Citation Nr: 22012887
Decision Date: 03/07/22	Archive Date: 03/07/22

DOCKET NO. 19-22 429A
DATE: March 7, 2022

ORDER

Service connection for the cause of the Veteran's death is granted.

FINDING OF FACT

With resolution of the factual doubt in the Appellant's favor, the Veteran's service-connected posttraumatic stress disorder (PTSD) contributed to his death.

CONCLUSION OF LAW

The criteria to establish service connection for the cause of the Veteran's death have been met. 38 U.S.C. § 1311; 38 C.F.R. § 3.312.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from December 1950 to November 1953. He died in 2017, and the Appellant is the Veteran's surviving spouse.

Service connection for the cause of the Veteran's death

In a claim of service connection for a veteran's cause of death, i.e., Dependency and Indemnity Compensation (DIC), evidence must be presented that links the death to a period of military service or to an already service-connected disability. 38 U.S.C. §§ 1110, 1310; 38 C.F.R. §§ 3.303, 3.312. 

For disabilities already service-connected at the time of death, the evidence must show that the disability was either the principal or contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. For a disability to be the "principal" cause of death, it must singularly or jointly with some other condition be the immediate or underlying cause of death or be etiologically related thereto. 38 C.F.R. § 3.312(b). For a disability to be a "contributory" cause of death, it must be shown that it contributed substantially or materially, that it combined to cause death, or aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c). 

In deciding claims, the Board evaluates the entire record on appeal. 38 U.S.C. § 7104 (a). When the evidence fully supports the claim, it will be granted. When the evidence for and against the claim is approximately balanced, The Board resolves any reasonable doubt in the Veteran's favor and grant the claim. When the evidence is not approximately balanced, there is no reasonable doubt to resolve and the claim will be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3rd 1391 (2021).

The Appellant contends that the Veteran's service-connected PTSD directly or substantially contributed to the Veteran's death. The Veteran's mental disorder was service connected effective in March 2000, and a 100 percent evaluation was assigned effective December 2010. 

According to the death certificate, the immediate cause of the Veteran's death was end stage dementia. However, in 2018, the Appellant submitted an amended death certificate listing PTSD as a significant condition "contributing to death but not resulting in the underlying cause of death." 

June 2017 VA hospice records noted "multiple disease processes" including dementia, diabetes mellitus type II (DM), gastroesophageal reflux disease (GERD), acute kidney injury (AKI), and frequent urinary tract infections (UTI). These records also noted severe dysphagia (difficulty swallowing), weight loss, weakness, "generalized pain," and altered mental status (AMS).

VA obtained several medical opinions about the relationship between the Veteran's PTSD and his dementia. In substance, they indicate no causal or worsening relationship.

However, in a May 2020 report, a private physician cited peer-reviewed medical literature suggesting a "strong clinical correlation" between PTSD and degenerative dementia. He cited studies that found veterans with PTSD or major depressive disorder have a significantly greater risk of developing dementia. The physician also cited medical literature suggesting that PTSD and sleep impairment changes the structure of the brain and these changes may weaken the body's defenses against dementia. The physician opined that the Veteran's PTSD was  clinically correlated to his degenerative dementia, and concluded PTSD directly caused the Veteran's death.

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The undersigned has reviewed the medical literature provided by the private physician. When compared with the Veteran's medical history, the evidence at least approximates balance to the point where the Board finds PTSD was a contributory cause of the Veteran's death. 

The finding of a contributory cause is sufficient to grant the benefit, and the appeal is allowed. 

 

 

Vito A. Clementi

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Hiaasen

The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.