Citation Nr: 21026086 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-63 095 DATE: April 29, 2021 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2012 to February 2016. Unfortunately, the Veteran died in July 2016, and the Appellant is his surviving spouse. The matter was most recently before the Board of Veterans’ Appeals (Board) in December 2019, when the Board issued a decision denying service connection for the case of the Veteran’s death. The Appellant appealed the decision to Court of Appeals for Veterans Claims (the Court). The parties signed a Joint Motion for Remand (JMR) that was granted by the Court, vacating the Board’s December 2019 decision, and remanding the issue to the Board for further development and readjudication consistent with terms of a December 2020 JMR. Entitlement to service connection for cause of death is remanded. The Appellant is claiming entitlement to service connection for the cause of the Veteran’s death. The Veteran’s certificate of death indicates his cause of death was anoxic encephalopathy due to cardiac arrest, resuscitated, due to administration of chemical restraint (Haldol, Benadryl, and Ativan). At the time of his death, the Veteran was service-connected for tinnitus and was not otherwise service-connected for any diseases or injuries. The Appellant has contended that the Veteran’s death resulted from an unspecified psychosis of an unknown etiology leading to the use of medication to sedate him, eventually causing his accidental death. Specifically, the Appellant contends that the Veteran was diagnosed with an “unspecified psychosis not due to a substance or known physiological condition.” Prior to the Veteran’s hospital admission in July 2016, he did not have a current diagnosis of psychosis. The record indicates that the Veteran was diagnosed with psychosis at the time of his July 2016 hospital admission, which was within one year of his separation from active duty in February 2016. Service connection for certain identified chronic diseases, including psychoses, may be established on a presumptive basis by showing that such a disease manifested itself to a compensable degree within a prescribed period following separation from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). The term “psychosis” means any of the following disorders listed in the DSM-4 and DSM-5: (a) Brief Psychotic Disorder; (b) Delusional Disorder; (c) Psychotic Disorder Due to Another Medical Condition; (d) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder; (e) Schizoaffective Disorder; (f) Schizophrenia; (g) Schizophreniform Disorder; and (h) Substance/Medication-Induced Psychotic Disorder. 38 C.F.R. § 3.384. Dependency and indemnity compensation (DIC) benefits may be awarded to a veteran’s spouse, children, or parents for death resulting from a service-connected or compensable disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In order for service connection for the cause of a veteran’s death to be granted, it must be shown that a service-connected disorder caused his or her death, or substantially or materially contributed to it. A service-connected disorder is one that was incurred in or aggravated by active service. Death is deemed to have been caused by a service-connected disability when the evidence establishes that a service-connected disability was either the principal or a contributory cause of death. 38 C.F.R. § 3.312(a). A service-connected disability is deemed to have been the principal cause of death when it, singly or jointly with another disorder, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312(b). In determining whether a service-connected disability was a contributory cause of death, it must be shown that a service-connected disability contributed substantially, materially, or combined with another disorder to cause death, or that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c); see Harvey v. Brown, 6 Vet. App. 390, 393 (1994). Therefore, service connection for the cause of a veteran’s death may be demonstrated by showing that the veteran’s death was caused by a disability for which service connection had been established at the time of death or for which service connection should have been established. After careful consideration of the claims file, the Board concludes that the evidence of record is inadequate for VA rating purposes. Consistent with VA’s duty to assist, VA must provide a medical examination when there is evidence of (1) a current disability; (2) an in-service injury; (3) some indication that the claimed disability may be associated with the established injury; and (4) insufficient competent evidence of record for VA to make a decision. See Wood v. Peake, 520 F.3d 1345, 1348 (2008). Therefore, this case must be remanded to ensure a complete record upon which to decide the claim on appeal. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The matter is REMANDED for the following action: 1. Obtain a medical opinion addressing the nature and etiology of the Veteran’s psychosis, to include any relation to alcohol abuse. Access to the electronic claims file, including a copy of this remand, must be made available for the examiner to review. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following questions, as appropriate: (a) Is it at least as likely as not (50 percent or more probability) that the Veteran had a current diagnosis of psychosis at the time of his death? For VA purposes, psychosis is defined as any of the following disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): (a) Brief Psychotic Disorder; (b) Delusional Disorder; (c) Psychotic Disorder Due to Another Medical Condition; (d) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder; (e) Schizoaffective Disorder; (f) Schizophrenia; (g) Schizophreniform Disorder; and (h) Substance/Medication-Induced Psychotic Disorder. 38 C.F.R. § 3.384. (b) If so, is it at least as likely as not (50 percent or more probability) that the psychosis resulted in at least occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant distress, or symptoms controlled t continuous medication within a year of the Veteran’s February 2016 discharge from service? (c) If the Veteran had psychosis, was such induced by alcohol abuse? (d) Is it at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s psychosis caused, contributed substantially or materially to cause, or aided or lent assistance to the production of his death? A complete rationale should be given for all opinions and conclusions expressed, and a discussion of the facts and medical principles involved must be provided. If the examiner cannot provide any requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information to make a determination or whether the opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 2. Thereafter, and after any additional development deemed necessary, readjudicate the issue on appeal. James Springer Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Fulmer, 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.