Citation Nr: 18149256 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 16-45 154 DATE: November 9, 2018 REMANDED Entitlement to service connection for a heart disability, to include coronary artery disease (CAD), is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1965 to February 1968, and from March 1971 to July 1992. The issue on appeal has been expanded pursuant to the Federal Circuit’s decision in Clemmons v. West, 206 F.3d 1401, 1403 (Fed. Cir. 2000). The issue has been recharacterized accordingly, as noted above. Entitlement to service connection for a heart disability, to include CAD, is remanded. The Board finds that additional development is needed prior to final adjudication of the issue on appeal. Specifically, the Board finds that a new VA examination and opinion are need. The December 2017 VA addendum opinion primarily addressed whether the Veteran had had a myocardial infraction. However, particularly given the expansion of the claim under Clemmons, the issue on appeal is not limited to this fact. The January 2017 VA opinion states that the Veteran’s CAD/ ischemic heart disease (IHD) is at least as likely as not caused by post-service deposition of cholesterol plaque in the Veteran’s coronary arteries. However, service treatment records note high cholesterol. See e.g., STRs, August 1991. In addition, the examiner based the opinion in part on the Veteran’s separation examinations. However, in the February 2014 Notice of Disagreement (NOD), the Veteran stated that his retirement physical in January 1992 was not a detailed examination and that only a very basic look at his medical records was taken. The Veteran has over twenty-four years of service, retiring in 1992. The record suggests that his heart disability was diagnosed in the 1990s. See Heart Condition DBQ, January 2014 (noting a development of heart disease in the 1990s); see also VA Examination, August 2013 (noting that CAD was diagnosed in 1992). The Veteran also describes a progressive deterioration of his physical condition. See NOD, February 2014. Service treatment records show complaints of chest pains and shortness of breath, and notations of sinus bradycardia (see e.g., STRs, December 1989, February 1982; June 1986; October 1988), in addition, to the cholesterol noted above. Given the totality of these circumstances, the Board finds that a full examination and opinion is appropriate. The matter is REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issue on appeal. All efforts to obtain these records should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for a VA examination to clarify the diagnosis of his heart disability and to address the etiology of any diagnosed disability(ies). For each disability diagnosed, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was caused by the Veteran’s active duty service or, if preexisting service, was aggravated therein. The examiner is asked to specifically address: (a) service treatment records that note high cholesterol, (see e.g., STRs, August 1991), as well as complaints of chest pains and shortness of breath, and notations of sinus bradycardia (see e.g., STRs, December 1989, February 1982; June 1986; October 1988); (b) the Veteran’s contentions that his retirement physical in January 1992 was not a detailed examination and that only a very basic look at his medical records was taken and that he has experienced a progressive deterioration of his physical condition, see NOD, February 2014; and (c) the date of diagnosis of the Veteran’s heart disability. For all examinations, all necessary development should be taken. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 3. If upon completion of the above action the issue is denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Foster, Associate Counsel