Citation Nr: 23018317 Decision Date: 03/23/23 Archive Date: 03/23/23 DOCKET NO. 15-12 678 DATE: March 23, 2023 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 Army from March 1970 to December 1971. He served in the Republic of Vietnam and received the Combat Infantryman Badge. He died in January 2009, and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The appellant presented testimony at a Board videoconference hearing before a Veterans Law Judge (VLJ) who is no longer employed by the Board in October 2019; a transcript of the hearing is associated with the record. In December 2019, the Board remanded the matter of entitlement to service connection for the cause of the Veteran's death to the Agency of Original Jurisdiction (AOJ) for additional development. An August 2020 Board decision denied service connection for the cause of the Veteran's death. The appellant appealed the August 2020 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a May 2021 order, which incorporated the parties' May 2021 Joint Motion for Remand (JMR), the Court vacated and remanded the matter to the Board. In March 2023, the appellant indicated she did not wish to appear at another Board hearing before another VLJ. Entitlement to service connection for the cause of the Veteran's death. The Board sincerely regrets additional delay, but based on the parties' May 2021 JMR and a reevaluation of the evidence, the Board finds a remand is required to obtain an adequate medical opinion. The appellant contends the Veteran's service-connected posttraumatic stress disorder (PTSD) with depression and alcohol dependence caused his death. An April 2009 supplemental report of cause of death listed methadone toxicity as the immediate cause of the Veteran's death. At the time of his death, the Veteran's only service-connected disability was the PTSD with depression and alcohol dependence. In February 2020, a VA examiner opined it was less likely as not that the Veteran's PTSD or related medication was a principal or contributory factor in the Veteran's death. The examiner reasoned that the medical records showed his death was due to methadone toxicity and that the methadone was prescribed for back pain, not PTSD. As noted in the parties' JMR, the appellant raised the contention that the Veteran's PTSD with depression and alcohol dependence in remission caused him to overdose, either intentionally or unintentionally, on his medications. The February 2020 VA examiner noted the Veteran had a history of medication misuse prior to his death, but did not address whether the Veteran's PTSD caused him to misuse medication and contributed to his death as a result. Accordingly, the February 2020 opinion is inadequate, and remand to secure an adequate opinion is necessary. In addition, the April 2009 supplemental report of cause of death indicates an autopsy of the Veteran's body was performed, but the full autopsy report is not associated with the claims file. On remand, reasonable efforts should be undertaken to obtain a copy of the autopsy report. The matter is REMANDED for the following action: 1. Obtain a copy of the Veteran's autopsy report and associate it with the claims file. To expedite this action, the appellant is encouraged to submit the report if it is in her possession. 2. Thereafter, obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's PTSD was a principal or a contributory cause of death. The claims file should be made available and reviewed by the examiner. The examiner should also have available for review the 38 C.F.R. § 3.312(c) definitions of principal cause of death and contributory cause of death. Following consideration of the evidence of record (both lay and medical), the examiner is asked to address the following: Is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's PTSD with depression and alcohol dependence caused or contributed (contributed substantially or materially; combined to cause death; aided or lent assistance to the production of death) to the Veteran's death? In addressing the above, the examiner should address whether the PTSD with depression and alcohol dependence caused him to overdose, either intentionally or unintentionally, on his medications, resulting in the methadone toxicity that immediately caused his death. The examiner must explain the rationale for all opinions. Colleen M. Glaser-Allen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board William A. Skowronski, 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.