Citation Nr: 22018922 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 18-15 169 DATE: March 30, 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 from February 1951 to December 1952. He died in April 2016 and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2017 by a Department of Veterans Affairs (VA) Regional Office. In August 2021, the appellant and her niece testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In December 2021, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for the cause of the Veteran's death. As noted in the December 2021 remand, the Veteran's original certificate of death, which was completed in May 2016, lists his causes of death as lung cancer and chronic obstructive pulmonary disease (COPD), with hypertension as a contributing condition, and the amended certificate of death, which was completed in August 2017, includes degenerative arthritis as an additional contributing condition. During his lifetime, the Veteran was service-connected for the sole disability of traumatic arthritis of the left ankle due to a gunshot wound. At such time, it was also observed that the appellant asserted that the Veteran's service-connected traumatic arthritis of the left ankle progressed over the years into degenerative arthritis, which was listed on the amended certificate of death as a contributory cause of death. Alternatively, she contends that the Veteran's hypertension, which was listed on his certificate of death as a contributory cause of death, had its onset in service as evidenced by elevated in-service blood pressure readings or, in the alternative, was caused or aggravated by psychiatric symptomatology related to his combat service or alcohol use due to chronic pain associated with his service-connected left ankle disability. Thus, in light of the advancement of such theories of entitlement, the Board remanded the case in order to obtain an opinion addressing the cause of the Veteran's death. Thereafter, in February 2022, a VA examiner reviewed the record and stated that the medical record and service treatment records (STRs) show no evidence of the diagnosis, treatment, or symptoms suggestive of hypertension, or that the Veteran met the [Joint National Committee (JNC)] criteria for a diagnosis of hypertension while on active duty or within one year of separation from military service. He further opined that it was less as likely as not that the Veteran's service-connected traumatic arthritis of the left ankle substantially or materially contributed to death, combined to cause death, aided or lent assistance to the production of death, or caused debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. However, the Board finds such opinion is inadequate to decide the claim. In this regard, the post-service medical record does contain diagnoses of hypertension, and the Veteran's STRs contain at least one notation, in December 1951, of an elevated blood pressure reading of 140/80. Furthermore, the examiner did not address whether the Veteran's hypertension was caused or aggravated by psychiatric symptomatology related to his combat service and/or alcohol use due to chronic pain associated with his service-connected left ankle disability, or whether service-connected left ankle traumatic arthritis progressed to degenerative arthritis, which is listed as a contributory cause of death on the amended certificate of death, as requested in the December 2021 Remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Therefore, the Board finds that another remand is necessary in order to ensure substantial compliance with the prior remand directives and obtain an addendum opinion that adequately addresses the matter at issue. The matters are REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate clinician, other than the February 2022 examiner, for an opinion addressing the cause of the Veteran's death. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not that the Veteran's hypertension, which is listed as a contributory cause of death on the certificate of death, had its onset in, or is otherwise related to, his military service, to include as a result of reported in-service elevated blood pressure readings, or was caused or aggravated by psychiatric symptomatology related to his combat service and/or alcohol use due to chronic pain associated with his service-connected left ankle disability? (B) If not, is it at least as likely as not that a disability of service origin, to include traumatic arthritis of the left ankle due to a gunshot wound, was the immediate or underlying cause of the Veteran's death or etiologically related thereto, contributed substantially or materially to the cause of his death, combined to cause death, or aided or lent assistance to the production of death? In offering an opinion in response to (B), the clinician must specifically address whether the Veteran's service-connected left ankle traumatic arthritis progressed to degenerative arthritis, which is listed as a contributory cause of death on the amended certificate of death. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly, 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.