Citation Nr: 18148709 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 09-14 143 DATE: November 8, 2018 REMANDED Entitlement to service connection for a heart condition, to include atrial fibrillation, cardiomyopathy, and congestive heart failure is remanded. Entitlement to service connection for a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a heart condition, to include atrial fibrillation, cardiomyopathy, and congestive heart failure is remanded. The Board previously remanded the issue of entitlement to service connection for a heart condition in April 2018 in order to obtain a supplementary medical opinion. However, the Board finds that the July 2018 opinion rendered by the VA examiner reflects a failure to consider all relevant evidence of record, and is therefore inadequate. Specifically, the examiner referenced three instances in the Veteran’s service treatment records (STRs) where chest pain was documented, on September 30, 1985, on January 10, 1986, and on April 9, 1986. The examiner stated that “there are no further chest pain complaints noted in the STRs.” A review of the Veteran’s STRs reflects four instances where he complained of chest pain during service. As noted by the examiner, he claimed chest pain on September 30, 1985 and April 9, 1986. The Board notes that while the examiner listed two separate complaints from 1986, the subject record seems to have the stamped January 10, 1986 date crossed out with the April 9, 1986 date handwritten below. Based upon the context of the record, it appears to be a single instance of a complaint of chest pain to a clinician, who then referred the Veteran to a doctor for further analysis on the same day. Accordingly, the Board will consider the record to be one instance of a complaint of chest pain on April 9, 1986 for the purposes of this appeal. The Veteran’s STRs also indicate that he reported chest pain on September 26, 1990 and December 17, 1992. Accordingly, the examiner’s opinion failed to consider all relevant medical evidence of record and a remand is necessary to obtain an addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The AOJ should also obtain any relevant, outstanding VA treatment records and provide the Veteran the opportunity to submit or identify any relevant, outstanding private treatment records. The AOJ should obtain any such records for which proper approval has been given. 2. Entitlement to service connection for a TDIU is remanded. Regarding the TDIU issue, a decision must be deferred until determinations are made regarding the Veteran’s service connection claim. This issue is inextricably intertwined with entitlement to a TDIU. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. The AOJ should also obtain any relevant, outstanding VA treatment records and provide the Veteran the opportunity to submit or identify any relevant, outstanding private treatment records. The AOJ should obtain any such records for which proper approval has been given. 2. Return the claims file, including a copy of this remand, to the examiner who provided the July 2018 VA medical opinion, if available, or another properly qualified examiner in order to provide an addendum opinion as to whether it is at least as likely as not that the Veteran’s current heart conditions are related to his active duty military service. The examiner should specifically discuss the complaints of chest pain referenced above, as well as the Veteran’s claims regarding onset and continuity of symptoms set out in his affidavit dated October 17, 2017 and any relevant evidence of record contained in the documents associated with the claims file after July 2018 which was not previously addressed. The examiner must provide a rationale for any opinions offered. If the examiner is unable to provide the requested opinions without resorting to speculation, he or she should discuss why and indicate whether the inability   is a result of insufficient evidence or the limits of scientific or medical knowledge. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Ferguson, Associate Counsel