Citation Nr: 22019693 Decision Date: 04/02/22 Archive Date: 04/02/22 DOCKET NO. 17-57 873 DATE: April 2, 2022 ORDER Service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The Veteran's death certificate reflects that he died in May 2017 with the cause of death listed as cardiopulmonary arrest, due to or a consequence of primary pancreatic carcinoma. 2. A disability of service origin did not cause or contribute to the Veteran's death. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran's death have not been met. 38 U.S.C. §§ 1310, 5107; 38 C.F.R. §§ 3.102, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from January 1969 to August 1970, including service in the Republic of Vietnam. He died in May 2017, 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 August 2017 by a Department of Veterans Affairs (VA) Regional Office. It was previously before the Board in August 2019 and June 2020, at which times it was remanded for further development. The Board finds that there has been substantial compliance with its remand orders, and further appellate review is appropriate. See Stegall v. West, 11 Vet. App 268 (1998) (Board remand confers a right on a claimant to compliance with the remand order). Regarding Stegall, the Board notes that in March 2021, the Appellant's representative sent a letter arguing that the VA failed to obtain certain requested medical records pursuant to the June 2020 remand, prior to a November 2020 addendum opinion. However, the Board must note that the outstanding medical records were added to the Veteran's file in October 2020, the same day that the request for the addendum opinion was made, and thus were part of the file at the time of the November 2020 opinion. Thus, the Board finds that there was no Stegall violation regarding private records. The appellant contends the Veteran's death from cardiopulmonary arrest was due ischemic heart disease (IHD), which developed due to the Veteran's in-service herbicide exposure while serving in Vietnam, thus warranting service connection. A veteran who, during active service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to certain herbicide agents, including an herbicide commonly referred to as Agent Orange. 38 U.S.C. § 1116 (f). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases (to include IHD) shall be service-connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). Service connection for the cause of a veteran's death may be granted if a disability incurred in or aggravated by service was either the principal or contributory cause of the veteran's death. 38 U.S.C. §§ 1110, 1310; 38 C.F.R. §§ 3.303, 3.312(a). For a service-connected disability to be the principal cause of death, it must singly 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). A contributory cause of death is inherently one not related to the principal cause. For a service-connected disability to be a contributory cause of death, it must have contributed substantially or materially; combined to cause death; aided or lent assistance to the production of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312(c)(1). It is not sufficient to show that it causally shared in producing death, but rather it must be shown that there was a causal connection. Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other diseases or injuries primarily causing death. 38 C.F.R. § 3.312(c)(3). The Veteran's death certificate reflects that he died in May 2017 with the immediate cause of death listed as cardiopulmonary arrest, due to or as a consequence of primary pancreatic carcinoma. At the time of his death, the Veteran was service-connected for prostate cancer and associated erectile dysfunction. In connection with the appellant's claim, and as noted supra, a VA medical opinion was obtained in November 2020. The examiner was asked at that time to identify all chronic cardiac disabilities, and to explain whether such was a form of IHD. For any disability that was not a form of IHD, the examiner was asked to discuss whether such had its onset in, or was otherwise related to, service, to include exposure to herbicide agents. The examiner was instructed to provide an opinion as to whether any cardiac disabilities caused or substantially to the Veteran's death. In his report, the examiner concluded that the Veteran did not have any form of IHD at the time of his death, and thus there was no appreciable contribution to his fatal cardiopulmonary arrest. He noted a March 2017 echocardiogram which showed normal left ventricular systolic function and an EKG with normal rhythm. Such results were not indicative of IHD. The examiner noted that the Veteran's only cardiac conditions were hypertension and hyperlipidemia, which were not a form of IHD and which did not develop due to service. Rather, the examiner explained in detail that rather than the Veteran's service causing cardiopulmonary arrest, it was in fact the Veteran's metastatic pancreatic cancer that caused the fatal heart attack. He noted that the certificate of death, as written, supported such a finding and concluded that the Veteran died of cardiopulmonary arrest secondary to cancer. The Board notes that, in an August 2019 decision, it found no link between the Veteran's pancreatic cancer and service, and denied service connection. The Board affords great probative weight to the November 2020 VA examiner's opinion as she considered all pertinent evidence of record, to include the Veteran's relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board has considered the appellant's assertions that the Veteran's death is related to his in-service exposure to herbicide agents; however, as she is a lay person, she does not possess the requisite training and experience necessary to address such complex medical matters. Specifically, such inquiries involve medical subjects concerning an internal physical process extending beyond an immediately observable cause and effect. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the cause of the Veteran's death, such falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the appellant's opinion as to the cause of the Veteran's death is not competent evidence and, consequently, is afforded no probative weight. Therefore, based on the foregoing, the Board finds that a disability of service origin did not cause or contribute to the Veteran's death. As such, service connection for the cause of the Veteran's death is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the evidence is persuasively against the appellant's claim of entitlement to service connection for the cause of the Veteran's death and that doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The claim is denied. JEREMY J. OLSEN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hetman 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.