Source: https://va-claim.com/2018/10/29/entitlement-to-service-connection-for-the-cause-of-the-veterans-death-denied-citation-nr-18131301/
Timestamp: 2019-04-21 08:38:50+00:00

Document:
Entitlement to service connection for the cause of the Veteran's death is denied.
1. The Veteran died in February 2006 and the death certificate lists the immediate cause of the Veteran’s death as pneumonia.
2. At the time of the Veteran’s death, service connection was in effect for coronary artery disease, rated at 60 percent disabling.
3. Coronary artery disease did not cause or contribute to the Veteran’s death.
4. The evidence does not show that the Veteran’s pneumonia or any other respiratory disorder had its clinical onset during service or was otherwise etiologically related to any incident or injury therein.
The criteria for service connection for the cause of the Veteran’s death are not met.  38 U.S.C. §§ 1110, 1131, 1310, 1312, 5103, 5103A, 5107, 7104 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.312 (2017).
The Veteran had active military service from January 1969 to January 1971.  As noted above, the Veteran dies in February 2006.  The appellant is the Veteran’s surviving spouse.
This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California.
In order to establish service connection for the cause of the Veteran’s death, the evidence must show that a service-connected disability was either the principal or a contributory cause of death. 38 U.S.C. § 1310 (2012); 38 C.F.R. § 3.312(a) (2017). 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. 38 C.F.R. § 3.312(b). 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. 38 C.F.R. § 3.312(c)(1). 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.
The death certificate of record shows that the Veteran died in February 2006.  The death certificate listed his immediate cause of death as pneumonia.  At the time of the Veteran’s death, the Veteran was service-connected for coronary artery disease.
A review of the evidence shows that the Veteran’s service treatment records (STRs) are silent for treatment for pneumonia or any other respiratory disability, or symptoms that could be attributed to a later a diagnosis of pneumonia, while the Veteran was in active service.  The Board acknowledges that the STRs include an August 1970 service separation examination report which notes that bilateral peripheral calcifications were present in both lung fields consistent with old granulomatous disease, and that central hilar calcifications were also present.  However, there is no indication from the record that such findings are in any way related to a diagnosis of pneumonia over 30 years later.
Moreover, the Veteran’s post-service treatment records are silent for treatment for pneumonia or any other respiratory problems until several decades following his separation from service.  To that end, the record reflects that the Veteran was diagnosed with pneumonia in 2004.  A September 2004 VA medical note indicates that the Veteran had a history of tobacco abuse and crack cocaine abuse.  At that time, the Veteran reported that he smoked approximately two packs of cigarettes a day.
In a November 2014 VA medical opinion, the examiner opined that it was less likely than not that the Veteran’s coronary artery disease contributed to the Veteran’s death.  In this regard, the examiner indicated that the Veteran’s coronary artery disease did not cause debilitating effects and general impairment of health to an extent that would render a person materially less capable of resisting the effects of other disease or injury primarily causing the Veteran’s death.  In his rationale, the examiner indicated that the Veteran’s pneumonia was most likely caused by his bronchial fistula and exacerbated by his smoking induced suspected chronic obstructive pulmonary disease (COPD).  The examiner indicated that neither bronchial fistulas nor COPD were known to be caused or aggravated by coronary artery disease.
Further, the examiner stated that the chest X-ray abnormalities found on the Veteran’s August 1970 service separation examination were benign, incidental findings that had no relationship to the Veteran’s development of pneumonia decades following his separation from service.  In reaching that conclusion, the examiner acknowledged the Veteran’s August 1970 service separation examination, which showed abnormalities of the chest.  The examiner noted that no respiratory symptoms were reported at that time of the service separation examination.  The examiner opined that it was less likely than not that such abnormalities were the cause of the Veteran’s respiratory conditions, to include pneumonia.
The Board finds that the November 2014 medical opinion is adequate because the examiner thoroughly reviewed the record and discussed the relevant evidence, considered the contentions of the appellant, and provided a thorough supporting rationale for the conclusions reached.  Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  As such, the November 2014 medical opinion is the most probative evidence of record.
While laypersons are competent to report observable symptoms, they are not competent to provide an opinion linking diagnosed pneumonia to active service and an opinion linking a cause of death to a service-connected disability.  Opinions of that nature require medical expertise and are outside the realm of common knowledge of a layperson.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  Therefore, the appellant is not competent to provide an etiology opinion in this case.
In sum, there is no competent evidence of record indicating that the Veteran’s pneumonia had its onset during his active service, or is otherwise etiologically related to such service.  Further, there is no competent evidence of record indicating that the Veteran’s service-connected coronary artery disease contributed substantially and material to the pneumonia that caused his death.  The appellant has not submitted any medical opinions or treatment records supporting her claim, and the only medical opinion of record, that of the November 2014 VA examiner, weighs against the claim.
Accordingly, the Board finds that a preponderance of the evidence is against the claim and entitlement to service connection for the cause of the Veteran’s death is not warranted.  38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

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