ptsd Grrr - I Got Another Rubber Stamp Denial

[akwidow]

AMC came through with a SSOC in todays mail. Once again, I am denied for DIC.

They did not list my evidence. (spoilation?) Rubber stamp again!

They did not address my issue - that PTSD contributed to my hubbys death. (denial made while not condiserating my position)

As an aside, they mentioned the DVD I sent them with the second set of papers but did not list the evidence, and never mentioned the original documents I sent...(spoilation?)

I have thirty days to respond, which I will, with the full gamut of information I have already supplied. They said if I do not respond within 30 days, they will send the file back to the BVA. Is that good for me or bad?

GRRR I am angry.

Should I ask for a reconsideration, or make a NOD?

I had already connected the dots, supplied IMO for PTSD, and copied them with their documents pertaining to his PTSD.

My friends here are telling me to get out of the loop and get congressional intervention, even though I told them about the retribution that it can cause.... any thoughts?

Thanks, please forgive me for venting,

AkWidow

[akwidow]

yes, the death certificate was amended to add PTSD as secondary cause of death.

I was going over his psych exams yesterday, and found the paragraph where in 2003 the VA examiner opined that my vet was suffering greatly in the early 90's from his ptsd. This co-insides with his psych phd counselor who made the same conclusion.

I reread medical reports I gathered, and feel my doctor letters both medical and psych efficiently support my claim. They all meet the at least likely as not standard. My first application was hand written, and poorly supported...grief written. The data I supplied after the remand was not listed as evidence and the reasons and basis section did not address the remand completely - they still did not tell my why my data did not count as proof. They simply dismissed it as immaterial.

[Wings]

x

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The ISSUE

Entitlement to service connection for cause of the Veteran's

death.

Service connection may be established for the cause of a

Veteran's death when a service-connected disability "was

either the principal or a contributory cause of death." See

38 U.S.C.A. § 1310 (West 2002); 38 C.F.R. § 3.312(a) (2008);

see also 38 U.S.C.A. §§ 1110 and 1112 (setting forth criteria

for establishing service connection). A service-connected

disability is the principal cause of death when that

disability, "singly or jointly with some other condition,

was the immediate or underlying cause of death or was

etiologically related thereto." See 38 C.F.R. § 3.312(b)

(2008). A contributory cause of death must be causally

connected to the death and must have "contributed

substantially or materially" to death, "combined to cause

death," or "aided or lent assistance to the production of

death." See 38 C.F.R. § 3.312©(1) (2008). See generally

Harvey v. Brown, 6 Vet. App. 390, 393 (1994).

In order to establish service connection for cause of death,

there must be (1) evidence of death; (2) evidence of in-

service incurrence or aggravation of a disease or injury; and

(3) medical evidence of a nexus between the claimed in-

service disease or injury and death. See Hickson v. West, 12

Vet. App. 247, 253 (1999).

yes, the death certificate was amended to add PTSD as secondary cause of death.

This "amendment" is significant medical evidence that would support direct service-connection. I do not know the legalities of a true and proper death certificate, but I would think that if the M.D.'s amenndment was, in fact, lawful procedure, then the VA could not ignore the credibility or weight of this evidence. Has this fact been entered into the Board's record?

I was going over his psych exams yesterday, and found the paragraph where in 2003 the VA examiner opined that my vet was suffering greatly in the early 90's from his ptsd. This co-insides with his psych phd counselor who made the same conclusion.

I reread medical reports I gathered, and feel my doctor letters both medical and psych efficiently support my claim. They all meet the at least likely as not standard. My first application was hand written, and poorly supported...grief written. The data I supplied after the remand was not listed as evidence and the reasons and basis section did not address the remand completely - they still did not tell my why my data did not count as proof. They simply dismissed it as immaterial.

Comment: Your "doctors letters" must be discusss in detail, see below. Also, have those reports Notorized!!

http://www4.va.gov/vetapp09/files2/0917900.txt

Citation Nr: 0917900

Decision Date: 05/13/09 Archive Date: 05/21/09

DOCKET NO. 05-38 298 ) DATE

)

)

On appeal from the

Department of Veterans Affairs Regional Office in Winston-

Salem, North Carolina

THE ISSUE

Entitlement to service connection for the cause of the

Veteran's death.

REPRESENTATION

Appellant represented by: The American Legion

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

C. J. Houbeck, Associate Counsel

INTRODUCTION

The appellant is the widow of a Veteran who served on active

duty from May 1944 to May 1946.

This matter comes before the Board of Veterans' Appeals

(Board) on appeal from an April 2005 administrative rating

decision of the Department of Veterans Affairs (VA) Regional

Office (RO) in Winston-Salem, North Carolina, which denied

the claim on appeal.

In March 2009, a travel board hearing was held before the

undersigned Veterans Law Judge at the Winston-Salem RO. A

transcript of the proceeding has been associated with the

record.

FINDINGS OF FACT

1. The Veteran died in September 1994 at the age of 68.

Cardiac arrest due to ASCVD was certified as the immediate

cause of death on his death certificate; diabetes mellitus,

osteomyelitis, and neuropathy were certified as the other

significant conditions contributing to death. The appellant

is his surviving spouse.

2. The Veteran had no diagnosis of any heart condition or

post traumatic stress disorder (PTSD) during service or

within one year after his discharge from service.

3. At the time of his death, the Veteran was not service-

connected for any conditions; nor had he sought service

connection for any condition; however, the Veteran could have

been service-connected for PTSD.

4. There is at least an approximate balance of positive and

negative evidence as to whether PTSD incurred in or

aggravated by military service contributed substantially or

materially to cause the Veteran's death.

CONCLUSION OF LAW

Resolving doubt in favor of the appellant, a disability

incurred in or aggravated by service caused or contributed

substantially or materially to cause the Veteran's death. 38

U.S.C.A. §§ 1110, 1310, 5103A, 5107 (West 2002 & Supp. 2008);

38 C.F.R. §§ 3.303, 3.312 (2008).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Veterans Claims Assistance Act of 2000 (VCAA)

The VCAA describes VA's duties to notify and assist veterans

in substantiating a claim for VA benefits. 38 U.S.C.A.

§§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp.

2008); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a)

(2008). In light of the favorable decision herein as to the

sole issue on appeal, the Board finds that any deficiencies

in notice were not prejudicial to the appellant.

Service Connection for Cause of Death

Service connection may be established for a disability

resulting from personal injury suffered or disease contracted

in the line of duty in the active military, naval, or air

service. 38 U.S.C.A. § 1110 (West 2002 & Supp. 2008). That

an injury or disease occurred in service is not enough; there

must be chronic disability resulting from that injury or

disease. If there is no showing of a resulting chronic

condition during service, then a showing of continuity of

symptomatology after service is required to support a finding

of chronicity. 38 C.F.R. § 3.303(b) (2008). Service

connection may also be granted for any injury or disease

diagnosed after discharge, when all the evidence, including

that pertinent to service, establishes that the disease or

injury was incurred in service. 38 C.F.R. § 3.303(d) (2008).

To establish service connection for a disorder there must be:

(1) medical evidence of the current disability; (2) medical,

or in certain circumstances, lay evidence of the in-service

incurrence of a disease or injury; and (3) medical evidence

of a nexus between the claimed in-service disease or injury

and the current disability. See Gutierrez v. Principi 19

Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App.

247, 253 (1999)).

Service connection for PTSD specifically requires medical

evidence establishing a diagnosis of the disability, credible

supporting evidence that the claimed in-service stressor

actually occurred, and a link, established by medical

evidence, between the current symptomatology and the claimed

in-service stressor. See 38 C.F.R. § 3.304(f) (2008).

If the evidence establishes that the Veteran engaged in

combat with the enemy and the claimed stressor is related to

that combat, in the absence of clear and convincing evidence

to the contrary, and provided that the claimed stressor is

consistent with the circumstances, conditions, or hardships

of the Veteran's service, the Veteran's lay testimony alone

may establish the occurrence of the claimed in-service

stressor. See 38 C.F.R. § 3.304(f)(1) (2008); see also, 38

U.S.C.A. § 1154(b) (West 2002 & Supp. 2008). Otherwise, the

law requires verification of a claimed stressor. Where a

determination is made that the Veteran did not "engage in

combat with the enemy," or the claimed stressor is unrelated

to combat, the Veteran's lay testimony alone will not be

enough to establish the occurrence of the alleged stressor.

See Moreau v. Brown, 9 Vet. App. 389, 395 (1996); Dizoglio v.

Brown, 9 Vet. App. 163, 166 (1996). In such cases, the

record must include service records or other credible

evidence that supports and does not contradict the Veteran's

testimony. Doran v. Brown, 6 Vet. App. 283, 289 (1994).

Moreover, a medical opinion diagnosing PTSD does not suffice

to verify the occurrence of the claimed in-service stressors.

See Moreau, 9 Vet. App. at 395-396; Cohen v. Brown, 10 Vet.

App. 128, 42 (1997).

To warrant service connection for the cause of a veteran's

death, the evidence must show that a disability incurred in

or aggravated by active service was the principal or

contributory cause of death. 38 U.S.C.A. § 1310; 38 C.F.R.

§ 3.312(a) (West 2002 & Supp. 2008). In order to constitute

the principal cause of death the service-connected disability

must be one of the immediate or underlying causes of death,

or be etiologically related to the cause of death. See 38

C.F.R. § 3.312(b) (2008). For a service-connected disability

to constitute a contributory cause of death, it must be shown

that it contributed substantially or materially; 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. 38 U.S.C.A. § 1310; 38 C.F.R. § 3.312.

The regulations provide that service-connected diseases

involving active processes affecting vital organs should

receive careful consideration as a contributing cause of

death 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 the disease primarily causing

death. 38 C.F.R. § 3.312©(3). Moreover, there are primary

causes of death, which by their very nature are so

overwhelming that eventual death can be anticipated

irrespective of coexisting conditions. A service-connected

disability is not generally held to have accelerated death

unless such disability affects a vital organ and was itself

of a progressive or debilitating nature. 38 C.F.R. §

3.312©(4).

Medical evidence is required to establish a causal connection

between service or a disability of service origin and the

Veteran's death. See Van Slack v. Brown, 5 Vet. App. 499,

502 (1993).

The debilitating effects of a service-connected disability

must have made the Veteran materially less capable of

resisting the fatal disease or must have had a material

influence in accelerating death. See Lathan v. Brown, 7 Vet.

App. 359 (1995).

In determining whether a veteran's service-connected

disabilities contributed to the cause of his death, the Board

has the duty to assess the credibility and weight to be given

to the evidence. See Madden v. Gober, 125 F.3d 1477 (Fed.

Cir. 1997). When all the evidence is assembled, VA is

responsible for determining whether the evidence supports the

claim or is in relative equipoise, with the appellant

prevailing in either event, or whether a preponderance of the

evidence is against the claim, in which case, the claim is

denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

The Veteran's death certificate reflects that he died in

September 1994 of cardiac arrest due to ASCVD. The appellant

contends that PTSD or other psychiatric disorder, incurred

during the Veteran's military service, substantially

contributed to or materially hastened the Veteran's death.

As an initial matter, the Board notes that the Veteran was

not service-connected for any condition at the time of his

death. Given that the Veteran was not service-connected for

a heart condition, PTSD, or other psychiatric condition, it

is necessary to determine whether service connection should

have been established for such.

The Board notes that according to the Veteran's personnel

records he was stationed aboard the U.S.S. Tyrrell from

December 1944 to April 1946, with an MOS of Ship Service Man

(Laundry). This is not a position normally associated with

combat; however, the Board notes that the Veteran received a

battlestar with his Asiatic-Pacific Campaign Medal. While

the Veteran was aboard the U.S.S. Tyrrell, the ship

participated in the invasion of Okinawa, from April 1 to

April 10, 1945. During the invasion, there is a well-

documented attempt by a Japanese pilot to crash his plane

into the Tyrrell. The records indicate that the Veteran

related the incident to his father immediately after service

(as documented in a 1948 treatment record) and noted that the

incident gave him a "terrible fright." In light of the

Veteran's reported statements as documented in treatment

records, and the official records of the Veteran's exposure

to a suicide attack aboard the U.S.S. Tyrrell, the Board

acknowledges that the Veteran was subject to an in-service

stressor that may be presumed to have occurred.

Even with a conceded in-service stressor, the evidence must

still establish by competent medical evidence that the

Veteran had a disability at the time of his death due to

those service events. See Gregory v. Brown, 8 Vet. App. 563,

567 (1996); see also Kessel v. West, 13 Vet. App. 9, 17-19

(1999). As there is an approximate balance of the positive

and negative evidence as to whether he had PTSD due to

service, the Board concludes service connection would have

been warranted.

A review of the Veteran's service treatment records do not

indicate - nor is it contended - that the Veteran was

diagnosed with or treated for PTSD or other psychiatric

disorders in service or within one (1) year of discharge.

Post service medical records reflect that the Veteran was

hospitalized for an anxiety disorder in May 1948 and July

1952, for eight (8) and ten (10) days respectively. The

Board notes that efforts to obtain the Veteran's complete

medical records of treatment from 1948 to 1952 at the VA

medical center in Fayetteville, Arkansas were unsuccessful,

save two (2) records of hospitalization, noted above, and a

social worker's report of an interview with the Veteran's

father in May 1948. The report noted "since [the Veteran's]

discharge from service it is necessary for the mother to

awaken him often because he seems to be struggling with

battle dreams." The Veteran's father was interviewed, who

reported that the Veteran had related the incident aboard the

USS Tyrrell, and noted that the incident gave him a

"terrible fright." The social worker also documented

reports that the Veteran was depressed, despondent, and had

"spoken short to his mother several times and hurt her

feelings." The Veteran's father also asserted the Veteran

suffered from a stomach condition that had been diagnosed as

"due entirely to his nerves." The social worker did note,

however, that the father "either blocked on pertinent

information about the son's nervous condition or else the son

is not a very nervous case." The claims file is otherwise

silent as to treatment for PTSD or other psychiatric

disorder.

In support of her claim, the appellant submitted three (3)

letters from the Veteran's treating physician. The first

letter, dated in September 2004, stated, in relevant part:

[The Veteran] suffered from severe anxiety,

depression, and post traumatic stress disorder from

his combat experiences in World War II. His whole

life was marred by anxiety and depression and I

believe his untimely death due to coronary artery

disease was greatly affected by his anxiety. All

during his married life, after the war, his

relationships, his employment opportunities and his

general functioning was affected by his anxiety and

depression which he was never able to overcome.

[The Veteran] suffered early coronary artery

disease and died of a heart attack largely from his

anxiety from his war experiences.

The private physician's second letter, dated in March 2005,

reiterated that the Veteran "served faithfully during the

South East Asian campaign against Japan and suffered

posttraumatic stress and anxiety his entire life as a result

of that." The physician stated that his psychiatric

conditions contributed to his death because they often caused

the Veteran to deny his heart and diabetic conditions or to

comply with diet, exercise, or rehabilitation regimens. The

third letter, dated in March 2008, stated:

[The Veteran] suffered from severe post traumatic

stress disorder that made him die early because he

did not care for himself adequately, being afraid

of things, tests and diseases. He ignored his

illnesses and did not care for his diabetes and

heart disease well.

He suffered nightmares and was always anxious,

suffering from anxiety and PTSD, unable to muster

the strength to eat well, follow up, and generally

live easily he developed diabetes and heart

disease. Unable to bring himself to compliance he

died prematurely, I believe greatly affected by

post traumatic stress from his service days.

The Board observes that the crux of the appellant's argument

is that service connection should be established for PTSD and

that the cause of death was related to such. The Board notes

the absence of any contemporaneous treatment records

diagnosing the Veteran with PTSD. However, based on the

Veteran's personnel records, reported statements, and letters

from his treating physician, the Board concludes that service

connection for PTSD can be established. As discussed above,

the Board concedes an in-service stressor. Based on the

Veteran's private treating physician's letters, the Board

concludes that the Veteran had a diagnosis of PTSD at the

time of his death and the physician has linked that current

diagnosis to the Veteran's military service. The Board notes

that the physician provided some basis and rationale for his

conclusion.

Although the absence of actual treatment records reflecting a

diagnosis of PTSD during the Veteran's life certainly weighs

against the claim, the Board finds that the 1948 report

discussed above, which corroborates that the Veteran had a

breakdown shortly after service, and that he had described

the incidents aboard the USS Tyrrell at that time as

frightening, at least places the record in relative

equipoise. Thus, giving the appellant the benefit of the

doubt, the evidence supports that the Veteran could have been

service-connected for PTSD at the time of his death.

Furthermore, the Board also finds that the competent and

probative evidence of record supports the conclusion that the

Veteran's PTSD substantially and materially contributed to

his death. This conclusion is based on the letters,

discussed in detail above, from the Veteran's private

treating physician. The physician unequivocally stated that

the Veteran's PTSD and other psychiatric disorders materially

and substantially contributed to his death, primarily because

his psychiatric conditions often manifested in his denial of

his heart and diabetic conditions and noncompliance with

diet, exercise, and rehabilitation programs.

The Board acknowledges that the Veteran's certificate of

death does not list PTSD as a primary or contributory cause. [yours does!]

The Board notes, however, that the Veteran's private

physician completed and signed the certificate of death.

Thus, his subsequent letters serve only to supplement the

causes listed on the certificate of death and cannot be

viewed as contradicting the certificate.

In summary, the evidence shows that the Veteran could have

been service-connected for PTSD at the time of his death.

Further, the only medical evidence of record unequivocally

states that the Veteran's PTSD was a substantial and material

contributory factor in his death. As noted, the Board is

admittedly troubled that the claims file does not include

contemporaneous treatment records for PTSD and that the

contemporaneous record of the cause of the Veteran's death,

the certificate of death, does not list PTSD as a primary or

contributory factor. However, given the clear opinions

expressed by the Veteran's treating physician and other

evidence of record such as the 1948 report discussed above,

as well as the absence of any conflicting medical opinions,

the Board finds the benefit of the doubt doctrine to be

applicable. See Gilbert, supra.

ORDER

Service connection for the cause of the Veteran's death is

granted.

____________________________________________

MICHAEL LANE

Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

[Vync]

Fascinating. I wonder how the physician worded the linkage to SC. It had to be "at least as likely as not".

[Wings]

x

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We can learn from this BVA case (what to do, and not do)! Your Nexus needs to be very well done, professional! ~Wings

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http://www4.va.gov/vetapp09/files3/0917791.txt

The Board observes that the only

medical evidence that indicates that his service-connected

anxiety disorder contributed to his death from colon cancer

is the death certificate certified by the coroner.

The Board notes, however, that the conclusion that anxiety disorder

contributed to death is unsupported by the contemporaneous

medical evidence of record. Notably, the only reference to

anxiety in the month preceding the Veteran's death is a note

on May 14, which described increased anxiety from caregiver

burden.

Moreover, the death certificate lists the appellant as the

coroner's informant, and there is no evidence that the

coroner's medical opinion was based on a review of the

contemporaneous medical records.

Therefore, the coroner's medical opinion as it pertains

to anxiety disorder as a contributory cause of death has

diminished probative value because it is unsupported by

the medical evidence of record and appears to be based on a history

provided solely by the appellant. See Black v. Brown,

5 Vet. App. 177 (1993) (an opinion that is based on history

furnished by the appellant that is unsupported by clinical

evidence is not probative); Wood v. Derwinski, 1 Vet.

App. 190, 191-92 (1991) (an opinion may be discounted if it

materially relies on a layperson's unsupported history as the premise for the opinion).

The Veteran's private physician, Dr. M. D., also provided

opinions regarding the Veteran's cause of death and

contributing factors. In a death summary

dated in July 2005, Dr. M. D. reported that the Veteran

expired from complications arising from colon cancer and lung

cancer, which were both primary causes. He noted that he was

admitted for delirium. These conclusions were supported by

the contemporaneous medical evidence; therefore, the July

2005 death summary from Dr. M. D. is persuasive because it is

consistent with the medical records.

Dr. M. D. provided two additional medical opinions regarding

contributory causes of death.

In April 2006, he stated that some of the Veteran's difficulties

with delirium could very well have been related to his posttraumatic

stress disorder (PTSD), which came from his days in the Airborne Service.

In October 2006, he indicated that at the end of his life, the

Veteran had some significant problems with delirium related

to medication for his multiple cancers. He added that this

was adversely influenced by his posttraumatic stress

syndrome. Here, Dr. M. D.'s opinions are not medically and

factually supported.

In fact, this physician's 2006 opinions

appear to be based solely on a desire to help the Veteran's

widow, the appellant. The Board points out that the medical

evidence of record fails to show that the Veteran was

diagnosed with, or treated for, PTSD at any time.

Moreover, the Veteran's military records reflect that he did not engage

in combat, and his service treatment records show that he was

hospitalized in early June 1944 when his friend was killed in

action. The Court has held that a bare conclusion, even one

reached by a medical professional, is not probative without a

factual predicate in the record. Miller v. Brown, 11 Vet.

App. 345, 348 (1998). Thus, the probative value of a medical

opinion is significantly lessened to the extent it is based

on an inaccurate factual premise, and a medical opinion based

on an inaccurate factual premise has no probative value.

Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). Therefore,

because the record contains no evidence that the Veteran was

ever diagnosed with PTSD, along with the facts that

Dr. M. D.'s 2006 medical opinions conflict with his own July

2005 death summary report and end-of-life treatment records,

these private medical opinions are not accorded any great

probative weight.

The Board also points out that the fact that this private

physician may have treated the Veteran on a regular basis-

without more-does not add significantly to the probative

value of the 2006 opinions. The Court has expressly declined

to adopt a "treating physician rule" which would afford

greater weight to the opinion of a veteran's treating

physician over the opinion of a VA or other physician. See,

e.g., Winsett v. West 11 Vet. App. 420 (1998).

By contrast, the Board finds more probative the medical

opinion of a VA physician, who reviewed the claims file,

which contained the end-of-life treatment records. In a

December 2006 VA medical opinion, a VA physician opined that

the Veteran's service-connected conversion reaction or

anxiety disorder was less likely as not a contributing factor

or cause of his death.

He reasoned that the Veteran's death

from metastatic cancer was imminent, and the numerous

medications that he was on, in addition to the burden of

having metastatic disease, most likely contributed to his

delirium. This opinion was further supported by his review

of the claims file, citing records that the Veteran was in

the hospice program due to his cancer, was being treated with

narcotic and psychotropic medications, and was being followed

by a psychiatrist for significant episodes of delirium. The

Board finds that the December 2006 VA medical opinion is

persuasive because it was based on a review of the claims

file and contemporaneous medical evidence, which supported

the VA physician's medical rationale. See Nieves-Rodriguez

v. Peake, 22 Vet. App. 295, 302-04 (holding that it is the

factually accurate, fully articulated, sound reasoning

for the conclusion that contributes to the probative value to a

medical opinion.)

Furthermore, the medical records

themselves provide persuasive evidence that the Veteran's

service-connected anxiety disorder did not contribute to his

cause of death, even though it is listed on his death

certificate. Rather, the records clearly show that the

Veteran experienced delirium as a result of narcotic pain

medication, and that the delirium subsided prior to his

death. Also, in December 2004, Dr. J. P. reported that the

Veteran's prognosis was very poor long term. Accordingly,

the appellant's claim for service connection for the

Veteran's cause of death must be denied.

The Board also notes that the Veteran's service treatment

records show no findings of treatment for colon, pulmonary,

or cardiovascular dysfunction, and post-service treatment

records first show colon cancer, lung cancer, and

hypertension many years after the Veteran's separation from

service. Similarly, the evidence of record contains no

opinion that colon cancer, lung cancer, or hypertension was

caused by or aggravated by any service-connected disability.

Therefore, service connection for the Veteran's cause of

death based on colon cancer, lung cancer, or hypertension is

also not warranted.

The Board acknowledges the appellant and her representative's

contentions that the Veteran's service-connected anxiety

disorder was a contributory cause of his death. However, the

record does not show that the appellant or her representative

has the medical expertise that would render competent their

statements as to the relationship between the Veteran's

military service, his service-connected anxiety disorder, and

his cause of death. These opinions alone cannot meet the

burden imposed by 38 C.F.R. § 3.312 with respect to the

relationship between events incurred during service, service-

connected disabilities, and the etiology of his fatal

disability. See Moray v. Brown, 2 Vet. App. 211, 214 (1993);

see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992); see

also 38 C.F.R. § 3.159(a) (2008).

The Board also has considered the articles submitted by the

appellant. Medical treatise evidence can, in some

circumstances, constitute competent medical evidence. See

Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38

C.F.R. § 3.159(a)(1) (competent medical evidence may include

statements contained in authoritative writings such as

medical and scientific articles and research reports and

analyses). Here, the medical articles submitted by the

appellant in April 2009 are general in nature and pertain

primarily to anxiety and psychological factors in relation to

hypertension. The Board finds that these documents lack

probative weight because they do not specifically address the

Veteran, to include his medical history documented in the

claims file. In a long line of cases, the Court has

consistently held that medical treatise evidence that is

generic and inconclusive as to the specific facts in a case

was insufficient to establish causal link. See, e.g.,

Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11

Vet. App. 314 (1998); ; Libertine v. Brown, 9 Vet. App. 521,

523 (1996); Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996).

As indicated above, in this case the Board finds the opinion

of the VA physician dispositive of the medical nexus

question. As the physician explained in detail the reasons

for his conclusions, which were based on consideration of the

record (for which he provided an accurate recitation of the

medical evidence in the claims file), the Board finds that

this opinion constitutes competent and persuasive evidence on

the matter upon which the claim turns. See Prejean v. West,

13 Vet. App. 444, 448-49 (2000); Gabrielson v. Brown, 7 Vet.

App. 36, 40 (1994).

For the foregoing reasons, the appellant's claim for service

connection for the Veteran's cause of death must be denied.

In arriving at this decision, the Board has considered the

applicability of the benefit-of-the-doubt doctrine. However,

as the preponderance of the evidence is against the claim,

that doctrine is not applicable. See 38 U.S.C.A. § 5107(b);

38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-

56 (1990).

[akwidow]

Wings you are wonderful! Thank you so much for that case law!

Yes, the VA has a copy of the death certificate.

Now here is a good question. Does that IMO have to be made by a famous doctor? My local professional already said that PTSD had a direct connection to my husband's death. He didn't say early death however in his statement. If his word will be enough, I can go back to him as ask for another statement that says 'early death' with a dot by dot connection, notarized of course. I have all the records to show the doctor, along with the statements of the other professionals who treated my late hubby and/or observed him over the years...

My spirit has been raised by your work, and I salute you~!

[Pete53]

Wings is a research demon and a treasure to Hadit.