Veterans Medical Advisor

                                                                            drbash@doctor.com

                   

                         Case from Bureau of Veterans Appeals

Dr. Bash is a veteran of


Citation Nr: 0001481

Decision Date: 01/18/00 | Archive Date: 01/27/00

DOCKET NO. 96-27 247

On appeal from the Department of Veterans Affairs (VA) Regional Office in St. Louis, Missouri

THE ISSUES

Whether new evidence is material to reopen a claim for service connection for the cause of the veteran's death and, if so, whether the reopened claim should be granted.

REPRESENTATION

Appellant represented by: Sean Kendall, attorney at law

WITNESS AT HEARING ON APPEAL

Appellant and son and appellant's niece

ATTORNEY FOR THE BOARD

Robert E. P. Jones, Counsel

INTRODUCTION

The veteran served on active duty from November 1942 until December 1945. The veteran died in March 1982. The appellant is the widow of the veteran. The veteran's awards and decorations included the Combat Infantryman Badge and the Purple Heart Medal. The record reveals that the veteran was captured by the enemy, but that he escaped and returned to friendly forces two weeks later.

This appeal initially arose from a September 1995 rating decision of the St. Louis, Missouri, Regional Office (RO) that denied the appellant's claim that she had submitted new and material evidence to reopen her claim for service connection for the cause of the veteran's death. In a decision dated in October 1997, the Board of Veterans' Appeals (Board) found that new and material evidence had not been submitted and denied the appellant's claim to reopen. The appellant appealed that determination to the United States Court of Appeals for Veterans Claims (Court). The Court determined that the appellant had submitted new evidence. The Court vacated the Board's October 1997 decision and remanded the case to the Board for further adjudication. [citation redacted].

Subsequent to the April 1999 decision by the Court, the appellant submitted additional evidence to the Board. The appellant also submitted a waiver of review by the RO of the newly submitted evidence. Accordingly, this evidence has been considered in the following decision.

FINDINGS OF FACT

1. All relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained by the RO.

2. A May 1990 Board decision denied service connection for the cause of the veteran's death.

3. The evidence received since the May 1990 decision includes new evidence which is so significant that it must be considered in order to fairly decide the merits of the claim.

4. The claim for service connection for the cause of the veteran's death is well grounded.

5. The veteran died of cardiovascular disease which had its onset during service.

CONCLUSION OF LAW

1. New and material evidence to reopen the appellant's claim has been presented and the appellant's claim for service connection for the cause of the veteran's death is reopened. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156 (1999).

2. The claim for service connection for the cause of the veteran's death is well grounded. 38 U.S.C.A. § 5107 (West 1991).

3. Cardiovascular disease was incurred in service, and caused, or contributed substantially or materially to cause, the veteran's death. 38 U.S.C.A. §§ 5107, 1310 (West 1991); 38 C.F.R. § 3.312 (1999).

REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Reopened Claim

The appellant contends that she is entitled to service connection for the cause of the veteran's death. The Board denied entitlement to service connection for the cause of the veteran's death in a May 1990 decision. The Board determined that the veteran's service-connected anxiety disorder and his other service-connected disabilities did not cause or contribute substantially or materially to the veteran's death from a myocardial infarction as a result of cardiovascular disease. The Board also determined that the veteran did not develop a cardiovascular disability as a result of service.

The evidence of record in May 1990 included the veteran's service medical records; VA medical records and examination reports; private medical records; a transcript of November 1982 testimony of the appellant before a hearing officer; the veteran's death certificate; an August 1982 statement from Alden P. Sargent, M.D., and November 1988, and May 1989 statements from John P. Sargent, M.D.

The service medical records indicate that the veteran had a blood pressure of 150/86 upon examination for entry to service, in November 1942. A March 1945 record indicates that the veteran's blood pressure was 140/90.

On initial VA examination subsequent to service in November 1949, the veteran complained of a frequent sensation of pressure in the region of his heart at night when lying down. The veteran complained of sharp epigastric pain with no relation to food and of having a tight or constricted feeling around his heart when examined by VA in December 1954. On VA hospitalization in February 1976 the veteran had a blood pressure of 160/94.

The veteran's death certificate indicates that the veteran died in March 1982 of an acute myocardial infarction due to arteriosclerotic cardiovascular disease. An autopsy was not performed.

At the time of the veteran's death service connection and a 70 percent rating was in effect for psychoneurosis. Service connection was also in effect for a prepyloric ulcer, rated 20 percent disabling, and for a scar on the left leg, rated noncompensable. He had a combined evaluation of 80 percent and was entitled to a total rating based on individual unemployability.

In his August 1982 opinion, Dr. Alden P. Sargent noted that cardiac conditions are adversely affected by stress. He stated that the veteran's service-connected nervous disorder should be considered a factor producing the stress that eventually contributed to his death. In his May 1989 opinion, Dr. John P. Sargent stated that the veteran's service related "nervous diathesis" was a significant and probably major factor leading to the veteran's death.

A previously denied claim will be reopened if new and material evidence is submitted in support thereof. 38 U.S.C.A. § 5108. "New and material evidence" means evidence not previously submitted to agency decisionmakers, which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with the evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a).

The evidence submitted since the May 1990 decision includes September 1994, May 1996, and November 1996 statements and attachments from Dr. John P. Sargent; an August 1996 opinion from a VA physician; a transcript of the appellant's hearing before a RO hearing officer in March 1997; and an October 1999 statement from Craig N. Bash, M.D.

In his May 1996 statement, Dr. Sargent pointed out that the veteran's records were replete with reports of chest pain from 1943 through 1982. It was his professional opinion that the veteran's symptoms were very suggestive and very possibly the earliest manifestations of his heart condition, aggravated by post-traumatic stress disorder, which together subsequently lead to his premature death. Dr. Sargent went on to note that while medical professionals at that time failed to properly diagnose the veteran's heart condition, there should be some allowance made for the fact that the medical diagnostic equipment used in the 1940's and 1950's was less adequate by today's standards.

The record contains an August 1996 opinion from a VA physician. The VA physician stated that there is no connection between post-traumatic stress disorder (PTSD) and aggravation of coronary artery disease, but also stated that PTSD can cause stress which can increase the oxygen demand upon the heart.

In an October 1999 statement, Dr. Bash noted that he had reviewed the veteran's record and he gave a report of the veteran's medical history. It was Dr. Bash's impression that the veteran's immediate cause of death was due to a myocardial infarction as a consequence of progressive arteriosclerotic cardiovascular disease which was exacerbated and accelerated both by excessive anxiety and post-traumatic stress disorder (because the veteran would not take his cardiac medications). Dr. Bash opined that the veteran had cardiovascular disease in service which persisted until his death and was initially manifest by hypertension in service. Dr. Bash noted that he agreed with Dr. Sargent's opinion that the veteran's death was directly due to his heart condition, which was present during his service. Finally, Dr. Bash stated that he disagreed with the August 1996 VA opinion because the physician apparently did not do a thorough review of the medical records.

Since the "new" post May 1990 medical opinions from Dr. Sargent and Dr. Bash directly link the veteran's cardiovascular disease to service, this evidence is clearly probative of a nexus relationship between the cause of the veteran's death and service-related disability. As such, it is significant and must be considered in order to fairly decide the merits of the claim. Consequently, the veteran's claim must be reopened and considered on a de novo basis.

II. De Novo Adjudication

The Board notes that the record does show that the veteran had measurements of elevated blood pressure during service. The Board further notes that two private physicians, one who examined the veteran while he was alive, and both who thoroughly examined the veteran's record, have stated that the veteran developed cardiovascular disease, which later resulted in his death, during service. As such, there exists a plausible basis for the claim, and the claim is well grounded. 38 U.S.C.A. § 5107 (West 1991). The competent clinical evidence of record which supports the appellant's claim is assigned a greater probative value than the August 1996 opinion of a VA examiner, as such opinions reflect a more reasoned analysis based on review of all the evidence of record. Consequently, the Board finds that the veteran's death from an acute myocardial infarction resulted from cardiovascular disease which first developed during service. Accordingly, the evidence supports the appellant's claim for service connection for the cause of the veteran's death.

ORDER

The appellant's claim for service connection for the cause of the veteran's death is reopened, and the appeal to this extent is granted.

The appellant's claim for service connection for the cause of the veteran's death is well grounded, and the appeal to this extent is granted.

Entitlement to service connection for the cause of the veteran's death is granted.




U. R. POWELL

Member, Board of Veterans' Appeals



Department of Veterans Affairs

drbash@doctor.com

______________________

Craig N. Bash M.D., M.B.A.

Neuro-Radiologist and Associate Professor

Uniformed Services School of Medicine

NPI/UPIN-1225123318

4938 Hampden Lane
Bethesda, Md 20814

Cell/Text 240-506-1556
Fax 301-951-9106