Citation Nr: 0000923 Decision Date: 01/12/00 Archive Date: 01/27/00 DOCKET NO. 97-13 190A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: Georgia Department of Veterans Service WITNESSES AT HEARING ON APPEAL Appellant and the veteran's son. ATTORNEY FOR THE BOARD Daniel R. McGarry INTRODUCTION The veteran had active service from January 1941 to February 1946. FINDINGS OF FACT 1. The veteran died in September 1996 at the age of 74. 2. The death certificate indicates that the immediate cause of the veteran's death was aspiration pneumonia due to or as a consequence of left middle cerebral artery stroke; and that other significant conditions contributing to the veteran's death were neurosis and traumatic arthritis. 3. At the time of his death, the veteran had service- connected disabilities from anxiety reaction, rated 30 percent disabling; degenerative joint disease of the cervical spine with cervical spondylosis, rated 20 percent disabling; shrapnel wound scar of the right anterior tibial spine, rated 10 percent disabling; degenerative joint disease of the left knee, rated 10 percent disabling; residuals of left wrist injury with decreased rating of motion, rated 10 percent disabling; and shrapnel wound scar of the left buttock, rated zero percent disabling. 4. The veteran's service-connected disabilities from anxiety reaction, degenerative arthritis of the cervical spine, shrapnel wound of the right anterior tibial spine, degenerative joint disease of the left knee, residual of left wrist injury, and shrapnel wound of the left buttock did not cause or contribute to the cause of his death. 5. The record contains no medical evidence that the veteran had pneumonia or cerebral artery disease during his active military service or that the cerebrovascular accident and aspiration pneumonia which caused his death were related to any disease or injury he incurred during his active military service. CONCLUSION OF LAW Service connection for the cause of the veteran's death is not warranted. 38 U.S.C.A. §§ 1110, 1310, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.310, 3.312 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the appellant's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). The record contains a certified copy of the death certificate in which a physician cites neurosis and traumatic arthritis as significant conditions contributing to the veteran's death. Service connection is in effect for anxiety reaction. The RO has assisted the appellant in all necessary matters, including seeking and securing treatment records. The Board is satisfied that all relevant facts which may be developed have been properly developed, and that no further assistance is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. Service connection for the cause of the veteran's death may be granted if a disability incurred in or aggravated by service was either the principal, or a contributory, cause of death. 38 C.F.R. § 3.312(a) (1999). For a service-connected disability to be the principal cause of death, it must singly or with some other condition be the immediate or underlying cause, or be etiologically related. 38 U.S.C.A. § 3.312(b) (1999). For a service-connected disability to be a contributory cause of death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. 38 U.S.C.A. § 1310 (West 1991); 38 C.F.R. § 3.312(c)(1) (1999). A service-connected disability may be a contributory cause of death if it results in debilitating effects and general impairment of health to the extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. 38 C.F.R. § 3.312(c)(3) (1999). A service-connected disability may be a contributory cause of death if it affected a vital organ and was of itself of a progressive or debilitating nature and was of such severity as to have a material influence in accelerating death. 38 C.F.R. § 3.312(c)(4) (1999). At the time of the veteran's death, he had service-connected disability from anxiety reaction, rated 30 percent disabling; degenerative joint disease of the cervical spine with cervical spondylosis, rated 20 percent disabling; shrapnel wound scar of the right anterior tibial spine, rated 10 percent disabling; degenerative joint disease of the left knee, rated 10 percent disabling; residuals of left wrist injury with decreased rating of motion, rated 10 percent disabling; and shrapnel wound scar of the left buttock, rated zero percent disabling. The combined disability rating had been 60 percent since October 25, 1984. The death certificate indicates that the veteran died in September 1996 at the age of 74. The immediate cause of the veteran's death was listed as aspiration pneumonia due to or as a consequence of left middle cerebral artery stroke. The reported onset of the pneumonia was 24 hours. The reported onset of the cerebral artery stroke was seven days. The physician who certified the cause of death reported on the death certificate that other significant conditions contributing to the cause of death were neurosis and traumatic arthritis. The claimant has asserted two theories in support of her claim for service connection for the cause of the veteran's death: 1) The veteran's service-connected neuropsychiatric disorder caused him to be noncompliant with his medication regime for hypertension and, as a result of such noncompliance, he developed high blood pressure which resulted in a cerebrovascular accident; 2) the veteran's anxiety neurosis caused him to be excessively anxious during his hospital treatment, thereby contributing to the worsening of his condition, and accelerating his death. Although the death certificate lists neurosis as a significant condition contributing to the cause of the veteran's death, the records from the veteran's final hospitalization do not support this notation. The summary of the veteran's last hospitalization indicated that his family had found him unresponsive at home on September 5, 1996. He was taken to Cobb Hospital, and transferred to a VA hospital. It was noted that he had a history of hypertension and prostate cancer. When admitted to the hospital, he had right sided-weakness and was not able to talk. Initially, the veteran was monitored in the hospital's intensive care unit. He did not have any improvement in his right-sided hemiplegia or aphasia. After several days in the hospital, the veteran was transferred out of intensive care. He was started on antihypertensive medications. On the morning of September [redacted], 1996, he appeared to be in acute respiratory distress. Aspiration pneumonia was suspected. In the early afternoon of September [redacted], 1996, the veteran was pronounced dead. The diagnoses reported in the hospital summary were: Large middle cerebral artery ischemic stroke; prostate cancer; and hypertension. The claims folder also contains the clinical records of the veteran's last hospitalization. After an examination by a physician on the day following his admission, the physician expressed an opinion that if the veteran survived the initial phase of the cerebrovascular accident, he would most likely be aphasic and have marked hemiplegia which would not respond to rehabilitation. The treatment plan included an instruction not to resuscitate the veteran in the event of cardiopulmonary arrest. Subsequently dated treatment notes contain an impression of ischemic - not hemorrhagic -- cerebrovascular accident. The veteran's condition did not change significantly during the ensuing days, although on the day prior to his death he was somewhat more responsive. His blood pressure was lowered slowly with medication. Notes made on his last hospital day show that aspiration pneumonia was suspected. He was treated with antibiotics and oxygen. The Board has thoroughly reviewed the medical evidence in the claims folder and finds no competent medical evidence or opinion which supports either of the claimant's theories. On the contrary, the treatment notes describe the veteran's cerebrovascular accident as ischemic rather than hemorrhagic. His treating physicians decided to slowly increase medication for high blood pressure to avoid further infarct-type lesion from a too rapid decrease in blood pressure. Further, the record contains no medical evidence or opinion that the veteran was noncompliant with his medication regime for hypertension, that his neuropsychiatric disorder caused or contributed to any such noncompliance, or that such noncompliance, if it did exist, caused or contributed to the fatal stroke or pneumonia. Finally, the record contains no competent medical evidence or opinion that the veteran's disability from anxiety reaction inhibited his treatment or accelerated his death. Clinical notes made during his last hospitalization indicate that he was mostly unresponsive to external stimuli. He opened his eyes to verbal stimuli and showed a finger grasping response in his left hand. Otherwise, there was no indication that the veteran was suffering from anxiety-related symptoms or that such symptoms interfered with his treatment or contributed to his death. Finally, the Board finds that the preponderance of the medical evidence contained in the claims folder does not support for the proposition that the veteran's service- connected disability from traumatic arthritis caused or contributed to the cause of his death. There is no indication that a vital organ was affected by such disorder, or that such disorder resulted in debilitating affects and general impairment of health which rendered the veteran materially less capable of resisting the effects of the stroke or pneumonia primarily causing his death. Treatment records show no indication that his disability from traumatic arthritis caused any concern to his treating physicians or played any role whatsoever in his demise from pneumonia and cerebrovascular accident. The Board has considered the assertions made by the claimant and the veteran's son during their testimony before a hearing officer, as well as the claimant's written statements. However, in the absence of evidence that either the claimant or the veteran's son have the expertise to render opinions about the causes of the veteran's death, their assertions are afforded no probative weight. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The claimant's assertions about what she was told by a physician who had treated the veteran during his last hospitalization are too remote and attenuated to constitute medical evidence which would support her claim. See Robinnette v. Brown, 8 Vet. App. 69 (1995). I have also considered whether the diseases that caused or contributed to the veteran's death - that is, cerebrovascular accident and pneumonia -- should be service connected. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991); 38 C.F.R. § 3.303 (1999). The filed does not contain the veteran's service medical records. There is some indication that such records may have been destroyed in the 1973 fire at the National Personnel Records Center. However, the record contains no competent medical evidence which indicates any relationship between the veteran's cerebrovascular accident and subsequent development of aspiration pneumonia and any disease or injury he incurred during his active military service. The Board finds that the veteran's cerebrovascular accident and subsequent development of aspiration pneumonia were not related to any disease or injury he incurred during his active military service. The Board concludes that the cause of the veteran's death, that is, aspiration pneumonia and left middle cerebral artery stroke, were not incurred during his active military service. ORDER Entitlement to service connection for the cause of the veteran's death is denied. MARY GALLAGHER Member, Board of Veterans' Appeals