Citation Nr: 18155796 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 09-26 462 DATE: December 6, 2018 REMANDED Service connection for a cardiac disability, to include as secondary to in-service trichloroethylene (TCE) exposure and/or service-connected chronic sinusitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 1965 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before a VA Decision Review Officer in November 2011 and before the undersigned Veterans Law Judge in August 2015 (Board Hearing). In October 2015, the Board remanded the Veteran’s appeal for additional development. In May 2018, the Board requested an opinion from a medical specialist under the employ of the Veterans Health Administration (VHA). The VHA provided the Board with the requested opinion in July 2018 (VHA Opinion). The Veteran was provided with a copy of the opinion and was informed that he had 60 days to respond. See 38 C.F.R. § 20.903. The Veteran timely submitted additional evidence and argument in response to the VHA Opinion, along with a waiver of initial consideration of that evidence by the Agency of Original Jurisdiction (AOJ). The Board observes that the Veteran has reported right eye disability, joint pain, a liver disability, a bilateral ankle disability, a urinary/bladder disability, and a gastrointestinal disability, fatigue, cognitive problems, and skin problems. See August 2015 Board Hearing Transcript at 13-14; November 2018 Correspondence. The Veteran is encouraged to file a claim for any disabilities that he believes are related to his service on the appropriate VA-promulgated form. 1. Service connection for a cardiac disability, to include as secondary to TCE exposure and/or service-connected chronic sinusitis, is remanded. Remand is necessary, as the July 2018 VHA Opinion did not clearly address the question posed by the Board – whether it is at least as likely as not that the Veteran developed his currently-diagnosed coronary artery disease as a result of his in-service TCE exposure. Thus, an addendum opinion is required on remand. Moreover, the Veteran asserts that his cardiac condition is related to infections caused by his service-connected chronic sinusitis. See December 2016 statement. On remand, an opinion concerning secondary service connection should be obtained. Updated VA and private treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then refer the claims file to a clinician for preparation of an addendum opinion. No additional examination of the Veteran is needed, unless the examiner determines otherwise. Following a review of the claims file, the examiner should whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s cardiac disability: (a) had its onset in service or is otherwise etiologically related to the Veteran’s active service, including as a result of conceded trichloroethylene (TCE) exposure and the Veteran’s competent and credible report that he first began to experience “flutters” in his chest during service; (b) is proximately due to the Veteran’s chronic sinusitis, to include recurrent strep infections related to chronic sinusitis; or (c) has been aggravated (worsened beyond its natural progression – please note that such worsening need not be permanent) by the Veteran’s chronic sinusitis, to include recurrent strep infections related to chronic sinusitis. Please address each inquiry separately. For the purpose of responding to this request, the examiner should concede as true that the Veteran was exposed to TCE during his service, as well as the Veteran’s competent and credible report that he first began to experience “flutters” in his chest during his service. In addressing these questions, please discuss (1) the October 2014 Draft Toxicological Profile for TCE submitted by the Veteran showing an excess death rate for aircraft workers exposed to TCE, as well as pre-ventricular contractions following acute TCE exposure, and (2) the November 2016 opinion of the Veteran’s physician that based on his review of the October 2014 Draft Toxicological Profile for TCE, he believed that it was at least as likely as not that TCE exposure “might have been an aggravating factor” in the Veteran’s cardiac disability. A comprehensive rationale must be provided for all opinions rendered. If the examiner cannot provide any requested opinion without resorting to speculation, the examiner should so state and explain why an opinion would be speculative. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.M. Badaczewski, Associate Counsel