Citation Nr: 25004487 Decision Date: 04/02/25 Archive Date: 04/02/25 DOCKET NO. 18-02 800 DATE: April 2, 2025 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 May 1976 to May 1996. He died in August 2013. The appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) from a January 2017 rating decision by the Agency of Original Jurisdiction (AOJ). In October 2021, the Board denied the claim. The appellant appealed the Board's decision to the U.S. Court of Appeals for Veterans Claims (Court). In December 2022, the Court granted the parties' Joint Motion for Remand (JMR), vacating the Board's decision and remanding the case for action consistent with the terms of the JMR. Thereafter, the case was remanded by the Board in May 2023 and October 2024 for additional evidentiary development. The claim is back before the Board for further appellate proceedings. However, the Board finds that further evidentiary development is necessary, and an additional remand is required. The appellant seeks service connection for the Veteran's cause of death. To grant service connection for the cause of a veteran's death, it must be shown that a service-connected disability caused the death, or substantially or materially contributed to it. A service-connected disability is one which was incurred in or aggravated by active service, one which may be presumed to have been incurred during such service, or one which was due to or the result of a service- connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In October 2024, the Board directed the AOJ to obtain an adequate opinion regarding the cause of the Veteran's death. See October 2024 Board remand directives. Accordingly, an October 2024 VA medical opinion was produced. The October 2024 VA clinician initially provided a negative nexus opinion, concluding that the "[c]ause of the Veteran's death was less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by (the) military duties during service. The [Veteran's] death was due to [myocardial infarction]. The death was likely due to [his] lifestyle and choices of health. The [V]eteran was a chronic smoker, abused alcohol, and was on chronic narcotic use. The [Veteran's] lifestyle was what led to the [his] demise from [myocardial infarction]. The service nor conditions of service had any potential to be the causation of [his] death. There is no nexus." See October 2024 VA medical opinion. However, when providing a statement regarding the conflicting medical evidence of record, the clinician provided a confusing, and contradictory opinion. First, she appears to provide a positive nexus opinion, stating that "it is my medical opinion that a disability related to the Veteran's period of active service aided or lent assistance to the production of his death." Namely, hypertension-which was noted to have been diagnosed in the Veteran since the 1970s. However, she goes on to contradict this statement and repeats her prior position that the cause the Veteran's fatal myocardial infraction is more likely his long smoking history, alcohol abuse, and narcotic use. Thereafter, she opines that the Veteran's "[hypertension] may have been a small contributor to the cause of death." See October 2024 VA medical opinion (emphasis added). Nevertheless, she ultimately concluded the opinion with the statement that the Veteran's hypertension is "not likely the cause of [his] death." Id. Medical opinions must contain clear conclusions with supporting data and a reasoned medical rationale. An adequate rationale must be provided for any medical opinion rendered; a conclusory, contradictory or incomplete analysis is not adequate. Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007). Here, the October 2024 VA clinician's opinions contain contradictory information and rationale and are therefore inadequate. Either the Veteran's diagnosed hypertension did or did not contribute to his death; however, the clinician does not provide a definitive response to this question. The opinions and supporting rationale are contradictory and lack a clear conclusion. Thus, remand is warranted to obtain an adequate opinion regarding the Veteran's cause of death. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (noting that once VA undertakes an examination, an adequate one must be produced). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriately qualified clinician to determine the etiology of the Veteran's cause of death. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. After the record review, the reviewing clinician is asked to respond to the following: Is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that a disability related to the Veteran's period of active service was the immediate or underlying cause of his death, contributed substantially or materially to the cause of his death, combined to cause his death, or aided or lent assistance to the production of his death? In considering these questions, the reviewing clinician shall specifically address the January 1990 Army Health Risk Appraisal noting that "hypertension (high blood pressure) is too serious condition to be treated lightly. Be sure to monitor your blood pressure regularly and follow your doctor's suggestions concerning medication, exercise, diet, weight control, etc.". The reviewing clinician is also directed to specifically address blood pressure readings as discussed in the March 2023 Appellate Brief. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) ? 2. Thereafter, readjudicate the claim. If any benefit sought remains denied, provide the appellant with a Supplemental Statement of the Case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Poe, 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.