Citation Nr: 18143205 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 16-29 925 DATE: October 18, 2018 REMANDED Entitlement to service connection for ventricular tachycardia status post dual-chamber implantable cardio-defibrillator placement, to include as due to herbicide exposure and as secondary to service-connected posttraumatic stress disorder (PTSD) and neuropathy of the lower extremities, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1960 to March 1968 and from July 1968 to December 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania. VA has found the Veteran to be incompetent, and the appellant is his wife and fiduciary for VA benefits purposes. The Veteran was afforded a VA examination in July 2014 in connection with his claim; however, the examiner did not address the etiology of the Veteran’s ventricular tachycardia, except to state that the condition is caused by an aberrant cardiac conduction pathway. The Veteran and his spouse have claimed that that he has ventricular tachycardia as a result of exposure to Agent Orange in the Republic of Vietnam. He served in the Republic of Vietnam during the Vietnam era; therefore, he is presumed to have been exposed to herbicides. Although ventricular tachycardia is not on the list of diseases that VA has associated with Agent Orange exposure, the regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. §§ 3.303(d), 3.309(e); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). Moreover, there is no medical opinion addressing whether the Veteran’s ventricular tachycardia may be caused or aggravated by his service-connected PTSD and neuropathy. For these reasons, the Board finds that a VA medical opinion are necessary to determine the nature and etiology of the Veteran's ventricular tachycardia. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for ventricular tachycardia. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA medical records and associate them with the claims file. 2. After completing the foregoing development, the AOJ should request a medical opinion to determine the nature and etiology of any ventricular tachycardia that may be present. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that laypersons are competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran or his spouse, the examiner should state this with a fully reasoned explanation. The examiner should state whether it is at least as likely as not that the Veteran has ventricular tachycardia that manifested in service or that is otherwise causally or etiologically related to the Veteran’s military service, to include his presumed herbicide exposure therein (notwithstanding the fact that it may not be a presumed association). The examiner should also opine as to whether it is at least as likely as not that the Veteran has ventricular tachycardia that was either caused by or permanently aggravated by his service-connected neuropathy and/or PTSD. In rendering this opinion, the examiner should address the contention that the Veteran has high IGM in his blood from his service-connected disabilities, which has resulted in or caused his current ventricular tachycardia and heart problems. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1 (2017), copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Chilcote, Associate Counsel