Citation Nr: 18154386 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-57 066 DATE: November 29, 2018 REMANDED Entitlement to service connection for a heart disability, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty form June 1969 to March 1073. 1. Service connection for a heart disability After a review of the record, the Board finds that a remand is warranted for a new medical examination and opinion because the December 2014 VA examination failed to address direct and secondary service connection for the Veteran’s heart disability. See December 2014 VA Heart Conditions Disability Benefits Questionnaire (DBQ). Specifically, the VA examiner diagnosed the Veteran with supraventricular arrhythmia and cardiomyopathy. Id. The VA examiner noted the Veteran does not have ischemic heart disease. Furthermore, the VA examiner found that these conditions are not entitled to presumptive service connection based on agent orange exposure. Although the Veteran’s diagnoses of supraventricular arrhythmia and cardiomyopathy, are not among the diseases provided presumptive service connection, the Veteran is entitled to consideration under a theory of direct service connection. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (which holds that the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation). Consequently, a remand is warranted to obtain an examination and opinion as to whether the Veteran’s heart condition, to include supraventricular arrhythmia and cardiomyopathy, was caused by or is related to his active service, to include his conceded exposure to herbicide agents. Additionally, the Board notes that the Veteran submitted a private medical opinion from Dr. E.S. in March 2017. See March 2017 Medical Opinion. Dr. E.S. stated “[b]ased on my experience and medical literature, Mr. [redacted] heart condition is at least as likely as not secondary to service connected mental health condition.” Id. However, Dr. E.S. did not provide any further rationale or cite the medical literature he relied upon in rendering his opinion. The Board finds this opinion is inadequate because Dr. E.S. failed to provide any rationale connecting the supporting data used to make his conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.). Thus, a remand is warranted to address secondary service connection. On remand, the VA examiner should opine whether the Veteran’s heart disability was caused by or aggravated beyond its natural progression by any of the Veteran’s service-connected disabilities to include his service-connected psychiatric disability. The matter is REMANDED for the following action: 1. Obtain copies of records pertaining to any relevant VA treatment records following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. Contact the Veteran and request he provide current private treatment records after December 2016 last received in March 2017 or a release. If he provides the necessary release(s), assist the Veteran in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e. non-duplicative) evidence should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and his representative should be notified. 3. After the foregoing development, schedule a VA examination to address the Veteran’s heart condition(s). All pertinent evidence should be made available to the examiner for review, and such review should be noted in the opinion report. The examiner should respond to the following, after reviewing and considering all the Veteran’s pertinent lay and medical evidence: (a.) Identify all current heart disorders including supraventricular arrhythmia and cardiomyopathy. (b.) Whether it is at least as likely as not that the Veteran’s heart condition, to include supraventricular arrhythmia and cardiomyopathy, is at least as likely as not (probability of at least 50 percent) related to the Veteran’s military service, to include his in-service exposure to herbicide agents. The VA has conceded that the Veteran was exposed to herbicide agents during service. Thus, the examiner’s opinion should address the Veteran’s in-service exposure to herbicide agents, and to fully explain the impact, if any, of such exposure. (c.) Provide an opinion whether it is it at least as likely as not that any currently diagnosed heart disability (to include supraventricular arrhythmia and cardiomyopathy) was caused or aggravated beyond its natural progression by the any of the Veteran’s service-connected disabilities including the Veteran’s psychiatric disability. The examiner is informed that aggravation here is defined as a permanent increase in disability beyond natural progress of a disease. If aggravation is present, the examiner should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. (Continued on the next page)   A full rationale should be provided for all stated medical opinions. If the examiner concludes that the requested opinion cannot be provided without resort to speculation, the examiner should so state and explain why this opinion would be speculative and what, if any, additional evidence would permit such an opinion to be made. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Lilly, Associate Counsel