Citation Nr: 21023721 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-42 281 DATE: April 21, 2021 REMANDED The issue of entitlement to service connection for the cause of the Veteran's death is remanded. The issue of entitlement to death pension with aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1955 to November 1957. The Veteran died in January 2013. The appellant is his widow. The Board previously remanded this appeal in September 2020 for additional development. Unfortunately, the Board finds that further remand is necessary in order to obtain an addendum opinion and potentially relevant outstanding treatment records, particularly as the appellant is not represented. Regarding service connection for the cause of the Veteran’s death, a January 2021 opinion obtained on remand found that the Veteran’s death due to cerebrovascular accident and cardiopulmonary disease was not related to in-service treatment for rubella or stomach complaints, generally, or to service-connected hearing loss and tinnitus. However, an opinion has not yet been offered as to whether the Veteran’s cardiopulmonary disease contributing to his death was in any way related to complaints of chest pain or to ancylostomiasis in service. In this regard, the Veteran was seen in July 1956 for chest pain that he had been experiencing for one month. He was also treated for chronic stomach complaints during service. Of note, he was hospitalized for ancylostomiasis and a cestode infection in April 1957 in conjunction with his gastrointestinal complaints. According to the Merck Manual Consumer Version, chronic ancylostomiasis (hookworm infection) can lead to anemia and occasionally heart failure. See https://www.merckmanuals.com/home/infections/parasitic-infections-nematodes-roundworms/hookworm-infection (last accessed April 9, 2021). Post-service treatment records show continued stomach complaints, as well as diagnoses of normocytic normochromic anemia and coronary artery disease (CAD). Given the foregoing, the Board finds an addendum opinion is necessary. Additionally, it does not appear that all relevant treatment records have been obtained. Available records show that the Veteran was diagnosed with CAD and underwent coronary artery bypass graft surgery at some point, but it is unclear when. As there is a possibility that the Veteran’s heart problems were related to service, the Board finds that those records are relevant. VA treatment records also show various medications prescribed by non-VA providers; thus, it appears that the Veteran received both VA and private treatment prior to his death. Given the foregoing, all relevant outstanding VA and private treatment records dating since service should be requested. Next, as the issue of entitlement to service connection for the cause of the Veteran’s death is being remanded, the Board will also remand the issue of entitlement to death pension with aid and attendance to provide the appellant with one more opportunity to clarify and submit any additional supporting documentation regarding her claimed unreimbursed medical expenses. As a final matter, the Board previously requested translation of specific documents from Spanish to English, including the Veteran’s death certificate. For some reason, the death certificate was not translated to English, as requested. The matters are REMANDED for the following action: 1. Ensure that the Veteran’s death certificate has been translated from Spanish to English. 2. With any assistance required of the appellant, obtain all relevant VA and private treatment records dating since service, to specifically include record related to treatment for heart and/or stomach problems. 3. After the foregoing development is completed to the extent possible, forward the Veteran’s claims folder to the examiner who provided the January 2021 opinion or another appropriate clinician for review and for an opinion on the cause of the Veteran’s death. The examiner must opine whether the Veteran’s cerebrovascular accident and/or cardiopulmonary arrest was at least as likely as not related to an in-service injury, event, or disease, to include complaint of chest pain and/or treatment for ancylostomiasis therein. In providing the foregoing opinion, the examiner should address (1) the July 1956 complaint of a one-month history of chest pain; (2) the treatment in service for ancylostomiasis in April 1957 followed by continued stomach complaints post service; and (3) the evidence that chronic ancylostomiasis (hookworm infection) can lead to anemia and occasionally heart failure. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 4. Once more, send the Appellant a letter asking whether her caregiver is a licensed health professional (an individual licensed to furnish health services by the state in which the services are provided such as registered nurses, licensed vocational nurses, and licensed practical nurses) and if so, provide supporting documentation. Ask her to provide documentation of the monthly caregiver expense in the form of a receipt bill, statement on the provider’s letterhead, a computer summary, or other form which specifies the amount paid, all dates of payment, and purpose of payment. The letter should be enclosed with Medical Expense Reports, and any other forms required for a full and accurate reporting of the appellant’s expenses for the period in question. S. C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Fagan 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.