When my grandfather died with cancer and fibrosis, one of the main complications involved in getting compensation from EEOICPA was the fact that his county doesn't have a coroner. They have a "medical examiner" who is based 70 miles away and never visits, plus some nurses he employs. As a result, death certificates in that county are only signed in extraordinary circumstances. The federal bureaucracy doesn't accept unsigned certificates for the purpose of establishing a cause of death. The county medical examiner is paid a flat yearly fee, so guess how many autopsies he performs?