PTSD was a result of service and caused his heart attack. However, there is no competent medical evidence that the Veteran suffered from undiagnosed PTSD or any other mental illness. There are no in-service or post-discharge treatment records showing complaints or treatments for any disability. Moreover, the March 2020 VA medical opinion indicates that the claimed symptoms do not support a diagnosis of PTSD as the information provided is vague and insufficient to make a credible PTSD diagnosis. The VA examiner addressed the Veteran’s symptoms, indicating that they can be attributed to a number of different unrelated disabilities, such as sleep apnea. The March 2020 VA medical opinion is afforded probative value as the Appellant’s contentions were completely addressed, and full rationale was provided for all conclusions reached. In essence, the evidence supporting a PTSD diagnosis is speculative at best and does not raise to the level of relative equipoise given the totality of the circumstances. Although the Appellant sincerely believes that the Veteran had undiagnosed PTSD which caused his cardiovascular disease, she is not competent to provide a medical opinion in this case. The diagnosis and etiology of the cause of the Veteran’s death cannot be competently addressed by the Appellant as a lay person. The issue is medically complex, as it requires knowledge of interpreting complicated diagnostic medical testing and interpretation of medical records and studies. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, while the Appellant may testify to the Veteran’s observable symptoms, she is not competent to provide a diagnosis or a nexus opinion in this case. As such, her opinion cannot service as a basis for a PTSD diagnosis or a nexus. In this light, there is no probative medical evidence supporting a PTSD diagnosis in this case. While the Appellant observed the Veteran having certain symptoms that she attributed to be undiagnosed PTSD, and her statements are not discounted in that regard, the medical evidence in this case illustrates that these symptoms do not support a clinical PTSD diagnosis. However, assuming arguendo, that the Veteran did have undiagnosed PTSD, there is still no evidence linking his PTSD to his service or to the Veteran’s cause of death. Thus, the evidence does not show a nexus. As there is no evidence to support a PTSD diagnosis and no other service-connected disability, the Veteran’s cause of death cannot be linked to a service-connected disability or his service. In other words, without a PTSD diagnosis, there is no service-connected disability contributing to his cause of death. The Appellant has not alleged, and the record does not reflect, that the Veteran’s arteriosclerotic cardiovascular disease is any other way related to service. Moreover, no records have been submitted suggesting any relationship between the Veteran’s arteriosclerotic cardiovascular disease and his active military service. Of note, service connection may be established for a Persian Gulf veteran who has a qualifying chronic disability due to an undiagnosed illness, medically unexplained chronic multisymptom illnesses (without conclusive pathophysiology or etiology characterized by overlapping symptoms and signs), or a certain listed infectious diseases. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Notably, however, arteriosclerotic cardiovascular disease is a diagnosed illness, and does not consist of a medically unexplained chronic multisymptom illness and is not a listed infectious disease as contemplated by this VA regulation. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection for the cause of the Veteran’s death. The benefit of the doubt doctrine is not for application, and entitlement to service connection for this disability is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.