Citation Nr: 18148434 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-30 363 DATE: November 7, 2018 REMANDED Service connection for atrial fibrillation and arrhythmia, to include as due to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to December 1971 and again from September 1977 to February 1982 with additional reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office. 1. Service connection for atrial fibrillation and arrhythmia is remanded. The Veteran asserts that he has atrial fibrillation and arrhythmia that is related to his active service. He underwent a radiofrequency ablation procedure in March 2016. The Veteran contends that his cardiac conditions result from his exposure to herbicide agents in Vietnam. The Veteran’s exposure to Agent Orange is established by virtue of his in-country service in the Republic of Vietnam during his first period of active duty. 38 U.S.C § 1116; 38 C.F.R §§ 3.307(a)(6)(iii), 3.309(e). However, none of his currently diagnosed cardiac conditions are among those for which presumptive service connection is available based on herbicide agent exposure. Id. Nevertheless, service connection may be warranted on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Moreover, no VA examination or opinion has yet been provided to address this claim. VA must provide a medical examination when there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, (3) some indication that the claimed disability may be associated with the established event, injury, or disease, and (4) insufficient competent evidence of record for VA to make a decision. McClendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). In this case, the record reflects that the Veteran was diagnosed with cardiac arrhythmia “around 1982.” As such, a VA examination is warranted. The matter is REMANDED for the following action: 1. Ask the Veteran to identify any remaining outstanding treatment (private or otherwise) records relevant to his claims. The Board is particularly interested in records from 1982 diagnosing the Veteran with arrhythmia. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken, to include notifying the Veteran of the unavailability of the records. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of his claimed cardiac condition. The claims file must be reviewed by the examiner. All indicated tests and studies deemed necessary by the examiner should be performed and all clinical findings reported in detail. After eliciting a full history, conducting a complete review of the claims file, performing an examination of the Veteran, and completing any clinically indicated diagnostic testing, the examiner must provide an opinion as to the following: Whether it is at least as likely as not (i.e., 50 percent or greater probability) that the Veteran had a cardiac disability at any point during the appeal period. The examiner should comment on the diagnosed atrial fibrillation and arrhythmia. For any identified disability, the examiner should comment on whether it had its clinical onset during active service or is related to any incident of service, to include herbicide agent exposure. In providing this opinion, the examiner should note that the Veteran’s exposure to Agent Orange is presumed by virtue of his service in Vietnam. Additionally, the examiner is advised that he or she may not rely solely on the fact that a diagnosed disability is not on the presumptive list of diseases associated with herbicide exposure. Rather, the evaluating clinician must opine as to whether or not there is a direct relationship between any diagnosed cardiac condition and the Veteran’s in-service herbicide agent exposure and must provide specific reasons in support of the opinion, to include, as relevant, why any statistical or medical studies are found to be persuasive or unpersuasive, whether there are other risk factors that might be the cause of the Veteran’s cardiac condition and whether the condition has manifested itself in an unusual manner. All examination findings, along with the complete explanation for all opinions expressed, must be set forth in the examination report. If the examiner is unable to answer any question without a resort to speculation, then he or she should so indicate and provide a rationale for why an answer could not be provided. M. Donohue Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jones Council, Associate Counsel