Citation Nr: 21022992 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 19-24 907 DATE: April 19, 2021 ORDER Entitlement to service connection for the Veteran’s cause of death is granted. FINDING OF FACT The Veteran’s service-connected right knee degenerative joint disease and post-concussion syndrome with headaches and dizziness were at least as likely as not a contributory cause of his death. CONCLUSION OF LAW The criteria for service connection for the Veteran’s cause of death have been met. 38 U.S.C. § 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1952 to April 1954. He died in October 2015. The Appellant is his surviving spouse. She seeks entitlement to service connection for the Veteran’s cause of death. To warrant service connection for the Veteran’s cause of death, the evidence must show that a service-connected disability was either a principal or a contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. A disability will be considered the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312(b). A disability will be considered a contributory cause of death when it contributed substantially or materially to death, combined to cause death, or aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c)(1). Service connection for the cause of death is determined in accordance with the statutes referable to establishing service connection for compensation purposes under Chapter 11 of 38 U.S.C. (§ 1101 et. seq.). 38 U.S.C. § 1310(a). Service connection will be granted for a disability resulting from disease or injury that was incurred or aggravated in the line of duty during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability, or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. (Continued on the next page)   Here, the evidence establishes the Veteran’s service-connected right knee degenerative joint disease and post-concussion syndrome with headaches and dizziness were at least as likely as not a contributory cause of his death. In March 2020, the Appellant submitted a detailed private opinion to support her claim. The author of the opinion, C.K., M.D., concluded that the Veteran’s service-connected right knee degenerative joint disease and post-concussion syndrome with headaches and dizziness were at least as likely as not a contributory cause of his death due to his extensive use of non-steroidal anti-inflammatory drugs (NSAIDs) over the years to ameliorate chronic pain due to his service-connected disabilities. C.K., M.D., referenced numerous treatment notes from the Veteran’s medical records that document his use of NSAIDs for his service-connected disabilities. C.K., M.D., explained there is a large-body of peer-reviewed literature that supports a link between the use of NSAIDs and congestive heart failure (CHF). C.K., M.D., further explained individuals with renal failure, diabetes, or hypertension, especially elderly individuals, are at greater risk for developing CHF with NSAID use than individuals without those conditions. C.K., M.D., noted the Veteran was diagnosed as having hypertension in 2007, placing him at higher risk for CHF and death due to cardiogenic shock. C.K., M.D., acknowledged the Veteran’s death certificate lists “shock” as his cause of death rather than explicitly noting cardiogenic shock, but C.K., M.D., explained that it is at least as likely as not the shock that led to the Veteran’s death was cardiogenic shock given his diagnosis of CHF in the months leading up to his death and the absence of evidence of any other kind of shock such as hypovolemic shock (caused by too little blood volume), anaphylactic shock (caused by allergic reaction), septic shock (cause by infections), or neurogenic shock (caused by damage to the nervous system). Thus, C.K., M.D., concluded it is at least as likely as not NSAID use associated with the Veteran’s service-connected disabilities contributed to his death, when considering his age and increased risk for the development of CHF due to hypertension. The Board notes the Agency of Original Jurisdiction (AOJ) elected not to obtain an opinion regarding the Appellant’s claim, so there is no evidence that rebuts the cogent, well-reasoned rationale provided by C.K., M.D. It is clear C.K., M.D., considered an accurate factual history of the circumstances leading to the Veteran’s death; therefore, the Board finds her opinion highly probative regarding the issue on appeal, resulting in at least an approximate balance of positive and negative evidence with regard to the material issue of whether the Veteran’s service-connected disabilities contributed to his death. Resolving reasonable doubt in favor of the claimant, the Board finds service connection for the Veteran’s cause of death is warranted. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’ the Nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding . . . benefits.”). M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. S. Kyle, 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.