Citation Nr: 18156392
Decision Date: 12/11/18	Archive Date: 12/07/18

DOCKET NO. 15-45 418
DATE:	December 11, 2018
REMANDED
Service connection for a heart disorder, as secondary to service-connected gastrointestinal disorders, is remanded.
REASONS FOR REMAND
The Veteran served honorably in the United States Air Force from January 1975 to October 1992. This appeal arises from a January 2012 rating decision, which denied service connection for a heart disorder as secondary to service-connected gastrointestinal disorders. 
The issue of service connection for a heart disorder as secondary to service-connected gastrointestinal disorders is remanded to ensure compliance with the prior remand directives. 
An August 2018 Board Remand directed medical opinions regarding the etiology of the heart disorders, including whether any current heart disorder was caused or aggravated by the service-connected diverticulitis and diverticulosis.  The record reflects no attempt to obtain such opinions.  Where the RO does not comply with a remand by the Board, the Board errs as a matter of law when it fails to ensure compliance. In consideration of the foregoing, the Board must again remand the matter. See Stegall v. West, 11 Vet. App. 268 (1998). 
Accordingly, the issue of service connection for a heart disorder, as secondary to the service-connected gastrointestinal disorders, is REMANDED for the following actions:
1. Expeditiously schedule a VA examination or file review for a new medical opinion.
Ask an appropriate examiner to provide medical opinions on the following questions of relationship between service-connected gastrointestinal disorders (diverticulosis, diverticulitis, and ulcerative colitis) and any diagnosed heart disorder(s):
Is it as likely as not that the service-connected diverticulosis, diverticulitis, and ulcerative colitis, including medications for ulcerative colitis, caused any of the diagnosed heart disorders?
Is it as likely as not that the service-connected diverticulosis, diverticulitis, and ulcerative colitis, including medications for ulcerative colitis, worsened in severity beyond a normal progression any of the diagnosed heart disorders?
In rendering these opinions, the examiner should address each of the following:
• Assume as fact that the Veteran is service connected for diverticulosis, diverticulitis, and ulcerative colitis, with an onset date of March 1986.
• Assume as fact that the diagnosed cardiomyopathy had an onset date of November 2009 and that the diagnosed congestive heart failure had an onset date of February 2010. 
• Review and discuss the submitted Danish study on IBD and increased risk of hospitalization for heart failure. 
• Discuss any other risk factors for developing any diagnosed heart disorder, identify any risk factors this Veteran has, and discuss whether any of those risk factors contributed to any of the Veteran’s diagnosed heart disorder(s).

After completing all indicated development, the RO should readjudicate the issue of service-connection for any heart disorder as secondary to the service-connected gastrointestinal disorders, which include ulcerative colitis.
The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999).  This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112.
 
J. PARKER 
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Dye, Associate Counsel