Citation Nr: 25005506 Decision Date: 04/23/25 Archive Date: 04/23/25 DOCKET NO. 15-25 473 DATE: April 23, 2025 ORDER Entitlement to service connection for cause of death (COD) is denied. FINDINGS OF FACT 1. The Veteran died in November 2011; the cause of death was gunshot wound to the head (suicide). 2. At the time of his death, the Veteran was service connected for bilateral hearing loss and tinnitus. 3. The Veteran's suicide did not manifest in service, and it was not otherwise etiologically related to service. CONCLUSION OF LAW The criteria for service connection for COD have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 1310, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.303, 3.307, 3.309, 3.311, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1967 to September 1971. The Veteran passed away in November 2011 and his surviving spouse has been properly substituted as Appellant. Service connection for the cause of the Veteran's death may be granted if a disability incurred in or aggravated by service was either the principle or a contributory cause of the Veteran's death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (a); see also 38 U.S.C.§ 1110; 38 C.F.R. § 3.303. For a service-connected disability to be the principle cause of death it must singly or with some other condition be the immediate or underlying cause or be etiologically related. 38 C.F.R. § 3.312 (b). For a service-connected disability to be a contributory cause of death it must have contributed substantially or materially and combined to cause death. 38 U.S.C. §1310; 38 C.F.R. § 3.312 (c)(1). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually 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 disease or injury primarily causing death. 38 C.F.R. § 3.312 (c)(3). Entitlement to service connection for cause of death The Appellant contends that the Veteran's reduction in bipolar medication by VA led to his death. The Veteran died in October 2011. The death certificate documented the immediate cause of death as gunshot wound to head. There are no other conditions listed as causing or contributing to the Veteran's death. The Board finds the cause of death is accurately reflected on the death certificate, as there is no definitive evidence that it is inaccurate. At the time of his death, the Veteran was service-connected bilateral hearing loss and tinnitus. In addition, there is no evidence of a claim for service connection for gunshot wound to head, or any other disability. The Veteran's service treatment records are silent for any complaints, treatment or diagnosis of a gunshot wound to head or related problems. The records are also devoid of any mention of suicide or any related symptoms. In a June 2013 statement in support of claim, the Appellant indicated that the Veteran was taken off all bipolar medications, that he was misdiagnosed, the Appellant's pleas were dismissed and that as a result the Veteran's condition he deteriorated and committed suicide. In a June 2014 VA medical opinion, the physician stated the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. The doctor noted the Appellant was claiming that the Veteran's death was due to VAMC negligence. To address this issue the entire electronic medical record as well as the C-file was reviewed. The death certificate, in particular the Supplemental Report of Cause of Death on February 1, 2012, clearly indicates that the cause of death was suicide by a contact type gunshot wound to the head. The examiner opined that it was less likely than not that the Veteran's suicide was caused by or became worse as a result of VA treatment, or resulted from carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel. The rationale provide was: ... His most recent treatment note in Mental Health on 10/13/2011 notes that the Veteran at his previous visit (7/11/2011) had complained of feeling oversedated and in response his psychiatrist lowered the dose of several medications. In the October visit he complained of being a "nervous wreck" and related this to the pressure of his wife's recent surgery "I'm not in a good place, more nervous that I've ever been before. I'm under too much pressure since my wife had surgery in August. I'm responsible for everything now. I'm not doing well." In response his psychiatrist performed a complete examination including history, mental status examination and suicide risk assessment. The Veteran denied being suicidal. He did appear anxious and the psychiatrist's assessment was that his mood disorder was "actually reasonably well controlled but his anxiety is intolerable." In response he INCREASED his anxiolytic medication and maintained him on the same doses of his sleeping medicine and antidepressant and antianxiety medication venlafaxine. He then scheduled the Veteran for close follow-up in 6-8 weeks. Unfortunately, in the interim the Veteran committed suicide. At his previous Mental Health visit in July 2011 it was the Veteran who discontinued the antipsychotic and mood stabilizing medication risperidone. He continued his other medications though at lower doses complaining of sedation. There are multiple notes where the wife's concerns were heard by his providers either through a message the Veteran brought (12/28/2008) or where the providers spoke directly with his wife by phone (12/10/2010). Family was appropriately included in his care. Finally, while earlier notes from circa 2005 entertained a "rule out" diagnosis of bipolar disorder this was never conclusively diagnosed. Whether at Asheville VAMC or the Franklin CBOC his most consistent diagnosis was either Mood Disorder Not Otherwise Specified (NOS) or Depressive Disorder NOS. His nonservice connected disability for pension purposes was Depression NOS not bipolar disorder. There was no confusion of misdiagnosis among his treatment providers or locations. From a thorough review of the chart a Mood NOS diagnosis considering the inconclusive possiblity of bipolar depression was appropriate and his subsequent psychopharm treatment was appropriate. Rationale: There is no evidence for carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel. There is no evidence that his suicide could have reasonably been foreseen by a reasonable healthcare provider and at his last Mental Health visit he was properly assessed for suicide risk and treated for anxiety. There was no failure on the part of the VA to timely diagnose and/or properly treat the claimed disease or disability. The acute progression could not have been reasonably forseen as was most likely a result of acute life stressors rather than a progression of his depressive illness or lack of psychiatric care. Conclusion: Based upon a review of the claims folder including the cited VA record it is therefore it is my opinion to a reasonable degree of medical certainty that the Veteran's suicide was NOT caused by or a result of or became worse as a result of VA treatment. After sympathetic and careful consideration of the evidence of record, to include the contentions and evidence cited in the lay statements, the Board finds that service connection for the cause of the Veteran's death is not warranted. In regard to a nexus, the Board initially notes that the Appellant is not competent to render a medical opinion in this case. The issue of cause of death presents a complex medical question requiring the opinion of a medical professional. The Board finds that linking cause of death to service or a service-connected disability is an inherently complex medical question not capable of lay observation and is not the type of medical issue for which a lay opinion may be accepted as competent evidence. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011); see also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge). Accordingly, the Appellant's beliefs that service connection for cause of death are not competent or probative evidence supporting the claim. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, a VA medical opinion was obtained, and the Board finds it both competent and probative and ultimately dispositive in this case. The evidence indicates that the Veteran's cause of death was not present in or related to service, nor is there any indication that his service-connected bilateral hearing loss and tinnitus played any role in his death by suicide. Based on the foregoing, the Board finds that the evidence of record weighs against a finding of a possible relationship between the cause of death listed on the death certificate and active-duty service and/or any VAMC negligence. In sum, the Board finds that the evidence of record is against the Appellant's claim for service connection for cause of death and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elliott, Robert A. 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.