Case A26039904

J. PARKER · 2026 · Case ID: A26039904

GRANTED

Summary

The Veteran, who served on active duty from January 1998 to April 2018, died in November 2019 from accidental motorcycle collision injuries, including basilar skull fractures and lacerations. The Veteran was service-connected for several conditions, including adjustment disorder with anxiety, migraine headaches, and various musculoskeletal disorders. The surviving spouse appealed for service connection for the cause of death, asserting that side effects from the Veteran's prescribed medications, Zoloft (sertraline) and medical marijuana, contributed to the fatal accident. The Board reviewed lay testimony, police reports, autopsy findings, and medical opinions. The Veteran's treating physician opined that the combined effects of Zoloft and THC likely contributed substantially to the death, citing potential side effects like confusion and delayed reaction time. Police reports noted THC and sertraline in the Veteran's system, with a prosecutor considering drug presence a contributing factor. The Medical Examiner, however, noted that while intoxication could be a factor, office protocol excluded drug intoxication from the official cause of death certificate when fatal traumatic injuries were present. The Board found the evidence in equipoise regarding whether the medication side effects substantially contributed to the death. Resolving reasonable doubt in the appellant's favor, the Board granted service connection for the cause of death.

Rationale

Evidence in equipoise regarding medication side effects contributing to death; Resolving reasonable doubt in appellant's favor; Private physician opined combined medication effects likely contributed substantially to death

Special Benefit

DIC / CAUSE OF DEATH

Docket No.

210824-182837

Full Decision Text

Citation Nr: A26039904
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210824-182837
DATE: April 29, 2026

ORDER

Service connection for cause of death is granted.

FINDINGS OF FACT

1. The Veteran died in November 2019.

2. The cause of the Veteran's death was accidental, operator of motorcycle in collision with pickup truck resulting in basilar skull fractures and lacerations of heart, coronary artery, and inferior vena cava; blunt impact to head and torso.

3. The Veteran was service connected for adjustment disorder with anxiety, migraine headaches, right shoulder disorder, right wrist disorder, right foot disorder, bilateral hip disorders, bilateral knee disorders, bilateral ankle disorders, cervical spine disorder, low back disorder, and tinnitus, among other disabilities.

4. The Veteran was prescribed Zoloft and medical marijuana to treat the service-connected psychiatric disorder and chronic pain associated with the service-connected physical disabilities.

5. Side effects of the medications prescribed to treat the service-connected psychiatric and physical disabilities contributed substantially and materially to the cause of the Veteran's death by accidental motorcycle collision.

CONCLUSION OF LAW

Resolving reasonable doubt in the appellant's favor, the criteria for service connection for cause of death have been met. 38 U.S.C. §§ 1110, 1310, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.312.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran, who is the Appellant, served on active duty from January 1998 to April 2018. The appellant is his surviving spouse.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2021 rating decision from the Regional Office (RO). In the August 24, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), the Veteran elected the Hearing docket. A Board hearing was held on May 1, 2025; therefore, the Board may only consider the evidence of record at the time of the July 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

Service Connection for Cause of Death

The appellant appeals for service connection for the cause of the Veteran's death. The appellant asserts that the side effects of the Zoloft (i.e., sertraline) and medical marijuana prescribed to treat the Veteran's service-connected psychiatric and physical disabilities may have impaired the Veteran's ability to react in enough time to avoid the motorcycle collision that caused the Veteran's death.

The appellant testified that the Veteran took Zoloft daily for the psychiatric disorder and that he was referred by a VA provider to a medical marijuana clinic for daily cannabis therapy to help manage the psychiatric symptoms and chronic pain. While the appellant testified that she did not notice any specific side effects of the medical marijuana and Zoloft when the Veteran left the home to ride his motorcycle, she noted that the depression and anxiety went up and down quite a bit and he would usually leave the home during heightened episodes of depression and anxiety. The appellant noted that the Veteran had been taking Zoloft for about four months prior to his passing and at that time seemed to have increased anxiety and may have been a little more reckless on the combination of prescribed medications. See May 2025 Board Hearing Transcript.

Dependency and indemnity compensation (DIC) is payable to the surviving spouse of a veteran if the veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. Service connection may be granted for the cause of a veteran's death if a disorder incurred in or aggravated by service either caused or contributed substantially or materially to the cause of death. To establish service connection for the cause of a veteran's death, competent evidence must link the fatal disease to a period of military service or an already service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. §§ 3.303, 3.312; Ruiz v. Gober, 10 Vet. App. 352 (1997).

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 service was the principal or contributory cause of death. 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. Contributory cause of death is inherently one not related to the principal cause. In order to constitute the contributory cause of death it must be shown that the service-connected disability contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production 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. 38 C.F.R. § 3.312; Lathan v. Brown, 7 Vet. App. 359 (1995); see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994).

The Veteran died in November 2019. The death certificate indicates the cause of death was accidental, operator of motorcycle in collision with pickup truck resulting in basilar skull fractures and lacerations of heart, coronary artery, and inferior vena cava; blunt impact to head and torso. The evidence shows that the Veteran was service connected for adjustment disorder with anxiety, migraine headaches, right shoulder disorder, right wrist disorder, right foot disorder, bilateral hip disorder, bilateral knee disorders, bilateral ankle disorders, cervical spine disorder, low back disorder, and tinnitus, among other disabilities.

After reviewing all the evidence, both lay and medical, the Board finds that the evidence is at least in equipoise as to whether the side effects of medication prescribed to treat the service-connected psychiatric and physical disabilities substantially or materially contributed to the cause of the Veteran's death. The VA and private treatment records indicate that the Veteran endorsed a history of anxiety multiple times a day, with symptoms of hypervigilance, feeling shaky, racing heart, and being easily angered. VA prescribed Zoloft 100mg daily, from which he endorsed some benefit, but not resolution of symptoms. One month prior to his death, the Veteran was also referred to a medical marijuana practice for cannibis therapy for psychiatric symptoms. The medical marijuana clinic offered the Veteran cannabis flower for tea as needed (high tetrahydrocannabinol (THC)) and oral capsules once daily (high CBD) for management of psychiatric symptoms. See October 2019 VA treatment record, October 2019 private treatment records.

The medical consent form included with the medical marijuana treatment plan advised that the use of marijuana can affect coordination, motor skills and cognition, i.e., the ability to think, judge, and reason. Driving under the influence of cannabis can double the risk of crashing, as such a patient should not drive, operate heavy machinery or engage in any activities that require the patient to be alert and/or respond quickly while using medical marijuana. Other potential side effects or medical marijuana include dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short term memory, and inability to concentrate, among other side effects. Additionally, some common side effects of sertraline (Zoloft) includes shaking, agitation or restlessness, tiredness, anxiety, dizziness, and confusion among other effects. See October 2019 private treatment record, June 2025 Medical Treatment Record Government Facility.

The police reports indicate that, while riding his motorcycle, the Veteran struck a pickup truck that attempted to make a left turn intercepting the Veteran's lane of travel. The report indicates that a friend who was riding a motorcycle beside the Veteran also struck the truck but sustained non-fatal injuries while attempting to avoid the truck in the collision. An Assistant State's Attorney (ASA) who is handling the case involving the Veteran's death noted that THC and/or metabolites of THC (11-Carboxy THC) were in the Veteran's system at the time of the fatal incident, which could indicate that the use of THC/marijuana around the time of the crash caused the Veteran's death. The autopsy reports shows that sertraline was also found in the Veteran's system at the time of the accident. The ASA noted that the
left turn intercepting the Veteran's lane of travel. The report indicates that a friend who was riding a motorcycle beside the Veteran also struck the truck but sustained non-fatal injuries while attempting to avoid the truck in the collision. An Assistant State's Attorney (ASA) who is handling the case involving the Veteran's death noted that THC and/or metabolites of THC (11-Carboxy THC) were in the Veteran's system at the time of the fatal incident, which could indicate that the use of THC/marijuana around the time of the crash caused the Veteran's death. The autopsy reports shows that sertraline was also found in the Veteran's system at the time of the accident. The ASA noted that the presence of THC in the Veteran's system, regardless of whether it was prescribed by a physician, was a factor that was considered when reviewing the case as the presence of drugs can be a contributing factor to the incident. See June 2025 Medical Treatment Record Government Facility.

A Hillsborough County Medical Examiner (ME) indicated that the police traffic reports, paramedical reports, and medical records were reviewed in this case. The ME noted that autopsy samples were positive for sertraline and THC. The examiner explained that cause of death and contributory cause of death are strictly medical terms that do not address the circumstances of death. The ME explained that, while intoxication may be considered a factor in death, per office protocol, intoxication by drugs or drug interactions are not considered contributory to the cause of death in motor vehicle accidents with fatal traumatic injuries, explaining that post-mortem drugs that are not in the fatal range do not belong on a death certificate. As such, in this case, the death certificate would only include the fatal injuries sustained during the motor vehicle accident and described the manner of death being accidental but would not include any drug intoxication or drug interaction as medically diagnosed causes of death, even if the effects of drugs is a factor in death. See February 2023 Medical Treatment Record Government Facility.

The Veteran's former treating physician noted that the Veteran died in a motorcycle accident. At the time of his passing, the Veteran was taking sertraline, which had been provided by VA for the adjustment disorder with anxiety, as well as THC which was prescribed by a medical marijuana practitioner on referral from the VA clinic for the psychiatric symptoms and chronic pain. The private provider noted that review of literature reveals that interaction between sertraline and THC can have deleterious effects including confusion, delayed reactions time, and impaired judgment or decision making. Upon considering the effects of the Veteran's medication regiment prescribed to treat service-connected disabilities and the levels of sertraline and THC in the Veteran's system per autopsy reports, the private examiner opined that it is likely that the side effects from the combined medications sertraline and THC prescribed for Veteran's psychiatric and physical disorders significantly contributed to his cause of death, accidental operator of motorcycle in collision with pickup truck resulting in basilar skull fractures and lacerations of heart, coronary artery, and inferior vena cava, with blunt impact to head and torso. See July 2021, June 2025 private treatment records.

Based on the foregoing, and resolving reasonable doubt in the appellant's favor, the Board finds that the psychiatric and physical disabilities, to include side effects of medications prescribed to treat the conditions, contributed substantially and materially to the cause of the Veteran's death by accidental motorcycle collision resulting in basilar skull fractures and lacerations of heart, coronary artery, and inferior vena cava, and blunt impact to head and torso. For these reasons, service connection for the cause of the Veteran's death is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Moore

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.

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