BVA9502833 DOCKET NO. 93-04 170 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Manila Philippines THE ISSUE Entitlement to service connection for the cause of the veteran's death. ATTORNEY FOR THE BOARD W. Pope, Counsel REMAND This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 1992 rating decision. The veteran had active service from August 1946 to July 1950. He died at the age of 71, on January 7, 1992. The Certificate of Death lists congestive heart failure as the immediate cause of death, CVA (cerebrovascular accident) as the antecedent cause of death, and HPN (hypertension) as the underlying cause of death. Tuberculous pericarditis and cardiomyopathy, nephritis, and tuberculous pleurisy were listed as "[o]ther significant conditions contributing to death." At the time of the veteran's death service connection had been established for tuberculous pericarditis with cardiomyopathy, evaluated as 30 percent disabling; nephritis, evaluated as 10 percent disabling; tuberculous pleurisy, evaluated as 10 percent disabling; and a surgical scar of the right thigh, evaluated as 10 percent disabling. The combined disability rating was 50 percent. The appellant, the veteran's widow, contends that the veteran's death was caused by his service-connected disabilities. A review of the veteran's claims folders disclose that service connection for nephritis, pleurisy and a surgical scar of the right thigh had been in effect since August 1, 1950, the day following his separation from service. Service connection for tuberculous pericarditis with cardiomyopathy had been in effect since November 26, 1976, the day of his hospital admission with complaints of epigastric fullness, anterior chest pain, increasing shortness of breath, orthopnea and bilateral leg edema. He was discharged from the hospital in January 1977 with diagnoses including "[t]ubercular pericarditis and pleurisy" and "[c]ardiomyopathy with compensated congestive heart failure." The veteran was hospitalized for approximately two weeks in December 1990 following the sudden onset of left-sided weakness. Computerized tomography scans of his head disclosed a hypodense area near the inferior lip of the internal capsule on the right. The diagnosis was stroke, right middle cerebral artery distribution with left-sided paraplegia. The veteran was also hospitalized for several days during May 1991 for treatment of diagnosed chronic bilateral pyelonephritis, and again for approximately three weeks during July and August 1991, and approximately two weeks during September and October 1991, with diagnoses of congestive heart failure secondary to arteriosclerotic cardiovascular disease, atrial fibrillation, and post-cerebrovascular accident, probably embolic. A VA field examination, conducted pursuant to a March 1992 request from the RO, was completed in July 1992. That examination included a June 1992 interview with Genoveva Zambrano, M.D., the individual listed on the veteran's certificate of death as the private physician who had attended him from December 5, 1991, and had certified his death. The interview report disclosed that Dr. Zambrano was a 67-year old physician practicing in the La Union province of the Republic of the Philippines, who had treated the veteran for over 20 years. Dr. Zambrano recalled that the veteran had suffered a stroke sometime in 1990 or 1991; that she had last seen the veteran just before Christmas in 1991; that she was not present when the veteran died in his home; that she had declared congestive heart failure as the cause of death because she was aware that the veteran had had a stroke and was hypertensive which led to his physical deterioration and eventual death; and that she had declared the stated disabilities as antecedent causes based on medical records shown to her by the veteran's widow. Dr. Zambrano also disclosed that she did not keep patient medical records and that the information she provided during the interview was based on her memory. In view of the above, the Board finds that a medical opinion concerning the veteran's service-connected disabilities and his death is desirable prior to appellate review. Accordingly, this case is REMANDED to the RO for the following: 1. The RO should refer the veteran's claims folders, including a copy of this REMAND, to the appropriate VA medical specialist(s) for proper review of the medical history. After complete review of the medical evidence the specialist(s) should provide an opinion as to the medical probability that the veteran's service-connected tuberculous pericarditis with cardiomyopathy, nephritis and/or tuberculous pleurisy caused, contributed substantially in producing or materially accelerated the veteran's death. 2. After the development requested above has been completed, the RO should again review the record and adjudicate the issue of service connection for the cause of the veteran's death. If the benefit remains denied the appellant should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. STEPHEN L. WILKINS Member, Board of Veterans' Appeals 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. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).