BVA9502181 DOCKET NO. 92-22 961 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: Missouri Veterans Commission ATTORNEY FOR THE BOARD J. A. McDonald, Associate Counsel INTRODUCTION The veteran served on active duty from August 1943 to April 1946. This matter comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from a rating decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri (hereinafter RO). This case was previously before the Board in March 1994, at which time it was remanded to the RO for further development. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the veteran died of a blood clot to his heart that originated in the area of the veteran's service-connected left ankle. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports the appellant's claim of entitlement to service connection for the cause of the veteran's death. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran died in March 1992, at the age of 67. 3. The veteran died from acute myocardial infarction due to or a consequence of coronary atherosclerosis and hypertension. An autopsy was not performed. 4. At the time of his death, service connection was in effect for a left ankle condition, evaluated as 40 percent disabling; gunshot wound to the left upper thigh, evaluated as 20 percent disabling; and gunshot wound to the left side of the neck, evaluated as 20 percent disabling. 5. Essential hypertension is reasonably perceived to have had origins during service. 6. The record demonstrates hypertension was a factor contributing to the veteran's demise. 7. A disability of service origin contributed substantially or materially to the veteran's death. CONCLUSIONS OF LAW 1. Hypertension was incurred in military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). 2. The veteran's death was substantially or materially contributed to by disability incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1310, 5107 (West 1991); 38 C.F.R. §§ 3.312 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Upon review of the record, the Board concludes that the appellant's claim is well-grounded within the meaning of the statute and judicial construction. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (hereinafter VA) therefore has a duty to assist the appellant in the development of facts pertinent to her claim. In this regard, the veteran's service medical records, post- service private clinical data, and VA outpatient, hospitalization, and examination reports have been included in his file. Upon review of the entire record, the Board concludes that the data currently of record provide a sufficient basis upon which to address the merits of the appellant's claim and that she has been adequately assisted in the development of her case. For a grant of service connection for the cause of death, pertinent regulations require a showing that either the fatal disease was incurred in or aggravated by service or, in some instances, was manifest to a compensable degree within one year of service discharge. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. In addition, service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). With the foregoing criteria in mind, the Board has reviewed the veteran's service medical records and all post service clinical records in light of the contentions of the appellant, and finds that the evidence is in equipoise as to the origin of the veteran's hypertension, and therefore supports the appellant's claim of entitlement to service connection for the cause of the veteran's death. Some of the facts are not in dispute. The veteran served on active duty from August 1943 to April 1946. A copy of the veteran's death certificate indicates that the immediate cause of death was acute myocardial infarction due to coronary atherosclerosis and hypertension. The veteran died in March 1992, at the age of 67. At the time of death, service connection was in effect for a left ankle condition, evaluated as 40 percent disabling; a gunshot wound to the left upper thigh, evaluated as 20 percent disabling; and a gunshot wound to the left side of the neck, evaluated as 20 percent disabling. The clinical data as reflected by the veteran's service medical records reveals on the veteran's entrance examination his blood pressure reading was 134/80 and his cardiovascular system was reported as normal. In May 1945, the veteran's blood pressure was recorded as 145/98. The veteran was discharged from military service due to his ankle disability in April 1946. Cardiovascular disease, to include coronary atherosclerosis and hypertension, was not reported. However, a VA examination conducted in November 1946 noted a blood pressure reading of 150/56. The veteran was hospitalized in February 1950 for a draining and purulent ulcer of the left ankle joint. A loud blowing systolic murmur was heard over the entire precordium and transmitted to the neck. The veteran's blood pressure was noted as 170/88. VA outpatient reports from 1948 to February 1992, document chronic draining osteomyelitis of the left ankle. In January 1986, the veteran was hospitalized for hypertension, with a systolic reading of 200, and renal insufficiency. The veteran reported that in approximately 1979, he was told his blood pressure was high and was put on medication for 6 months, which he had not needed since. The veteran further reported that in 1984, he was told that "everything [was] normal." A blood pressure reading at admission was 210/120. His cardiovascular system examination was normal, without murmurs, gallop or pericardial fricture rub. There was no pedal or sacral edema. On discharge, the veteran's blood pressure was 120/80. Further VA outpatient treatment records show that the veteran's hypertension was not adequately controlled with medication until approximately 1991. A VA outpatient treatment record in March 1992, noted the veteran's hypertension was "ok" and his chronic osteomyelitis was stable. The veteran's final hospital summary in March 1992 noted that the veteran presented with an acute inferior wall myocardial infarction. After admission, several episodes of ventricular fibrillation occurred for which cardiopulmonary resuscitation was performed, as well as the veteran being defibrillated and medicated. It was reported that he was relatively stable overnight; however, in the morning the veteran developed apnea and there was a question of a stroke with right-sided hemiparesis. He was intubated but developed electromechanical dissociation and cardiac arrest. An opinion by the VA Chief, Medical Service in December 1992, states that after review of the veteran's entire record, there is no relation between the veteran's myocardial infarction which caused his death, to the veteran's service-connected foot problem. However, it is the defined and consistently applied policy of the VA to administer the law under a broad interpretation; consistent with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, such doubt will be resolved in favor of the appellant. 38 U.S.C.A. § 5107(b). In the instant case, it is noted that efforts have been made to develop the record on appeal, with particular regard to obtaining additional blood pressure readings during the years immediately following service. As the record now stands, only a few blood pressure readings are documented during service, and for several years immediately following service. It is significant to note, however, that all readings in-service, and in 1946 and 1950 were elevated. Although a diagnosis of hypertension is not documented until many years following service, to conclude on the basis of the current record that hypertension did not have origins in service would, in the view of this Board member, be a finding that would not withstand Court scrutiny. As a case could be made for a finding at this time that the evidence is in equipoise as to whether there is a reasonable basis for concluding that hypertension had inservice origins, it is felt that to further delay reaching a final decision in this case in order to obtain a medical opinion regarding this matter would not be in the best interests of the appellant. Accordingly, hypertension, diagnosed several years post service, is not shown otherwise than to have had origins in service. 38 C.F.R. § 3.303(d). . VA regulations provide, in pertinent part, that the death of a veteran will be considered as having been due to a disability of service origin when the evidence establishes that such disability was either the principal or contributory cause of death. 38 C.F.R. § 3.312(a). A disability of service origin is considered the principal or primary cause of death "when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto." 38 C.F.R. § 3.312(b). As evidenced by the death certificate, the medical findings indicate that the veteran died of acute myocardial infarction due to or as a consequence of coronary atherosclerosis and hypertension. Service connection is therefore warranted for the cause of the veteran's death. ORDER Service connection for the cause of the veteran's death is granted. JEFF MARTIN Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.