Citation Nr: 25001067 Decision Date: 01/27/25 Archive Date: 01/27/25 DOCKET NO. 14-42 391 DATE: January 27, 2025 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1971 to April 1973. The Veteran died in September 2011. See September 2011 Death Certificate. The appellant is the Veteran's surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2017, the appellant's son testified at a Board hearing before a Veterans Law Judge (VLJ). A copy of the transcript of that hearing has been associated with the claims file. In a September 2021 letter, the appellant was notified that the VLJ who conducted the November 2017 hearing was no longer available, and of her right to another Board hearing. The letter also indicated that the Board would assume that the appellant did not want another hearing and proceed accordingly if she did not respond within 30 days of the date of the letter. See September 2021 BVA Letter. To date, no response to the September 2021 letter has been received; thus, a second hearing is not warranted. By way of background, this matter was initially before the Board in January 2018 and May 2019, when it was remanded for additional development. See January 2018 BVA Decision; May 2019 BVA Decision. Thereafter, in a June 2020 decision, the Board denied the claim of entitlement to service connection for the cause of the Veteran's death, and the appellant appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court). See June 2020 BVA Decision. In March 2021, the Court granted the parties' Joint Motion for Remand (JMR), which vacated the Board's June 2020 decision and remanded the matter for readjudication. Specifically, the parties agreed that remand was warranted because the Board failed to provide an adequate statement of reasons or bases. See April 2021 CAVC Decision. This matter was last before the Board in November 2021 and February 2024, when it was remanded for additional development. See November 2021 BVA Decision; February 2024 BVA Decision. Entitlement to service connection for the cause of the Veteran's death is remanded. In February 2024, the Board remanded the appellant's claim to obtain an addendum medical opinion to determine the relationship, if any, between the cause of the Veteran's death and his service-connected mood disorder. Specifically, the Board asked the examiner to opine as to whether it was at least as likely as not that the Veteran's service-connected mood disorder (i) caused or (ii) contributed to the cause of death as listed on his death certificate. In this regard, the Board noted that the Veteran's immediate cause of death was acute myocardial infarction with chronic obstructive pulmonary disease (COPD) and hypertension listed as other significant conditions contributing to death. In addition, the Board asked the examiner to explain the rationale behind his opinion and indicated that reasons should be provided for any opinion rendered. See February 2024 BVA Decision. After a review of the evidence of record, the Board notes that the requested medical opinion was obtained in March 2024. However, the Board finds that the March 2024 VA examiner did not substantially comply with the February 2024 Board remand directives, and as such, additional development is needed before the appellant's claim can be decided. Stegall v. West, 11 Vet. App. 268, 271 (1998). As noted above, VA obtained an addendum medical opinion in March 2024. After reviewing the evidence of record, to include the Veteran's death certificate, the February 2024 Board remand, lay statements, and the medical articles submitted by the appellant, the examiner opined that the Veteran's service-connected mood disorder did not contribute to his causes of death. In this regard, the examiner noted that the Veteran died of an acute myocardial infarction and that COPD and hypertension were listed on his death certificate as other significant conditions contributing to death. The examiner further noted that the Veteran's service-connected mood disorder was a behavioral health condition and opined that such would not have caused the cardiac or pulmonary conditions that caused his death. See March 2024 C&P examination. After a review of the evidence of record, the Board finds that a remand is required to obtain an addendum medical opinion. Specifically, the Board finds that the March 2024 VA examiner did not provide sufficient rationale to support his opinions, as requested by the February 2024 Board remand. In this regard, although the VA examiner indicated that he reviewed the evidence of record in connection with his opinions, he did not provide any rationale to support his opinion that the Veteran's service-connected mood disorder did not contribute to his causes of death beyond reiterating the diagnoses identified on the Veteran's death certificate. Similarly, although the examiner stated that the Veteran's mood disorder was a behavioral health condition, he did not offer any rationale to explain how he determined that the disorder would not have caused the cardiac or pulmonary conditions that caused his death. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Stegall v. West, 11 Vet. App. 268 (1998). Based on the foregoing, the Board finds that a remand is warranted to obtain an addendum medical opinion to determine the relationship, if any, between the cause of the Veteran's death and his service-connected mood disorder. The matter is REMANDED for the following action: Obtain an addendum medical opinion by an appropriately qualified examiner to determine the relationship, if any, between the cause of the Veteran's death and his service-connected mood disorder. The examiner should provide the following opinion: Is it at least as likely as not that the Veteran's service -connected mood disorder (i) caused or (ii) contributed to the cause of death as listed on his death certificate (immediate cause of death acute myocardial infarction with COPD and hypertension listed as other significant conditions contributing to death)? Please explain why or why not. The Veteran's claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner in conjunction with the examination. The examiner should specifically consider the following evidence and articles submitted by the appellant to support her claim: (a.) The private medical opinion from Dr. Craig Bash dated in January 2012. After reviewing the evidence of record, Dr. Bash opined, with at least 50 percent level of probability, that the Veteran's demise was due to his service-connected disabilities. See May 2012 Medical Treatment Record - Non-Government Facility. (b.) An article published by the Centers for Disease Control and Prevention titled Heart Disease and Mental Health Disorders, which indicates that people experiencing depression, anxiety, stress, and PTSD over a long period of time may experience certain physiological effects on the body, such as increased cardiac reactivity including increased hear rate and blood pressure, reduced blood flow from the heart, and heightened levels of cortisol. The article further states that the physiologic effects could lead to calcium buildup in the arteries, metabolic disease, and heart disease over time; (c.) An article published by Better Health Channel titled Heart Disease and Mental Health, which found that depression could be as big of a risk factor for coronary heart disease as smoking, high cholesterol, and high blood pressure and could also affect the recovery of people with coronary heart disease and increase the risk of future heart problems; (d.) An article by Joseph Pritchard titled How Does Starvation Affect High Blood Pressure?, which indicates that starvation and malnutrition subject the human body to stress and potential potassium and vitamin D deficiencies that are likely to cause an individual's blood pressure to rise; (e.) An article by Paula Martinac titled What is a Dangerously Low BMI?, which states that individuals with dangerously low BMIs, such as less than 18.5, are at an increased risk for malnutrition and premature death. See June 2022 Correspondence. The service-connected disability will be considered as the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. A contributory cause of death is inherently one not related to the principal cause. 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; 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. A complete rationale for all opinions rendered is required. The Board emphasizes that a bare conclusion, without a rationale to support the conclusion reached, will be determined to be inadequate and likely result in another remand. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Justis, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. ยง 20.1303.