Citation Nr: 18154177
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 16-49 711
DATE:	November 29, 2018
REMANDED
The issue of entitlement to service connection for the cause of Veteran’s death is remanded.  
REASONS FOR REMAND
The Veteran had active service from November 1981 to November 2001.  The Veteran died in March 2013.  The Appellant seeks surviving spouse benefits.  
The issue of entitlement to service connection for the cause of the Veteran’s death is remanded.  
The Appellant asserts that service connection for the cause of the Veteran’s death is warranted as he believes that “she was exposed to something that caused her cancer” during her 20 years of active service.  
In order to establish service connection for the cause of a veteran’s death, the evidence must show that a disability incurred in or aggravated by active military service either caused or contributed substantially or materially to the veteran’s demise.  For a service connected disability to be the cause of death, it must singly or with some other condition be the immediate or underlying cause or be etiologically related to the cause of death.  For a service connected disability to constitute a contributory cause 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.  Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death.  38 U.S.C. § 1310; 38 C.F.R. § 3.312.  
The Veteran’s March 2013 death certificate states that the Veteran died due to “natural cardiorespiratory failure;” “septic shock with multi organ dysfunction;” a urinary tract infection; and metastatic colorectal cancer.  
At the time of the Veteran’s death, service connection was in effect for total abdominal hysterectomy residuals with bilateral salpingo oophorectomy residuals and estrogen replacement therapy; lumbar spine osteoarthritis; right wrist fracture residuals with open reduction/internal fixation; right hip strain; left hip strain; right knee meniscal degenerative changes; left knee strain; right ankle strain; and left ankle strain.  
Clinical documentation from University Hospital dated in November 2012 states that the Veteran was admitted for treatment of back pain and fatigue.  Clinical documentation from the Fort Leonard Wood Army Community Hospital dated in November 2012 and December 2012 shows that “patient most likely has colon cancer of some type, but has severe back pain.”  Treating Army medical personnel directed “consider MRI on back due to severe back pain.”  The resulting diagnostic study reported an impression of “r/o cancer and or arthritis or other reasons for severe pain.”  
The report of a September 2013 Department of Veterans Affairs (VA) evaluation and a May 2016 addendum state that “it is less likely as not that the Veteran’s service connected conditions resulted in debilitating effects and general impairment of health to an extent that would render the Veteran less capable of resisting the effects of other disease or injury primarily causing death” and “there is no indication from her clinical records that the other SC conditions were active, or affecting her health, in any way.”  
The Board of Veterans’ Appeals (Board) notes that the VA examiner’s conclusions are contradicted by the private and retired military clinical documentation of record which shows that the Veteran was being treated shortly before her death for severe lumbar spine pain which was etiologically linked to either or both the service connected lumbar spine disability and the diagnosed colorectal cancer.  
VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical evaluation which is accurate and fully descriptive.  McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991).  When VA obtain an evaluation, the evaluation must be adequate.  Barr v. Nicholson, 21 Vet. App. 303 (2007).  Because of the cited deficiencies in the September 2013 VA evaluation and the May 2016 addendum, the Board finds that further VA evaluation is necessary to determine the relationship, if any, between the diagnosed colorectal cancer and the lumbar spine and other service connected disabilities.  
The matter is REMANDED for the following action:
Forward the Veteran’s records to an appropriately qualified physician for review.  The examiner should opine whether it is more likely than not (50 percent or greater probability) that service-connected lumbar spine osteoarthritis and the other service connected disabilities contributed substantially or materially in bringing about her demise.  For a service connected disability to constitute a contributory cause 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.  The examiner should discuss the findings of severe back pain prior to the Veteran’s death in providing the opinion.  A rationale for all opinions should be provided.  

 
Harvey P. Roberts
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. T. Hutcheson, Counsel

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