Citation Nr: 22016506 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 17-02 706 DATE: March 22, 2022 ORDER New and material evidence has been submitted to re-open a claim for entitlement to service connection for deep vein thrombosis and blood clot of the right lower extremity. Entitlement to service connection for deep vein thrombosis and blood clot of the right lower extremity is granted. FINDINGS OF FACT 1. The December 2010 rating decision that denied the Veteran's claim for blood clots was not appealed, nor was new and material evidence received during the appeal period; however, evidence received since the final December 2010 rating decision is new and raises a reasonable possibility of substantiating the claim. 2. Resolving reasonable doubt in the appellant's favor, the Veteran's deep vein thrombosis and blood clot of the right lower extremity is at least as likely as not related to service-connected prostate cancer. CONCLUSIONS OF LAW 1. The December 2010 rating decision that denied the Veteran's claim for entitlement to service connection for deep vein thrombosis and blood clot of the right lower extremity is final; however, new and material evidence has been received and, as such, the claim is reopened. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. The criteria for service connection for deep vein thrombosis and blood clot of the right lower extremity are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is the Veteran's surviving spouse. The Veteran died in December 2018. In an April 2020 letter, the AOJ notified the appellant that she was formally recognized as a substitute claimant in the Veteran's appeal. New and Material Evidence A claimant may reopen a finally adjudicated claim by submitting new and material evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. The threshold to reopen a claim is low and does not require new and material evidence regarding each element of the claim that was not proved in the prior decision. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The Veteran filed an original claim for service connection for blood clotting in June 2010 that was denied in a December 2010 rating decision. The Veteran did not appeal or submit additional evidence within the appeal period and, accordingly, the December 2010 decision became final. In February 2015, the Veteran filed a petition to reopen the claim for blood clots. New evidence submitted since the final December 2010 decision includes February 2017 and October 2021 private medical opinions linking his blood clots to service-connected prostate cancer. For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). This evidence is new and material, is neither cumulative nor redundant of the evidence previously of record, is presumed credible, and raises a reasonable possibility of substantiating the claim, particularly the nexus element. Accordingly, the claim is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. Service Connection The appellant contends that the Veteran's deep vein thrombosis and blood clot of the right lower extremity is related to service-connected prostate cancer. The Board concludes that the Veteran had deep vein thrombosis and blood clot of the right lower extremity during the pendency of the appeal that is related to service-connected prostate cancer. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Private treatment records and a July 2015 VA examination show the Veteran had a diagnosis of deep vein thrombosis and blood clot of the right lower extremity during the pendency of the appeal. Thus, the question becomes whether the current disability is related to service-connected disability. By way of history, service connection for prostate cancer was in effect prior to the Veteran's death. On June 20, 2005, the Veteran underwent a prostate biopsy. On June 22, 2005, he was admitted to the emergency room and transferred to the intensive care unit with probable sepsis. A triple lumen catheter was placed in his right femoral vein, and he recovered uneventfully. On July 1, 2005, private treatment records noted that he was admitted with right lower extremity deep venous thrombosis, with multiple risk factors including recent immobility and a triple-lumen catheter. Private treatment records indicate that the Veteran continued to experience intermittent clotting of the right lower extremity thereafter, to include in February 2012. There are probative opinions in favor of and against the claim. The evidence against the claim includes July 2015 and December 2016 VA examinations that determined that the Veteran's deep vein thrombosis were most likely caused by Factor V Leiden, an abnormal gene resulting in a higher risk of blood clots. In determining that the Veteran's deep vein thrombosis was not proximately due to prostate cancer, the July 2015 and December 2016 VA examiner indicated that it was due to the Veteran's Factor V Leiden gene abnormality. The rationale was that the Veteran's mother had a history of deep vein thrombosis with Leiden Factor deficiency and the Veteran's blood clot coincidentally happened at the time of treatment with a triple lumen catheter that was used to treat his sepsis infection. The evidence in favor of the claim includes February 2017 and October 2021 private opinions by Dr. S.M., Dr. B.N., and Dr. R.M. that determined the Veteran's deep vein thrombosis was at least as likely as not a result of a complication related to the biopsy performed for service-connected prostate cancer. In February 2017, Dr. S.M. and Dr. B.N. collectively stated that given that the insertion of a central venous catheter is known to be one of the causes of clotting, the timing of the clots (the clots appeared less than 24 hours from catheter removal), the location of the clots (the right leg femoral vein, exactly where the catheter was inserted), and that the Veteran never experienced any clotting issues before the biopsy, it was reasonable to assume that his deep vein thrombosis was caused by the trauma of the catheter used to treat an infection resulting from a prostate cancer biopsy. Additionally, the doctors stated that the Veteran inherited only one copy (heterozygous) of the Factor V Deficiency, which carries less than a 1 percent chance of contributing to the development of a clot. It was noted that this is quite different from the two copy gene (homozygous) which carries a much greater risk. In October 2021, Dr. R.M. stated that medical notes indicate the trauma from the insertion and removal of the peripherally inserted central catheter (PICC) line caused the blood clots. He recited the Veteran's medical history and cited to a medical study noting that thrombosis was a major type of complication from PICC lines. Additionally, he opined that the timeline of events that led to the blood clots, in addition to the aforementioned medical literature is compelling and, as such, the condition was at least as likely as not a result of a biopsy performed for prostate cancer. The Board finds that the VA and private medical opinions contain probative value. The VA opinions are probative as they are based on review of the Veteran's medical history, records, and a clinical examination. The private treatment records are based on the Veteran's medical history, medical record, lay statements, medical literature, and/or clinical treatment of the Veteran. The opinions contain sufficient supporting rationales. Accordingly, the Board finds the medical record, as it stands, is sufficient to make an informed decision on the appeal. In sum, the record contains well-reasoned, probative medical opinions both for and against the claim. The VA opinions indicate that the Veteran's deep vein thrombosis and blood clots of the right leg are due to a gene abnormality. In contrast, the private opinions indicate that though the Veteran had a gene abnormality, he inherited only one copy of the gene which carries a less than 1 percent chance of clot development and, given the circumstances of how the clots developed, the Veteran's deep vein thrombosis and blood clots of the right lower extremity are at least as likely as not related to service-connected prostate cancer. Additionally, the medical evidence and the Veteran's lay statements indicate that the Veteran did not have blood clots or deep vein thrombosis prior to the June 2005 prostate biopsy. For these reasons, the Board finds that the evidence is solidly in equipoise on whether the Veteran's deep vein thrombosis and blood clot of the right lower extremity is related to service-connected prostate cancer. The claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When the evidence supports the claim or is in relative equipoise, the claim will be granted. Gilbert v. Derwinski, 1 Vet. App. 49, 54-55 (1990); see Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for deep vein thrombosis and blood clot of the right lower extremity is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Vang, 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.