Citation Nr: 22017969 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 18-26 071 DATE: March 27, 2022 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 United States Air Force from February 1972 to February 1976 and from February 1980 to October 1984, to include service in the Republic of Vietnam. The Veteran died in May 2016. The Appellant is the Veteran's widow. The Appellant testified at a November 2021 Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. Entitlement to service connection for the cause of the Veteran's death is remanded. Remand is required to obtain a VA examination. In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims indicated that there was a four-part test to determine whether an examination was necessary under 38 C.F.R. § 3.159(c)(4). Id. at 81. Under this test, VA will provide a medical examination or obtain a medical opinion where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence to make a decision on the claim. Id.; see also 38 C.F.R. § 3.159(c)(4). In a November 1981 service treatment record (STR), the Veteran complained of tightness and pain in the chest and the left arm. The medical provider noted the electrocardiogram (EKG) was within normal limits. On the March 1984 STR report of medical history, the Veteran indicated he experienced pain or pressure in the chest. The Veteran denied experiencing frequent or severe headaches; however, he indicated he experienced dizziness or fainting spells. On the March 1984 STR examination, the medical provider remarked that the Veteran's chest pains in 1982 were diagnosed as muscle spasms and he was treated with unknown medication. The medical provider also stated the Veteran experiences dizziness on occasion since 1981 and has not been diagnosed. The medical provider stated the dizziness is probably due to exercise. At the November 2021 Board hearing, the Appellant, a medical professional, testified that the Veteran experienced chest pain and head pain in service after an injury he incurred while playing football. T. at 3. She stated that these symptoms were not treated while the Veteran was in service. T. at 4. The Appellant asserts that the Veteran's headaches could have been early stages of strokes and that if a scan had been performed when he was first experiencing these symptoms, a diagnosis could have been found. Id. She stated that in her professional opinion, the bleeding was in relationship to the issues he was experiencing prior to having the aneurysm (hemorrhage). Id. The Appellant stated the Veteran continued to complain of headaches after separation from service. T. at 8-9. In relation to the heart disorder, the Appellant stated that the Veteran experienced chest pains. T. at 5. She recounted the Veteran complaining about not being able to sit up and would be holding his chest. Id. She stated that these are symptoms of an underlying issue. Id. The Appellant stated the Veteran continued to complain of chest pain after separation from service. T. at 8. Also, the representative contends at the Board hearing that the Veteran was awarded medals showing service in the Republic of Vietnam. T. at 5. The representative asserts that the herbicide exposure due to service in the Republic of Vietnam caused the Veteran's atrial fibrillation and may be a form of coronary artery disease or ischemic heart disease. Id. The Appellant stated the Veteran told her of walking through rice fields in Vietnam but did not disclose much of his work because he worked as a paralegal and later in his career was assigned to intelligence. T. at 6-7. Therefore, the criteria for McLendon have been met. And as a result, the Board cannot make a fully informed decision on the issue of entitlement to service connection for the cause of the Veteran's death because no VA examiner has opined whether the Veteran's in-service headaches and chest pains caused or aggravated the Veteran's cause of death. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion from an appropriate clinician to determine the nature and etiology of the factors that caused the Veteran's death. The examiner must review the claims file, including this Remand, and consider all pertinent evidence of record, to include, but not limited to, the Veteran's service treatment records, VA and private treatment records, the Appellant's assertions as a medical professional, and the Certificate of Death which lists the causes of death as atrial fibrillation, subarachnoid hemorrhage, and acute encephalopathy. The examiner must determine if the Veteran's atrial fibrillation can be characterized as ischemic heart disease. The examiner must further opine whether any diagnosed heart disorder, specifically atrial fibrillation, is at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease, to include in-service complaints of chest pain and an in-service injury incurred while the Veteran was playing football. The examiner must also provide an opinion on whether it is at least as likely as not (50 percent probability or greater) that the Veteran's subarachnoid hemorrhage is related to an in-service injury, event, or disease, to include complaints of dizziness and headaches and an in-service injury incurred while the Veteran was playing football. The VA examiner must then provide an opinion on whether it is at least as likely as not (50 percent probability or greater) that the Veteran's service-connected disabilities, either separately or in combination, Caused any of the Veteran's causes of death listed on his Certificate of Death, or Aggravated beyond its natural progression any of the Veteran's causes of death listed on his Certificate of Death. The VA examiner must also provide an opinion on whether it is as least as likely as not (50 percent probability or greater) that any incident, injury, or disease the Veteran experienced in service caused, materially contributed to, or hastened his death, to include in relation to all of the causes of death listed on his Certificate of Death. In addressing these questions, the VA examiner must specifically address all of the Appellant's contentions, specifically, that in-service headaches and dizziness are related to the subarachnoid hemorrhage and in-service chest pains are related to atrial fibrillation. If the examiner cannot provide an opinion without resorting to speculation, he or she must provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. A complete rationale must be supplied for any opinion rendered. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, 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.