Citation Nr: 0006440 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 97-22 420 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for the cause of the veteran's death. ATTORNEY FOR THE BOARD C.A. Skow, Counsel INTRODUCTION The veteran served on active duty from November 1966 to November 1968. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a May 1996 rating decision of the Montgomery, Alabama, Department of Veterans Affairs Regional Office (VARO). FINDING OF FACT Competent medical evidence has not been presented showing a nexus, or link, between the veteran's gastrointestinal hemorrhage or ulcers and his service-connected post traumatic stress disorder. CONCLUSION OF LAW A well grounded claim for service connection for the cause of the veteran's death has not been presented. 38 U.S.C.A. §§ 1310, 5107 (West 1991 & Supp. 1999); 38 C.F.R. § 3.312 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant seeks service connection for the cause of the veteran's death. She argues that the veteran's service- connected post traumatic stress disorder (PTSD) caused or contributed to the stomach problems, which in turn led to his death. Service connection for the cause of the veteran's death may be granted if the evidence of record demonstrates that a disability incurred in service caused the veteran's death. 38 U.S.C.A. § 1310 (West 1991); 38 C.F.R. § 3.312 (1999). Additionally, the death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either a principal or contributory cause of death. The issue involved must be determined by the exercise of sound judgment, without recourse to speculation, after careful analysis of all the facts and circumstances surrounding the death of the veteran. 38 C.F.R. § 3.312(a) (1999). A findings that the service-connected disability was a contributory cause of death requires objective evidence that it substantially or materially contributed to the cause of death, by either combining to cause death, or aiding or lending assistance to the production of death. It is not sufficient to show that the service-connected disability casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1) (1999). However, the threshold question to be answered in all cases is whether the appellant's claim is well grounded; that is, whether it is plausible, meritorious on its own, or otherwise capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990); Epps v. Gober, 126 F. 3d 1464 (1997), adopting the definition in Epps v. Brown, 9 Vet. App. 341, 344 (1996). If a particular claim is not well grounded, then the appeal fails and there is no further duty to assist in developing facts pertinent to the claim since such development would be futile. 38 U.S.C.A § 5107(a) (West 1991 & Supp. 1999). Furthermore, a claim which is not well grounded precludes the Board from reaching the merits of a claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). In cases such as this, where the determinative issue is one involving medical causation, competent medical evidence in support of the claim is required for the claim to be well grounded. See Caluza v. Brown, 7 Vet. App. 498, 504 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). An appellant has, by statute, the duty to submit evidence that a claim is well grounded. 38 U.S.C.A. 5107(a) (West 1991 & Supp. 1999). Where such evidence is not submitted, the claim is not well grounded, and the initial burden placed on the appellant is not met. See Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Evidentiary assertions by the appellant must be accepted as true for the purposes of determining whether a claim is well grounded, except where the evidentiary assertion is inherently incredible. See King v. Brown, 5 Vet.App. 19 (1993). A review of he claims folder reflects that the veteran served on active duty from November 1966 to November 1968. He served in the Republic of Vietnam and received the Combat Infantryman Badge. In June 1986, the veteran was hospitalized for chronic depression with anxiety dating, by history, to his military service, and he reported taking medication for control of his nerves. During psychiatric treatment and after a trial dose of Imipramine, the veteran complained of stomach distress, treated with Pro-Banthine. Discharge diagnoses included depression with anxiety, possible PTSD, and dyspepsia. Service connection for depression with anxiety and PTSD was initially denied by a February 1987 rating decision. VA treatment records dated 1986 and 1987 show treatment for psychiatric complaints, including depression and anxiety. By a rating decision dated June 1988, service connection was established for PTSD at the 10 percent disability level. The veteran's disability evaluation was increased to 50 percent in a September 1989 rating decision, and to 100 percent in a December 1994 rating decision. Numerous psychiatric treatment records are associated with the claims folder. In April 1996, the appellant filed a claim for service connection for the cause of the veteran's death. A death certificate shows that the veteran died in March 1996 due to severe upper gastrointestinal hemorrhage due to large gastric ulcer. In support of the appellant's claim the following evidence was received. Private treatment notes dated from 1978 to 1979 reflects that the veteran complained of stomach and nerve problems. A private hospital report for the period of July to August 1979 reflects that the veteran was treated for severe gastrointestinal symptoms and nervousness. The final diagnoses were pylorospasm, gastroenteritis, and anxiety neurosis and exhaustion syndrome. A private hospital report dated September 1979 reflects that he veteran was admitted for a self-inflicted gunshot wound, a possible depressive reaction. Private hospital admission record dated June 1981 reflects that the veteran was admitted with "acute psychoic [sic]." A private medical statement dated April 1981 reflects that the veteran was seen for progressive emotional disorders that required further evaluation and possible hospitalization. The veteran was described as moderately depressed with a great deal of anxiety. It was noted that the veteran should avoid work because he was "too anxious" and under too much pressure. A follow-up medical statement dated April 1981 reflects that the veteran had significant psychological problems, including suicidal tendencies. A private discharge summary dated June 1981 reflects that the veteran was admitted for back strain and seen by staff psychologists during hospitalization. The final diagnoses were acute back strain, acute and chronic depressive reaction, and status post gunshot wound to the right chest. Discharge medications included Tagamet. VA outpatient treatment records dated March 1995 to March 1996 show treatment for multiple disabilities, including PTSD, chronic obstructive pulmonary disease, congestive heart failure, gout, and diabetes mellitus. Private medical records reflect that the veteran was admitted to a private hospital in March 1996 for an upper gastrointestinal bleed, described as significant. Upper endoscopy failed to locate precise site of the bleeding ulcer, but surgery revealed the ulcer at the highest point of the posterior gastric fundus. It was noted that the veteran had at least 2 to 2.5 liters of blood in his stomach, and gallstones were found. Operations performed were laparotomy with gastrotomy and evacuation of large clot, over-sew of ulcer, vagotomy and pyloroplasty, and cholecystectomy. The procedures were noted to have been tolerated well. A death summary dated March 1996 reflects that the veteran was admitted to a private hospital for a gastrointestinal hemorrhage. It was noted that the veteran had no prior history of gastrointestinal hemorrhage or ulcer disease, but he had reported epigastric distress in the 2 weeks prior to hospitalization. He took Prilosec daily for upset stomach for the prior month. Soon after admission, the veteran reported chest pain and myocardial infarction was suspected, but it was elected to proceed with an upper endoscopy because of severe gastrointestinal bleeding. The veteran was thereafter sent to surgery to stop the hemorrhage. Post operatively the veteran survived several hours after surgery but then he became asystolic. Resuscitation was unsuccessful. The death diagnoses were (1) Death due to combination of several severe events including massive upper gastrointestinal hemorrhage and acute myocardial infarction; (2) acute inferior wall myocardial infarction; (3) severe upper gastrointestinal hemorrhage from a bleeding large gastric ulcer which had eroded into the bed of the pancreas causing arterial bleeding from a pancreatic vessel; (3) history of myocardial infarction and congestive heart failure in the past; (4) history of gout, diabetes, coronary artery bypass graft surgery in 1990, and cervical spine surgery; (5) skin cancer of the nose, and; (6) chronic chest wall pain after previous bypass surgery. Having reviewed the evidence submitted in this case, the Board finds that competent medical evidence has not been presented showing a nexus, or link, between the veteran's gastrointestinal hemorrhage or ulcers and his service- connected post traumatic stress disorder. While the records show treatment for stomach and psychiatric problems, these conditions are not linked medically. Additionally, we observe that there are no records of treatment or diagnosis of stomach problems either during the veteran's service or within a one-year period thereafter. Medical records indicate that the veteran was not diagnosed with ulcer or chronic gastrointestinal disability until his terminal hospital admission in March 1996, and there is no competent medical opinion linking his gastrointestinal problems, specifically his gastrointestinal hemorrhage and ulcer, to either the veteran's service-connected PTSD or his period of service generally. Because the appellant is a lay person, her opinion that the veteran's stomach problems were caused or contributed to by service-connected PTSD, eventually leading his death, is insufficient to well ground the cause of death claim. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992) (holding that lay persons are not competent to offer medical opinions). Because the appellant has failed to meet her initial burden of submitting evidence of a well grounded claim for cause of death benefits, the VA is under no duty to assist her in developing the facts pertinent to her claim. See Epps v. Gober, 126 F.3d 1464, 1468 (1997). As the Board is not aware of the existence of additional available evidence that might well ground the appellant's claim, a duty to notify does not arise pursuant to 38 U.S.C.A. § 5103(a). See McKnight v. Gober, 131 F.3d 1483, 1484-85 (Fed. Cir. 1997). That notwithstanding, the Board views its discussion as sufficient to inform the appellant of the elements necessary to well ground her claim, and as an explanation as to why her current attempt fails. ORDER Service connection for the cause of the veteran's death is denied. C.P. RUSSELL Member, Board of Veterans' Appeals