Citation Nr: 18148402
Decision Date: 11/08/18	Archive Date: 11/07/18

DOCKET NO. 16-36 005A
DATE:	November 8, 2018
REMANDED
Entitlement to service connection for ischemic heart disease, to include as secondary to herbicide agent exposure, for the purposes of entitlement to retroactive benefits, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from November 1950 to November 1974.  He passed away in July 2011.  The appellant is one of his surviving children, who has been substituted as the claimant.
The underlying February 2012 rating decision was based on a Nehmer review, which essentially readjudicated a previously denied claim for service connection for heart disease due to changes in regulations related to Veterans who were exposed to herbicide agents during active service.  See Nehmer v. United States Veterans Admin., 284 F.3d 1158 (9th Cir. 2002).
At issue in this case is whether the Veteran had a diagnosis of ischemic heart disease during his lifetime.  In July 2016, a VA examiner concluded that the Veteran’s heart conditions, as described in his medical records, were not consistent with ischemic heart disease.  However, subsequent to that VA medical opinion, while filing the instant appeal to the Board in August 2016, the appellant submitted additional medical documentation.  This documentation included a private medical record from August 2010 that included a finding that the Veteran had a sinus rhythm with second degree atrioventricular block; possible inferior infarct, age undetermined; and myocardial infarct finding now present.  As this record was not available for review by the July 2016 VA examiner, and his report does not otherwise address the presence of any myocardial infarction, the Board finds that an addendum medical opinion is necessary.  Significantly, the statutory definition of ischemic heart disease includes “old myocardial infarction.”  38 U.S.C. § 3.309(e).  
The matter is REMANDED for the following action:
Obtain an addendum opinion from an appropriate clinician.  Based on a review of the record, the examiner should provide an opinion as to whether it at least as likely as not (50 percent or better probability) that any of the Veteran’s heart conditions qualified within the generally accepted medical definition of ischemic heart disease.  The examiner should specifically address the August 5, 2010, private medical record indicating that the Veteran had a sinus rhythm with second degree atrioventricular block; possible inferior infarct, age undetermined; and myocardial infarct finding now present.  
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A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate.
 
A. ISHIZAWAR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	N. Shah, Associate Counsel