Citation Nr: 21040935 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-63 036 DATE: July 7, 2021 ORDER Entitlement to service connection for cause of the Veteran's death is denied. FINDING OF FACT 1. The Veteran served on active duty in the United States Navy from June 1964 to June 1968. 2. The Veteran died in February 2016, and his death certificate lists dementia as the immediate cause of death. 3. At the time of his death, the Veteran was service-connected for posttraumatic stress disorder (PTSD). 4. The most probative evidence does not reflect that the cause of the Veteran's death is etiologically related to service, to include as secondary to a service-connected disability. CONCLUSION OF LAW The criteria to establish service connection for the cause of the Veteran's death are not met. 38 U.S.C. §§ 1310, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.312 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION To establish service connection for the cause of a veteran's death under the relevant laws and regulations, the evidence must show that a disability incurred in or aggravated by active service either caused or contributed substantially or materially to cause death. For a service-connected disability to be the cause of death, it must singly or with some other condition be the immediate cause or underlying cause, or be etiologically related. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death, but, rather, a causal connection must be shown. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. The basic facts are not in dispute. The Veteran died in February 2016 at the age of 69. His immediate cause of death was listed as dementia and there were no other significant conditions contributing to death. At the time of his death, he was service-connected for PTSD at a rating of 100 percent. The appellant contends that the Veteran's death stems from his service-connected PTSD. Turning first to the issue of whether the cause of the Veteran's death is related to service, service treatment records (STRs) do not show treatment or diagnosis related to dementia or neurocognitive problems during service. Such conditions were not shown until approximately 2012, decades after his separation from active duty in 1968. Further, a January 2020 VA physician found it less likely than not that dementia was incurred in or caused by service. The physician explained that there was no evidence of mental health or neurocognitive problems during service. In addition, neurocognitive problems were not diagnosed until 2012. Therefore, the disorder that caused his death was not directly related to service. Next, the appellant's primary contention is that the Veteran's service-connected PTSD led to dementia, which was the ultimate cause of his death. Weighing against the claim, a January 2020 VA examiner found it less likely than not that that dementia was proximately due to or the result of service-connected PTSD. He explained that dementia was not related to PTSD as either a means of coping with the disorder or as a psychological reaction. Instead, the physician reflected that dementia was a separate entity entirely from PTSD and was unrelated. Accordingly, the clinician opined that there was no nexus between the dementia and PTSD. In support of the above-recounted opinion, the physician referenced multiple medical studies on the relationship between dementia and PTSD. Specifically, the clinician addressed the medical article submitted by the appellant which reported increased risk of developing dementia in individuals with PTSD. The physician explained that while there were certain risk factors for the development of dementia, a cause and effect relationship did not exist. As such, it was opined that it was less likely than not that dementia, which caused his death, was caused by service-connected PTSD. The clinician also concluded that PTSD was not a principal or contributory cause of death and was not an underlying cause of death because there was no cause and effect relationship between PTSD and dementia. In addition, the clinician found that PTSD did not contribute substantially or materially to dementia. Further, the same physician opined it was less likely as not that dementia was aggravated beyond its natural progression by service-connected PTSD. As rationale, the clinician explained that dementia was a progressive neurological condition with no known cure. As such, the clinician concluded that dementia was not aggravated beyond its natural progression by service-connected PTSD. The Board has considered the lay statements and testimony offered by the appellant. Lay witnesses are competent to report their observations because this requires only personal knowledge as it comes to them through their senses. They are not competent to provide a complex medical opinion regarding issues such as the cause of the Veteran's death. Such competent evidence concerning the cause of the Veteran's death has been provided by the medical personnel who have rendered pertinent opinions during the current appeal. The medical findings (as provided in the clinical records) directly address the criteria under which the issue is evaluated. Accordingly, the Board attaches greater probative weight to the clinical findings than to the lay statements and testimony that have been submitted. Bloom v. West, 12 Vet. App. 185, 187 (1999); Black v. Brown, 10 Vet. App. 297, 284 (1997). In sum, the weight of the evidence does not establish that the cause of the Veteran's death was related to service, to include as due to service-connected PTSD. For these reasons, the appeal is denied and there is no doubt to be otherwise resolved. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.