Citation Nr: 0004676 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 98-10 863 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. S. Tierney, Counsel INTRODUCTION The veteran served on active duty from February 1943 to September 1945. The veteran died on March [redacted], 1998. The appellant is the widow of the veteran. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. FINDING OF FACT The claim for service connection for the cause of the veteran's death is not plausible. CONCLUSION OF LAW The claim for service connection for the cause of the veteran's death is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant contends that the veteran's heart disorder was first found by VA in 1975 and that he had had this disorder since he had been released from service. She also contends that the veteran suffered from a psychiatric disorder due to combat in service and that the psychiatric disorder contributed to the veteran's heart problems due to increased stress. Direct service connection may be granted for disability resulting from disease or injury incurred or aggravated during active service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Service incurrence of cardiovascular disease or a psychosis during wartime service may be presumed if manifested to a compensable degree within one year of the veteran's discharge from service. 38 U.S.C.A. §§ 1101, 1112 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Service connection may also be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice- connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). To establish service connection for the cause of the veteran's death, the evidence must show that disability incurred in or aggravated by service either caused or contributed substantially or materially to the cause of death. For a service-connected disability to be the cause of death, it must singly or with some other condition be the immediate or underlying cause or be etiologically related thereto. For a service-connected disability to constitute a contributory cause, 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. 38 U.S.C.A. § 1310 (West 1991); 38 C.F.R. § 3.312 (1999). As a preliminary matter, however, the Board must determine whether the appellant has submitted evidence of a well- grounded claim. 38 U.S.C.A. § 5107(a). If she has not, her claim must fail, and VA is not obligated to assist the appellant in its development. 38 U.S.C.A. § 5107(a); Grottveit v. Brown, 5 Vet. App. 91 (1993); Tirpak v. Derwinski, 2 Vet. App. 609 (1992). The United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals before March 1, 1999) (hereinafter Court) has stated repeatedly that 38 U.S.C.A. § 5107(a) unequivocally places an initial burden on a claimant to produce evidence that a claim is well grounded. See Grivois v. Brown, 6 Vet. App. 136 (1994); Grottveit at 92; Tirpak at 610-11. A well-grounded claim is a plausible claim, that is, a claim which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has stated that the quality and quantity of evidence required to meet this statutory burden depends upon the issue presented by the claim. Grottveit at 92-93. Where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is plausible or possible is required. Id. The veteran's death certificate shows that he died on March [redacted], 1998, at the age of 74. The immediate cause of death was cardiac arrest, due to ischemic cardiomyopathy. Coronary arteriosclerotic disease was listed as an underlying cause that initiated events resulting in death. At the time of the veteran's death, service connection was in effect for hearing loss in the left ear, evaluated as 10 percent disabling, and an asymptomatic scar from a shell fragment wound of the left ear, evaluated as noncompensable. The combined rating for the service-connected disabilities was 10 percent. The veteran's service medical records are negative for any complaints, finding or diagnosis of cardiovascular disease or a psychiatric disorder. The September 1945 separation examination report notes shrapnel wound to the right ear in May 1945 and to the left ear in June 1945. The cardiovascular system was normal. Blood pressure was 132/60. Pulse was 76 while sitting and 108 immediately after exercise. Chest X-ray was negative. The veteran's psychiatric status was normal. A VA medical report of a hospitalization from November to December 1969 contains a diagnosis of moderate anxiety neurosis. The veteran had been admitted to the hospital because of increasing nervousness and severe neurodermatitis. Another VA medical report of a hospitalization from June to July 1970 also notes a diagnosis of moderate anxiety neurosis. There is no indication in either of these two records that the veteran's anxiety neurosis was due to service more than 24 years earlier. A VA examination in November 1975 showed that the veteran had regular heart rhythm and no murmurs. A chest X-ray revealed normal heart size with a left ventricular configuration. There were no mediastinal abnormalities. The veteran had wheezing and difficulty getting his breath, and it was noted that he was quite obese. His respiratory problems were attributed to lack of lung space due to his obesity. A neuropsychiatric examination disclosed no mental disorder. A VA psychiatric examination in July 1988 resulted in diagnoses of mild dementia, probably secondary to alcohol and cerebrovascular disease; atypical anxiety disorder; and alcohol dependence by history. At a Travel Board hearing in October 1999 before the undersigned Board Member, the appellant testified that the veteran had had a slight heart attack in 1981 and had been treated for cardiac problems prior to that in the 1970's. She reported that Dr. James Gaye, a cardiologist in Lexington, Kentucky, and their family doctor, Dr. James Noble, in Beattyville, Kentucky, treated the veteran. The appellant also stated that the veteran received treatment at the VA Medical Center in Lexington, Kentucky, in the 1970's for psychiatric problems but not for his cardiac disorder. The appellant testified that she believed that the veteran suffered from a psychiatric disorder due to combat in service, and that this psychiatric disorder contributed to a heart problem from the increased stress. The appellant testified that, to her knowledge, a doctor had never confirmed her theory that the veteran's psychiatric problems caused or contributed to his heart disorder. The Board notes that the record contains no medical evidence suggesting the presence of cardiovascular disease or a psychiatric disability in service or until decades thereafter or suggesting that either disorder was etiologically related to service. Moreover, there is no medical evidence on file suggesting that the veteran's service-connected disabilities, consisting of left ear hearing loss and an asymptomatic scar from a shell fragment wound of the left ear, either caused or chronically worsened the veteran's cardiovascular disease, or that they otherwise caused or contributed substantially or materially to the veteran's death. The record does not include any medical opinion which indicates that the condition which caused the veteran's death, coronary artery disease, was in any way related to the veteran's service. The medical articles submitted are not specific to the veteran's case and the references to generic relationships between coronary heart disease and exposure to war-zone stress are insufficient to well-ground the claim. See Sacks v. West, 11 Vet. App. 314 (1998), Wallin v. West, 11 Vet. App. 509 (1998). The only evidence supportive of the theory that the veteran's period of service resulted in a psychiatric disability which contributed to his coronary artery disease and cause of death consists of the lay assertions of the appellant. As the Court held in Espiritu v. Derwinski, 2 Vet. App. 492 (1992), however, lay persons are not competent to offer medical opinions, so the assertions of lay persons concerning medical causation cannot constitute evidence of a well-grounded claim. In light of these circumstances, the Board must conclude that the appellant's claim is not well grounded. ORDER Entitlement to service connection for the cause of the veteran's death is denied. SHANE A. DURKIN Member, Board of Veterans' Appeals