BVA9507220 DOCKET NO. 93-10 565 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Manila, Philippines THE ISSUE Service connection for the cause of the veteran's death. ATTORNEY FOR THE BOARD Michele M. Florack, Associate Counsel INTRODUCTION The veteran had recognized guerrilla service from January 1944 to October 1945 and several periods of Regular Philippine Army service between October 1945 and June 1946. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that service connection for the cause of the veteran's death is warranted. Essentially she claims that he died as a result of service-connected disabilities. DECISION OF THE BOARD The Board of Veterans' Appeals (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 preponderance of the evidence is against the claim for 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. 2. The veteran died in June 1992 as a result of cardiorespiratory arrest, multi-organ failure, and sepsis secondary to pneumonia, decubitus ulcers and urinary tract infection. 3. The evidence of record does not show that a cardiorespiratory disorder, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, or urinary tract infections, were shown in service, or that any of the disorders that became manifest many years after his separation from service were related to service or his service-connected disabilities. 4. During the veteran's lifetime, service connection was in effect for moderately severe residuals of injury to muscle group XVII of the left buttock with healed ischial tuberosity, rated as 40 percent disabling, and abscess secondary to infected fistula of the right iliac region secondary to peritoneal adhesion following colostomy, rated as 10 percent disabling. 5. The evidence does not show a cause-and-effect relationship between any of the veteran's service-connected disabilities and his death, or that his service-connected disabilities hastened his death. CONCLUSIONS OF LAW 1. Cardiorespiratory disorder, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, and urinary tract infection were not incurred in or aggravated by service and were not proximately due to or the result of service-connected disability. 38 U.S.C.A. §§ 1110, 1112, 5107(a) (West 1991) 38 C.F.R. § 3.310 (1994). 2. A service-connected disability did not cause or contribute substantially or materially to cause the veteran's death. 38 U.S.C.A. §§ 1310, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.312 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the appellant's claim for service connection for the cause of the veteran's death is "well grounded" or plausible within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Department of Veterans Affairs (VA) therefore has a duty to assist the appellant in the development of facts pertinent to her claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. §§ 3.103, 3.159 (1994). In this case, the appellant has requested that a medical opinion as to the cause of death be obtained from the physician who was treating the veteran at the time of his demise. The Board finds that the duty to assist does not require the VA to obtain an opinion from a specific physician. Moreover, from the following discussion, it will be evident that the records of the treating physician do not suggest that there is a question of medical controversy. As stated by the United States Court of Veterans Appeals, "The duty to assist is not always a one-way street. If the [appellant] wishes help, (s)he cannot passively wait for it in the circumstances where (s)he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet.App. 190, 193 (1991). In other words, the statutory duty to assist does not encompass the a requirement that any and all assertions by an appellant must be investigated. The appellant has not provided medical evidence which suggests that further development is indicated. Thus, the Board finds that the VA has fulfilled its duty with respect to developing the claim as provided by 38 U.S.C.A. § 5107(a) (West 1991). The appellant claims that service connection for the veteran's cause of death is warranted. In order to establish service connection for the cause of the veteran's death, it must be demonstrated that a service-connected disability caused or contributed substantially and materially to cause the veteran's death. 38 U.S.C. § 1310 (West 1991); 38 C.F.R. § 3.312 (1994). The cause of death as shown by the death certificate was cardiorespiratory failure, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, and urinary tract infection. To establish service connection for a claimed disability, the facts, as shown by evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred in wartime service, or in the case of a preexisting injury or disease aggravated by wartime service. 38 U.S.C.A. § 1110 (West 1991). Service connection may also be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (1994). The veteran's service medical records are silent as to any complaints, treatments, diagnoses or any other findings related to cardiorespiratory failure, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, and urinary tract infections, the conditions listed as the cause of the veteran's death. These disorders were first shown over 40 years later; there has not been evidence presented to connect these disorders to the veteran's period of service. Thus, the Board finds that service connection cannot be granted for cardiorespiratory failure, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, and urinary tract infection. At the time of his death, service connection was in effect for moderately severe residuals of injury to muscle group XVII of the left buttock with healed ischial tuberosity, rated as 40 percent disabling, and abscess secondary to infected fistula of the right iliac region secondary to peritoneal adhesion following colostomy, rated as 10 percent disabling. The Board notes that these disabilities, which stemmed from the same in-service injury, were rated as 40 percent and 10 percent disabling from August 1949 to the veteran's death in June 1992, with the exception of a temporary 100 percent rating for hospitalization for three months in 1968. This suggests that the disabilities were stabilized for most of the veteran's lifetime. In addition, while these disabilities may have been significant, they did not affect a vital organ. 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; or 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. 38 C.F.R. § 3.312(c) (1994). The veteran was hospitalized between May 18th through the date of his death, June 19, 1992. Nurses' admitting notes dated May 18, 1992 indicated that he was admitted for decubitus ulcers on his upper and lower extremities and buttocks. Further notations described ulcers on the veteran's right trochanteric area, left knee, left trochanter, and left elbow. Physicians' notes for the period of hospitalization indicated that the veteran had Parkinson's disease with decubitus ulcers. (See, e.g., notes dated June 8 and June 15th.) Various physician's entries, such as the notes dated June 9th, indicated that Parkinson's disease had been identified 5 years earlier, that his condition had deteriorated and he became bedridden in the last 5 months, and that decubitus ulcers had developed. In a dermatology consultation report, dated May 25, 1992 the veteran's condition was described as Parkinson's' disease, which caused the veteran's instability to walk, resulting in decubitus ulcers. There has been no medical evidence submitted which shows that the veteran's service-connected disabilities caused the development of the cardiorespiratory failure, pneumonia, or sepsis which resulted in his death. The evidence also does not show that the veteran's service-connected disabilities were of such a nature or extent as to result in debilitation rendering the veteran incapable of resisting the effects of other disease or injury primarily causing death. While the appellant has asserted that the veteran's service-connected disabilities were a factor in causing his death, she is not qualified to make such a determination. Evidence that requires medical knowledge must be provided by someone qualified as an expert by knowledge, skill, experience, training, or education. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The Board is sympathetic with the appellant on the loss of her husband and does not doubt that her claim was pursued with all sincerity. However, the medical evidence of record does not show that the service-connected disabilities constituted material factors which either rendered the veteran less able to withstand cardiorespiratory failure, multi-organ failure, sepsis secondary to pneumonia, decubitus ulcers, and urinary tract infection, or hastened his demise. None of the service-connected disorders were shown to be related to the disabilities that caused his death. It is the judgment of the Board that the veteran's death was not the result of disability which was incurred in or aggravated by active service, or causally related to a service- connected disability. In reaching this determination, it is the judgment of the Board that the preponderance of the evidence is against the veteran's claim and, therefore, there is no doubt to be resolved in her favor. 38 U.S.C.A. § 5107(b) (West 1991). ORDER Service connection for the cause of the veteran's death is denied. V. L. JORDAN 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. 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.