Citation Nr: 21027683 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-43 766 DATE: May 6, 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 in the Navy from July 1962 to November 1967. The Veteran died in March 2015. The Appellant is the Veteran's surviving spouse. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Appellant testified at a hearing before the undersigned; a transcript of that hearing is of record. Entitlement to service connection for the cause of the Veteran's death is remanded. In August 2016, a VA medical opinion was prepared as to service connection for the cause of the Veteran's death. The reviewing physician opined that it was less likely than not that the Veteran's hypertension was caused or aggravated by his service-connected posttraumatic stress disorder (PTSD). However, the VA medical opinion is incomplete because its rationale ends in the middle of a sentence. The Veteran's death certificate states that the cause of death was obstructive airway disease, with other significant factors contributing to his death including dementia and hypertension. Along with being incomplete, the VA medical opinion is also inadequate in that it did not address whether the Veteran's dementia or obstructive airway disease was caused or aggravated by his service-connected PTSD. Once VA undertakes the effort to provide an opinion, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, remand is necessary in order to obtain an adequate medical opinion. At the February 2021 hearing, the Appellant testified that the Veteran received treatment at the Henderson Clinic. It is unclear from this statement whether the Appellant was referring to the VA Outpatient Clinic in Henderson, Nevada or to a private provider. Additionally, the most recent VA treatment records that have been associated with the file are from December 2014. Therefore, it is unclear whether all pertinent treatment records prior to the Veteran's death have been associated with the claims file. Additionally, during the hearing, the Appellant's representative indicated that he had located pertinent medical literature and was going to submit it in support of the claim. However, the record does not reflect that the Appellant's representative submitted the referenced literature. As the appeal is being remanded, the Appellant and her representative will have another opportunity to submit any pertinent evidence in support of her appeal. The matter is REMANDED for the following action: 1. Contact the Appellant and her representative in order to identify any outstanding non-VA treatment records for treatment of the Veteran prior to his death and to request submission of the medical literature identified by the Appellant's representative at the February 2021 Board hearing. Ask the Appellant to complete a VA Form 21-4142 for any identified providers of the Veteran. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain and associate with the claims file any outstanding VA treatment records up to the date of the Veteran's death. 3. Once the development requested in items 1 and 2 is complete, obtain a medical opinion as to the cause of the Veteran's death. A complete copy of the claims file must be provided to the examiner, including a copy of this remand. After a thorough review of the medical and lay evidence of record, the examiner should opine as to the following: A) For the Veteran's (1) obstructive airway disease, (2) dementia, and (3) hypertension, please answer the following questions for each disability: (i) Was each disability at least as likely as not proximately due to the Veteran's service-connected PTSD? (ii) Was each disability at least as likely as not aggravated, i.e., any worsening of the condition beyond its natural progression, by the Veteran's service-connected PTSD? B) Is it at least as likely as not (50 percent or greater probability) that the Veteran's service-connected PTSD, singularly or jointly with some other condition, the immediate or underlying cause of death, or was etiologically related thereto, or contributed substantially or materially to death, or aided or lent assistance to the production of death? In answering the questions, the clinician should address the evidence, including the June 2010 article submitted into evidence in May 2016 which stated that there is a link between dementia and PTSD, and the three articles submitted in August 2016 which discussed COPD and hypertension and PTSD. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean 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.