El-Amin: DIC, Alcoholism, PTSD and an Inadequate Medical Examination

Khadijah El-Amin v. Eric K. Shinseki, Opinion Number 10-3031, decided January 15, 2013 concerns a widow’s entitlement to VA benefits for the cause of her husband’s death.

The veteran served in Vietnam and was service connected for PTSD.  When he died, his death certificate listed his cause of death as hepatic cirrhosis.  His widow sought benefits asserting her husband’s PTSD caused or aggravated his alcoholism, which in turn led to his death.

The RO and Board denied the claim, principally relying on a VA medical opinion which found “there is no confirmatory or supportive evidence that the veteran’s post-traumatic stress disorder caused his alcohol abuse….  Conversely, it is more likely than not that the veteran’s alcohol abuse was related to factors other than the veteran’s post-traumatic stress disorder.”

The Court noted that benefits are appropriate if aggravation by a service connected condition can be shown to have contributed substantially or materially to the production of death, combined to cause death, or aided or lent assistance to the production of death.  The Court noted the Board did not address the question of aggravation.

The Court also noted the VA medical opinion was inadequate as it focused solely on direct causation, concluding PTSD did not cause the alcoholism.  The Court considered the opinion’s conclusion that “it is more likely than not that the veteran’s alcohol abuse was related to factors other than the veteran’s post-traumatic stress disorder,” but stated “it is not clear to the Court that this encompasses a discussion of aggravation (the theory on which Mrs. El-Amin bases her claim) at all, let alone with respect to post-traumatic stress disorder.”

Decided by Chief Judge Kasold and Judges Hagel and Moorman.