UNDIAGNOSED ILLNESSES

Summary

The veteran, who served from March 1954 to January 1958, passed away in March 2022. His surviving spouse filed a claim for dependency and indemnity compensation, contending that the veteran's service-connected PTSD substantially contributed to his death. The veteran's death certificate lists complications of a right femur fracture as the principal cause. The appellant testified that the veteran, agitated by his PTSD symptoms, exited their vehicle abruptly, leading to his fall and subsequent fracture. Their son corroborated that the veteran's anger and frustration from PTSD influenced his actions. The appellant's attorney also noted that the veteran's PTSD medication, Sertraline, has side effects including dizziness and irritability. The Board found the veteran's PTSD symptoms, including impaired impulse control and irritability, to be a contributory cause of death. The Board noted that the veteran's irritability led him to exit the car rashly, increasing the likelihood of the fall. The Board also took judicial notice that dizziness and irritability are common side effects of Sertraline. While acknowledging negative VA opinions, the Board found they failed to adequately address the PTSD's contribution to the fall. The Board applied the benefit-of-the-doubt principle, finding the evidence in approximate balance and resolving it in the veteran's favor. Service connection for the cause of the veteran's death was granted.

Rationale

Credible evidence establishes PTSD symptoms including impaired impulse control, irritability, and anger.; Veteran and son testified that irritability led to abrupt exit from car, causing fall.; Judicial notice taken that dizziness and irritability are common side effects of Sertraline, prescribed for PTSD.

Full Decision Text

Citation Nr: A26038782
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250929-593099
DATE: April 27, 2026

ORDER

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

FINDINGS OF FACT

1. The Veteran died in March 2022 from complications of right femur fracture with other significant conditions contributing to death to include hypertensive cardiovascular disease. See March 2022 Death Certificate.

2. At the time of the Veteran's death, service connection was not in effect for a right femur fracture, the principal cause of the Veteran's death. However, the credible evidence of record demonstrates that the service-connected PTSD was a contributory cause of his March 2022 death. See Jan. 2025. And Jan. 2026 Brd. Hrg. Trans. and Jan. 2025 Lay Statement.

CONCLUSION OF LAW

The criteria for service connection for the cause of the Veteran's death are met.  38 U.S.C. §§ 1110, 1154(b), 1310, 5107; 38 C.F.R. §§ 3.102, 3.302, 3.303, 3.312.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1954 to January 1958. This matter comes before the Board of Veteran's Appeal (Board) on appeal from a June 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran passed away in March 2022. The appellant is the Veteran's surviving spouse. Subsequently, on July 21, 2022, filed her claim for dependency and indemnity compensation. See July 2022 VA Form 21-534. Subsequently, in October 2022, the RO denied this claim. Thereafter, in October 2023, the Appellant submitted VA Form 20-0995 Supplemental Claim Application. In June 2024, the RO again denied this claim. In response, in October 2024, the Appellant submitted a VA Form 10182 and selected the Hearing with a Veterans Law Judge docket at the Board. On January 16, 2025, the Appellant and her son testified before a Veterans Law Judge. The hearing transcript is of record. 

In March 2025, the Board remanded the claim for further development, including a VA medical opinion. After the requested development was completed, in June 2025, the RO again denied this claim. In response, in September 2025, the Appellant submitted a VA Form 10182 and selected the Hearing with a Veterans Law Judge docket at the Board. On January 12, 2026, the Appellant and her son testified before the undersigned Veterans Law Judge. The hearing transcript is of record. 

Based upon the selection of the Hearing docket, the Board may consider the evidence of record as of June 4, 2025-the date of issuance of the rating decision on appeal, and evidence submitted at or within 90 days of the January 12, 2026 Board hearing. See 38 C.F.R. §§ 20.302. 

As a final note, in November 2025, the Appellant was informed that she had a year from the date her rating decision was mailed to her or within 60 days of the date the Board received her NOD to switch her Board review option. The Appellant did not respond to the Board's November 2025 letter. However, the Appellant has already testified before the Board, therefore, the Appellant is precluded from switching her Board review option. Accordingly, the Board will adjudicate this appeal.

Service Connection the Cause of the Veteran's Death

The Appellant is seeking service connection for the Veteran's cause of death.  Specifically, she contends that the Veteran's PTSD substantially contributed to the cause of his death. She testified that on the day that the Veteran fell, resulting in a right femur fracture, she and the Veteran were driving home. See Jan. 2025 Brd. Hrg. Trans. He quickly got out of the car agitated, which caused him to fall. Id. Additionally, the Veteran and Appellant's son testified that the Veteran dealt with anger and frustration due to PTSD, and would not have gotten out the car by himself had he not been angry. See Jan. 2026 Brd. Hrg. Trans. Alternatively, the Appellant's attorney reported that the Veteran began taking Sertraline for PTSD symptoms, and that this medication's side effects include dizziness, imbalance, and irritability. Id.

Service connection may be established for a disability resulting from
 resulting in a right femur fracture, she and the Veteran were driving home. See Jan. 2025 Brd. Hrg. Trans. He quickly got out of the car agitated, which caused him to fall. Id. Additionally, the Veteran and Appellant's son testified that the Veteran dealt with anger and frustration due to PTSD, and would not have gotten out the car by himself had he not been angry. See Jan. 2026 Brd. Hrg. Trans. Alternatively, the Appellant's attorney reported that the Veteran began taking Sertraline for PTSD symptoms, and that this medication's side effects include dizziness, imbalance, and irritability. Id.

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service.  See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

Service connection for cause of death may be awarded to a veteran's surviving spouse for death resulting from a service-connected disability or a disability related to service.  38 U.S.C. § 1310; 38 C.F.R. § 3.312.  To establish service connection for the cause of the Veteran's death, the evidence must show that a disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death.  The death of a veteran will be considered as having been due to a service-related disability when the evidence establishes that such disability was either the principal or the contributory cause of death. Id. A contributory cause of death is one that contributed substantially or materially to death, combined to cause death, and aided or lent assistance to the production of death.  38 C.F.R. § 3.312(c).  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.  Id.  Although there are primary causes of death that by their very nature are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, even in such cases, consideration must be given to whether there may be a reasonable basis to hold that a service-connected condition was of such severity as to have a material influence in accelerating death, where the service-connected condition affected a vital organ and was of itself of a progressive or debilitating nature.  Id.  

Initially, the record establishes a current disability, as the Veteran was diagnosed with PTSD. Thus, the remaining question is whether there is a nexus between the PTSD and the fall that led to his death.  Following a review of the opinion evidence of record, the Board finds that there is.

In the instant case, after reviewing the evidence of record, the Board concludes that PTSD was a contributory cause of death. In this regard, the competent and credible evidence establishes that the Veteran's PTSD symptoms included impaired impulse control, irritability, and angry outbursts. See March 2013 VA Medical Opinion. Additionally, both the Appellant and his son testified that the Veteran's irritability led to him getting out the car in a brash manner. Further, the Board takes judicial notice of the fact that publicly available medical information indicates that both dizziness and irritability are common side effects of taking sertraline, which the Veteran was prescribed for PTSD. See VA Treatment Records.  Based on the foregoing, the Board finds that the Veteran's PTSD was a contributory cause of his death because without his irritability and irritability, he would not have gotten out of the car in a brash manner, increasing the likelihood of a fall. Accordingly, the Board finds that a nexus has been established.

Comparatively, the Board acknowledges that there is negative VA opinion evidence to the contrary. However, these examiners failed to adequately address whether the PTSD was a contributory cause of the Veteran's death due to causing his fall. As such, the Board finds that these medical opinions are entitled to little probative weight.

In Lynch v. McDonough, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that, under 38 U.S.C. § 5107 (b), the benefit-of-the-doubt principle may be triggered where the evidence of record is nearly equal. 21 F.4th 776, 781 (Fed. Cir. 2021) (citations omitted). The Federal Circuit further explained that this interpretation of 38 U.S.C. § 5107(b) "
, these examiners failed to adequately address whether the PTSD was a contributory cause of the Veteran's death due to causing his fall. As such, the Board finds that these medical opinions are entitled to little probative weight.

In Lynch v. McDonough, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that, under 38 U.S.C. § 5107 (b), the benefit-of-the-doubt principle may be triggered where the evidence of record is nearly equal. 21 F.4th 776, 781 (Fed. Cir. 2021) (citations omitted). The Federal Circuit further explained that this interpretation of 38 U.S.C. § 5107(b) "necessarily includes scenarios where the evidence is not in equipoise but nevertheless is in approximate balance." Id. 

Accordingly, since the PTSD symptoms were contributory causes in the Veteran's death in March 2022, service connection for the cause of the Veteran's death is established.

In sum, because the criteria have been met, service connection is warranted for the cause of the Veteran's death.  38 U.S.C. §§ 1318, 5107; 38 C.F.R. §§ 3.22, 3.102, 3.303.

 

 

S.C. Krembs

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Foster, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.