Citation Nr: 21023771 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-43 092 DATE: April 21, 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 March 1969 to January 1971. Service in the Republic of Vietnam was indicated by the record. The Veteran was the recipient of the Combat Infantry Badge (CIB) and Purple Heart Medal, among with other awards and decorations. He died in June 2015. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which denied the appellant’s claim of entitlement to service connection for the cause of the Veteran’s death. She filed a notice of disagreement (NOD) in August 2016 and a statement of the case (SOC) was issued in July 2018. The appellant perfected a timely appeal in August 2018. In October 2020, the appellant presented sworn testimony during a virtual hearing, which was chaired by the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the Veteran’s VA claims file. 1. Entitlement to service connection for the cause of the Veteran's death is remanded. In this matter, the appellant asserts entitlement to service connection for the cause of the Veteran’s death. She contends that the Veteran’s service-connected ischemic heart disability (IHD) and/or posttraumatic stress disorder (PTSD) caused or contributed to the Veteran’s death. See the October 2020 Board hearing transcript. The Veteran’s June 2015 death certificate indicates he died from acute respiratory distress. Although terminal treatment records from University Hospital Parma Medical Center have been associated with the Veteran’s VA claims file, the appellant, reported that certain private treatment records remain outstanding. See the Board hearing transcript dated October 2020. To this end, the Board recognizes the contention of the Veteran’s daughter that cardiac activity continuous rhythm records dating from the day of the Veteran’s death should be associated with the record. See the statement of the Veteran’s daughter dated May 2018. The Board therefore finds that this matter should be remanded in order to obtain any outstanding private treatment records identified by the appellant as being pertinent to the pending claim. In support of her claim, the appellant submitted two journal articles; specifically, ‘Cardiac Manifestations of Idiopathic Pulmonary Fibrosis’ and ‘Chronic Obstructive Pulmonary Disease and Ischemic Heart Disease Comorbidity: Overview of Mechanisms and Clinical Management.’ She also submitted a fact sheet on ‘Sudden Cardiac Arrest and Sudden Cardiac Death’ from the Cleveland Clinic. A VA medical opinion was obtained in July 2018, at which time the examiner determined, “[i]t is less likely as not that the Veteran's service-connected CAD or PTSD contributed substantially or materially to his death. His most recent echo showed LV function that was not indicative of any myocardial damage due to his CAD, which was apparently successfully treated with stents.” The examiner additionally noted, “PTSD would not have any effect on ILD, which is what caused the Veteran's death.” The VA examiner further stated that “there is no evidence that any treatment for the SC conditions contributed to his death, but actually the opposite was true in that the stenting for the CAD improved his quality of life and by doing so would have helped somewhat in his ability to withstand his devastating ILD.” The examiner concluded, “[t]herefore, by the same token the CAD did not cause debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of his ILD that primarily caused his death.” Critically, the July 2018 VA examiner failed to address the articles submitted by the appellant concerning a potential comorbidity between IHD and respiratory disease including chronic obstructive pulmonary disease (COPD). In fact, the July 2018 VA examiner did not cite any medical literature in support of the conclusion rendered. At the October 2020 Board hearing, the Veteran’s daughter, who is a nurse, reported her belief that, based upon her medical research and documentation provided by the appellant, the Veteran’s service-connected IHD was more than likely a contributing factor to his cause of death. See the Board hearing transcript, pg. 4. She asserted that the Veteran’s service-connected heart disability “essentially rendered him less capable of resisting the effects of the lung disability.” Id. In light of the July 2018 VA examiner’s failure to address the medical research presented by the appellant, as well as the testimony of the Veteran’s daughter, who is a nurse, the Board finds that the evidence of record is insufficient to determine whether service connection is warranted for the cause of the Veterans’ death. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide one that is adequate for purposes of the determination being made). This matter must therefore be remanded to obtain a new VA opinion as to the etiology of the claimed disability. The matters are REMANDED for the following action: 1. The AOJ should request the appellant to identify the provider(s) of any evaluations or treatment the Veteran received for his fatal disabilities prior this death, and to provide all releases necessary for VA to obtain any private records of such evaluations or treatment. The AOJ should obtain for the record complete records of all such evaluations and treatment from all providers identified, to specifically include all terminal treatment records from University Hospital Parma Medical Center (where the Veteran died in June 2015). If any records requested are unavailable, the reason must be explained for the record. [If the appellant does not provide the requested releases so that VA may obtain the records, the AOJ must request that the appellant obtain such records herself and provide them to VA.] 2. Arrange to have an appropriate VA physician comprehensively review the record and provide opinion addressing the relationship, if any, between the Veteran’s service and his death. The contents of the entire claims file must be made available to, and be reviewed by, the designated physician, and the opinion should include discussion of the Veteran's documented medical history and all lay assertions, to include those advanced by the appellant and on her behalf. Specifically, the physician should render an opinion, consistent with sound medical judgment, as to whether it is at least as likely as not (i.e., a 50 percent or greater possibility) that the Veteran’s service-connected IHD and/or PTSD caused or materially contributed to his death. In rendering his/her opinion, the physician should address the contention of the Veteran’s daughter that the service-connected heart disability rendered the Veteran’s less capable of resisting the effects of his fatal lung disability. The physician should also address the articles submitted by the appellant, which are referenced above. Complete, clearly-stated rationale for the conclusions reached must be provided. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. K. Buckley, 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.