BVA9504917 
DOCKET NO.  93-08 213     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Pittsburgh, Pennsylvania

THE ISSUE

Entitlement to service connection for the cause of the veteran's
death.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESSES AT HEARING ON APPEAL

The appellant and her son

ATTORNEY FOR THE BOARD

K. E. Harrison, Associate Counsel

INTRODUCTION

The veteran had active military service from January 1943 to
September 1945.  This matter came before the Board of Veterans'
Appeals on appeal from an August 1991 decision by the RO.

REMAND

The veteran died on May [redacted] 1991.  The cause of death was listed
on the death certificate as cardiorespiratory arrest due to
cerebral vascular accident due to sepsis syndrome.  At the time
of death service connection was in effect for residuals of
fractures of the lumbar vertebra with deformity of L4, evaluated
as 50 percent disabling; post-traumatic encephalopathy, evaluated
as 30 percent disabling; and laparotomy scar, evaluated at a
noncompensable disability.

This appeal involves a determination as to whether a service-
connected disability was the principal or a contributory cause of
the veteran's death.  There is conflict in the medical evidence
as to this determination.  A March 1992 statement from Fuad
Ramadan. M.D., related that he informed the veteran's family that
it

"would be very difficult to state that [the
veteran's] demise was a direct result of
the arthritis [the veteran] suffered from
as a result of his back injury that he
received in the service."

The evidence of record also contains a letter received in April
1992 by Robert Schlichtig, M.D., stating:

...I believe that his very severe back
injury, suffered when a crane boom broke
and landed on him during his service to the
United Stated in World War II, contributed
to his death.  As a result of this injury,
he was in severe pain for the remainder of
his days, and was confined to a wheel chair
for his final 5 years.  During my 8 years
caring for critically ill surgical
patients, I have uniformly noted that
patients who are bed or wheel chair-bound
tolerate the stress of hospitalization much
more poorly than do mobile patients.  I
therefore believe that he would have
survived considerably longer had he not
sustained a back injury while in the
military, even if it did not directly cause
his stroke and heart attack.

Regarding the medical opinions in the record the Board is
required to make a determination concerning the credibility of
statements submitted in support of a claim for benefits.  Gilbert
v. Derwinski, 1 Vet.App. 49 (1990).  In making this
determination, the Board may only consider independent medical
evidence.  Colvin v. Derwinski, 1 Vet.App. 171 (1991).
Consequently, the Board requires outside medical assistance in
determining whether a service connected disability caused,
contributed or accelerated the veteran's death.

In view of the foregoing, additional development of the evidence
is needed therefore, the case is REMANDED to the RO for the
following actions:

1.  The RO should take appropriate steps to
secure all records referable to the
veteran's treatment by VA since 1984.  This
should include all documents pertaining to
his period of terminal hospitalization from
the VA medical center in Pittsburgh,
Pennsylvania.

2.  Following completion of the foregoing,
the claims folder, including a copy of this
REMAND, should be referred for review by a
VA cardiologist in order to obtain an
opinion as to the likely involvement of the
veteran's service-connected disorder in his
demise.  The examiner should review the
entire record in this regard.  The examiner
should be asked to express an opinion as to
the medical probability that any service-
connected disability singly or jointly
contributed materially in producing or
substantially accelerated the veteran's
death, as suggested by Dr. Schlichtig, and
provide a clinical rationale for whatever
conclusion is reached.

3.  When the foregoing development has been
completed, the claim should be reviewed by
the RO.  If the decision remains adverse to
the appellant, a supplemental statement of
the case should be prepared and the
appellant and her representative should be
given a reasonable period of time for
reply.

Thereafter, the claim should be returned to the Board for further
review, if in order.  No action is required of the veteran until
he receives further notice.  The purpose of this REMAND is to
obtain additional information.  The Board does not intimate any
factual or legal conclusions as to the outcome ultimately
warranted in this appeal.

          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) (1994).