Citation Nr: 18153687 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 16-53 358A DATE: November 28, 2018 REMANDED Entitlement to service connection for an aortic aneurysm disability is remanded. REASONS FOR REMAND The agency of original jurisdiction (AOJ) denied the Veteran’s service-connection claim for a heart condition in August 2015. Within one year, the Veteran requested service-connection specifically for an aortic aneurysm, secondary to his service-connected lung disability. He noted that his treating physician had told him that such a relationship exists. The Veteran’s competent lay assertions as to what his physicians have told him constitute new and material evidence under the provisions of 3.156(b), and the Board need not first reopen the Veteran’s claim, insofar as it pertains exclusively to an aortic aneurysm, before reaching its merits. The Veteran served on active duty from December 1970 to June 1971, including service at the De-Militarized Zone (DMZ) in the Republic of Korea. Entitlement to service connection for an aortic aneurysm disability is remanded. The Veteran contends that his current aortic aneurysm disability is connected to his service connected lung disability. The Veteran was afforded a VA examination in January of 2016. The examiner noted that the Veteran’s aortic aneurysm was less likely than not proximately due to or the result of the Veteran’s service connected lung condition. The examiner further noted that the Veteran has a bicuspid aortic valve which is a congenital issue that creates a higher risk factor for an aortic aneurysm. However, the examiner did not address whether the Veteran’s service connected lung condition aggravated his aortic aneurysm disability beyond its natural progression. An opinion that something “is not related to” or “is not due to” does not answer the question of aggravation. Allen, 7 Vet. App. at 448. When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Given that the medical evidence of record fails to adequately address the issue raised, the Board finds that a new examination is necessary. Furthermore, the AOJ has conceded that the Veteran served at the DMZ in Korea while on active duty between December 1970 and June 1971. As a result, the Veteran is presumed to have been exposed to herbicides. Although aortic aneurysm is not one of the listed disabilities that qualifies for presumptive service connection under 38 C.F.R. § 3.309(e), on remand an opinion should be obtained addressing whether a relationship may exist between the aneurysm and in-service herbicide exposure on a direct basis. The matter is REMANDED for the following action: 1. The Veteran should be afforded a new VA examination to determine whether his current aortic aneurysm disability is related to his military service and/or secondary to his service-connected disabilities. The record must be made available to, and reviewed by the VA examiner. Any indicated evaluations, studies, and tests should be conducted. Following a review of the entire record, the examiner should address the following questions: (a) Is it at least as likely as not (i.e., a 50 percent or greater probability) that an aortic aneurysm disability had its onset in, or is otherwise related to his period of active duty service, to include his presumed in-service exposure to herbicide agents? (b) Notwithstanding the above, is it at least as likely as not (i.e., a 50 percent or greater probability) that an aortic aneurysm disability was caused or aggravated beyond its natural progression by his service-connected lung disability? In this regard, the Board emphasizes that causation and aggravation are two separate inquiries, and both must be answered. In offering any opinion, the examiner must consider the full record, to include the Veteran’s lay statements asserting that his previous physician told him of a possible connection between his aneurysm and his service-connected lung disability. A complete rationale must be provided for all opinions provided. (Continued on Next Page) 2. Readjudicate the appeal. If the benefit sought is denied, issue the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David M. Sebstead, Associate Counsel