When a veteran passes away, VA must determine whether the death was caused by or related to a service-connected disability in order to award DIC and enhanced survivor benefits. The determination involves reviewing the death certificate, the veteran medical records, and any other relevant evidence. VA looks at whether a service-connected condition was the principal cause of death, meaning it was the primary underlying cause listed on the death certificate, or whether it was a contributory cause, meaning it combined with other conditions to bring about death. A service-connected condition can be considered a contributory cause even if it was not the immediate cause of death. For example, if a veteran had service-connected heart disease and died from a stroke that was aggravated by the heart condition, the death may be considered service-connected. VA also considers whether service-connected disabilities debilitated the veteran to the point that they were materially less capable of resisting the effects of the disease that ultimately caused death. This is sometimes called the debilitation theory. The surviving spouse or other claimant bears the burden of showing that the death was at least as likely as not related to service. Medical opinions connecting the cause of death to service-connected conditions are important evidence. If the death certificate does not list the service-connected condition as a cause, a medical opinion explaining the connection can overcome that.
Note: This article references sections of the VA's M21-1 Adjudication Procedures Manual. The VA periodically reorganizes the M21-1 and section numbers may have changed since this article was written. For the most current section references, visit the VA's public M21-1 Web Automated Reference Material System (WARMS).