Khadijah El-Amin v. Eric K. Shinseki
2013 U.S. Vet. App. LEXIS 73
| Vet. App. | 2013Background
- Khadijah El-Amin’s husband, a Vietnam-era Marine, died in 2006 from hepatic cirrhosis; PTSD disability was at 70% at death.
- Mrs. El-Amin sought VA burial and death benefits, alleging the veteran’s service-connected PTSD aggravated his non-service-connected alcoholism, contributing to cirrhosis and death.
- The Board denied in August 2010, relying largely on a October 2008 VA medical opinion that PTSD did not cause alcoholism.
- The Court issued a memorandum decision in May 2012, then vacated and replaced it with a full opinion in November 2012.
- The Court vacated the Board’s decision and remanded for a new medical opinion addressing aggravation and its impact on cirrhosis, and for possible burial-benefits interconnection.
- The remand directs the Board to obtain a single comprehensive medical opinion (or a suitable qualified opinion) on aggravation and its degree, and to proceed with expeditious readjudication.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does the examiner’s ‘related to factors other than PTSD’ statement prove aggravation? | El-Amin argues it supports aggravation by PTSD. | Secretary argues it only addresses direct causation, not aggravation. | Remand for explicit aggravation opinion. |
| Was the October 2008 examination adequate to decide aggravation and causation? | Examination failed to address aggravation, was not fully explained. | Examination provided reasoning on causal links; adequate under law. | Board erred; need a thorough, reasoned opinion addressing aggravation. |
| Did the Board properly weigh whether PTSD aggravated alcoholism contributing to cirrhosis and death? | AGGRAVATION potentially established; should be weighed, not discarded. | Evidence did not show PTSD-caused alcoholism; agnosticism allowed under current record. | Remand to evaluate aggravation and its impact on cirrhosis. |
| Should burial benefits be remanded as intertwined with death-benefits claim? | Burial benefits denied based on death causation; intertwined with cause-of-death issue. | Burial claim separate but affected by death-benefits decision. | Remand of burial-benefits claim is proper. |
Key Cases Cited
- Allen v. Brown, 7 Vet.App. 439 (1995) (aggravation compensation framework for service-connected and non-service-connected conditions)
- D'Aries v. Peake, 22 Vet.App. 97 (2008) (clear error standard for factual findings; need adequate medical opinion)
- Nieves-Rodriguez v. Peake, 22 Vet.App. 295 (2008) (reasoned medical explanations are needed in medical opinions)
- Green v. Derwinski, 1 Vet.App. 121 (1991) (adequacy of medical examinations and consideration of prior history)
- Stefl v. Nicholson, 21 Vet.App. 120 (2007) (medical opinions must describe disability in detail with rationale)
- Bowling v. Principi, 15 Vet.App. 1 (2001) (duty to return inadequate examinations for proper evaluation)
- Gilbert v. Derwinski, 1 Vet.App. 49 (1990) (two permissible views of evidence; not clearly erroneous)
- Bielby v. Brown, 7 Vet.App. 260 (1994) (limits of independent medical opinions tainted by constrained inquiries)