Citation Nr: 0004953 Decision Date: 02/25/00 Archive Date: 03/07/00 DOCKET NO. 98-02 996 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Hancock, Counsel INTRODUCTION The veteran had active service from May 1941 to June 1945. He died in September 1997. This matter comes before the Board of Veterans' Appeals (Board) from an October 1997 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina denying, in pertinent part, the veteran's claim of entitlement to service connection for the cause of the veteran's death. The appellant was afforded a personal hearing before a local hearing officer in November 1998. FINDINGS OF FACT 1. During the veteran's lifetime, service connection had been established for neurodermatitis, tinea pedis, and appendectomy scar. 2. The veteran's death certificate shows he died in September 1997 of osteomyelitis of the right foot, due to, or as a consequence of, peripheral vascular disease and arteriosclerotic cardiovascular disease. Congestive heart failure secondary to high blood pressure and/or ischemia was listed as a significant condition contributing to death but not resulting in the underlying cause. 3. An addendum to the terminal hospital records, dated following the date in which the death certificate was signed, listed the discharge diagnoses as: congestive heart failure, peripheral vascular disease, osteomyelitis of the right great metatarsal bone, benign prostatic hypertrophy with prostatitis, urinary tract infections due to Enterococcus and Escherichia, and recurrent ileus. 4. There is no medical evidence of record that demonstrates that the veteran's death was caused by a disability of service origin, or that a disability of service origin substantially or materially contributed to the veteran's death. CONCLUSION OF LAW The claim of entitlement to service connection for the cause of the veteran's death is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such a disability was either the principal or contributory cause of death. 38 U.S.C.A. § 1310 (West 1991). A service-connected disorder is one that was incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). However, before reviewing the merits of any claim, the initial question that must be considered is whether the appellant has presented a well-grounded claim. A well- grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. In this regard, the appellant has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). For the appellant's claim for service connection for the cause of the veteran's death to be well grounded, the disability that caused the veteran's death must be shown to have been related to the veteran's period of service. There must be competent evidence of a nexus or relationship between the inservice injury or disease and the veteran's death. The nexus or relationship must be shown by medical evidence. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir 1997). In this case, the death certificate, shown to have been signed on September 11, 1997, shows that the immediate cause of the veteran's death was osteomyelitis of the right foot, due to, or as a consequence of, peripheral vascular disease and arteriosclerotic cardiovascular disease. The death certificate further lists congestive heart failure secondary to high blood pressure and/or ischemia as another significant condition that contributed to death but did not result in the underlying cause. Review of the terminal hospital records, in the form of a VA hospital summary showing that the veteran was admitted from April 21, 1997, to September [redacted], 1997, the date of the veteran's death, shows that he was initially admitted with a left medial/distal metatarsal ulcer on his left foot which was chronically non-healing. A left below-the-knee amputation was performed on April 21, 1997. In early July 1997 it was noted that a superficial ulcer was noted over the right great toe area, which, despite treatment, progressed in severity. The ulcer was debrided in August 1997, following which time he developed a recurrent ileus with persistent abdominal distention. Subsequent bone culture testing was noted to show the presence of osteomyelitis which was noted to be caused by Methicillin-resistant Staphylococcus aureus and Proteus. The report also noted that despite interventions taken for his ileus, congestive heart failure, and osteomyelitis, the veteran's overall condition progressively declined. Following consultation between medical personnel and the appellant, the veteran was continued with intensive medical and supportive care, and resuscitation was not attempted when the veteran expired on September [redacted], 1997. As part of an addendum to the report, shown to have been dated on September 16, 1997, the discharge diagnoses were listed as: congestive heart failure, peripheral vascular disease, osteomyelitis of the right great metatarsal bone, benign prostatic hypertrophy with prostatitis, urinary tract infections due to Enterococcus and Escherichia, and recurrent ileus. As noted above, the appellant was afforded a hearing in November 1998. She testified that the veteran, in essence, died as a result of problems manifested over the years ever since he contracted "jungle rot" while serving overseas. She added that rashes which would occasionally break out over various parts of his body contributed to his death. This condition she alleged caused the veteran to have his right leg amputated. See VA discharge summary, noting period of hospitalization from April 21, 1997, to September 11, 1997. She further testified that the veteran's service-connected neurodermatitis disorder caused him to experience itching involving several bodily areas. In this case, as reported above, the death certificate shows that the immediate cause of the veteran's death was due to osteomyelitis of the right foot, with both peripheral vascular disease and arteriosclerotic cardiovascular disease listed as underlying causes of death. Also, the above- discussed VA hospital summary addendum dated subsequently on September 16, 1997, included discharge diagnoses of 1) congestive heart failure, 2) peripheral vascular disease, and 3) osteomyelitis of the right great metatarsal bone. The appellant essentially contends that the veteran's death was caused by problems associated with jungle rot which the veteran contracted overseas some 50 years previous. However, there is no medical opinion that suggests that any of the above-cited causes of death, to include congestive heart failure, peripheral vascular disease, or osteomyelitis of the right great metatarsal bone had any nexus or relationship to the veteran's period of military service. The Board here notes that a review of the evidence of record shows that no cardiac-related abnormalities were documented as part of the veteran's service medical records and, in addition, coronary artery disease, first documented as part of a VA hospital summary showing a discharge date in December 1966, was determined not to be service-connected by the RO in January 1967. After a careful review of the clinical evidence in the claim file, the Boards finds no medical evidence supporting the appellant's claim that the veteran's cause of death, either as reported on the death certificate or as shown in the above-discussed September 1997 hospital discharge diagnoses addendum, is linked to his period of active service. There is further no medical evidence of record which goes to show that either the veteran's service-connected neurodermatitis, tinea pedis, or appendectomy scar was linked to his death. The Board does acknowledge the contentions of the appellant concerning her belief that the veteran's death was related to service. However, the Board notes that where the issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1991). Since the record does not indicate that the appellant possesses the medical training and expertise necessary to render a cause of the veteran's death, her lay statements alone cannot serve as a sufficient predicate upon which to find the claim for service connection to be well grounded. See Heuer v. Brown, 7 Vet. App. 379, 384 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). Accordingly, the Board finds that the appellant's claim for the cause of the veteran's death is not well grounded in the absence of medical evidence which relates the above- documented causes of death to the veteran's period of active service. ORDER Evidence of a well-grounded claim not having been submitted, service connection for the cause of the veteran's death is denied. SANDRA L. SMITH Acting Member, Board of Veterans' Appeals