BVA9501804 DOCKET NO. 92-53 366 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Harold A. Beach, Counsel INTRODUCTION The veteran, who died in August 1989, served on active duty from February 1941 to June 1946 and from July 1946 to August 1961. He was a prisoner of war of the Japanese Government from April 9 to April 24, 1942. His awards and decorations included the Combat Infantryman Badge. The appellant, his widow, seeks service connection for the cause of his death. This matter was previously before the Board of Veterans' Appeals (Board) in July 1992, at which time it was remanded for further development of the evidence. The Board requested that the RO verify the dates that the veteran was a prisoner of war. It also requested that the RO obtain the report of an insurance examination, performed in 1963, as well as medical records from the Silas B. Hays Community Hospital, Ft. Ord, California, dated from 1961 to 1978. In February 1993, following the requested development, the RO confirmed and continued the denial of service connection for the cause of the veteran's death. Thereafter, the claims folder was returned to the Board of Veterans' Appeals. In July 1993, the appellant had a hearing at the Board. During the hearing, she raised contentions to the effect that the Army and the VA had not provided the veteran with proper medical care and that she wished to file a claim in that regard. That issue has not been developed or certified for appeal; therefore, it is referred to the RO for disposition. During the course of the appeal, the Board member who conducted the July 1993 hearing left the Board. In November 1994, the Board wrote to the appellant and inquired whether she wished an additional hearing. She did not respond to that inquiry, and the Board will, therefore, proceed with its review. CONTENTIONS It is contended by and on behalf of the appellant that the veteran's fatal cerebrovascular hemorrhage was a result of hypertension which developed in service; that hypertension was first manifested by an elevated blood pressure reading during an annual examination in service in 1960; that the diagnosis was confirmed during an insurance examination in 1963; that the veteran continued to demonstrate hypertension thereafter; and that service connection for the cause of death is, therefore, warranted. DECISION OF THE BOARD The 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 does not support the claim for service connection for the cause of the veteran's death. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the appellant's claim has been obtained by the RO. 2. The veteran died in August 1989, at age 69, of cerebral edema due to cerebrovascular hemorrhage. 3. The fatal cerebral edema and cerebrovascular hemorrhage were first clinically reported at the time of the veteran's death. 4. Hypertension was first clinically demonstrated many years after service, and there are no clinical findings that it is in any way related thereto. 5. At the time of the veteran's death, service connection was in effect for bilateral defective hearing, evaluated as 30 percent disabling, and malaria, evaluated as non-compensable. 6. The veteran's service-connected disabilities were not a causative factor in his death. CONCLUSIONS OF LAW 1. Cerebral edema due to a cerebrovascular hemorrhage was not incurred in or aggravated by service, nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5107(a) (West 1991); 38 C.F.R. §§ 3.303(a)-(b), 3.307, 3.309 (1993). 2. A disability incurred in or aggravated by service did not cause or contribute substantially or materially to cause the veteran's death. 38 U.S.C.A. §§ 1310, 5107(a) (West 1991); 38 C.F.R. § 3.312 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board notes that the appellant's claim for service connection for the cause of the veteran's death is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, she has presented a claim which is not implausible. The Board is also satisfied that all reasonable efforts have been expended to develop the evidence. 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 cause death. For a service-connected disability to be the cause of death, it must singly or with some other condition be the immediate cause or underlying cause, or be etiologically related. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death, rather, it must be shown that there was a causal connection. 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312. Service connection connotes many factors, but, basically, it means that the facts, shown by the evidence, establish that a particular disease or injury, resulting in disability, was incurred coincident with service in the Armed Forces. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic". When the disease identity is established, there is no requirement of an evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). For certain disorders, such as a brain hemorrhage or hypertension, service connection is presumed, when those disorders are shown to a degree of 10 percent during the first year after the veteran's discharge from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. As noted above, the veteran died in August 1989, some 28 years after his last discharge from service. The cause of death was cerebral edema due to a cerebral hemorrhage which reportedly occurred only hours before his death. The appellant maintains, however, that they were the result of hypertension which was first manifested in service. Although the relationship between hypertension and cerebrovascular accidents is well-established, the evidence does not show hypertension in this case until many years after service. The veteran's service medical records show that, in February 1960, he had an elevated blood pressure reading of 144/106. That was apparently an isolated event, however, as an additional reading that day was within normal limits at 122/86. Indeed, there were no further elevated readings in service or any diagnosis of hypertension. At the time of his retirement examination in June 1961, the veteran's blood pressure was 118/78, and he answered in the negative, when asked if he then had, or had ever had, high blood pressure or low blood pressure. Persistently high blood pressure and a diagnosis of hypertension were not clinically reported until 1978, when the veteran was being treated at the Silas B. Hays Army Community Hospital in Ft. Ord, California. There were no findings, however, that it was in any way related to service. The veteran filed his initial claim for service connection for hypertension in August 1986. He reported that since 1961, he had been treated for hypertension at the Silas B. Hays Hospital. During a VA examination in 1987, he reported that hypertension had been found on an insurance examination in 1963. Several attempts to obtain those records have met with negative results. During her hearings on appeal, the appellant also testified to the veteran's treatment for hypertension since 1961. In light of the foregoing findings, however, and lack of supporting documentation, the Board does not find such testimony credible. At the time of the veteran's death, service connection was in effect for bilateral defective hearing and malaria. The appellant does not contend, and the evidence does not show, that either of those disorders played any etiological role in the veteran's death. Absent any findings that a disease or injury in service or during the first year after service caused or contributed substantially or materially to cause the veteran's death, the Board is of the opinion that there is no reasonable basis for favorable action. ORDER Service connection for the cause of the veteran's death is denied. J. J. SCHULE 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. (CONTINUED ON NEXT PAGE) 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.