Citation Nr: 18156651 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-59 351 DATE: December 11, 2018 REMANDED Entitlement to service connection for a heart disability, to include as due to herbicide agent exposure, is remanded for additional development. REASONS FOR REMAND The Veteran had active military service with the U.S. Army from April 1971 to April 1972. During this time, he was awarded the Vietnam Service Medal and the National Defense Service Medal. This matter comes to the Board of Veteran’s Appeals (Board) on appeal from an August 2013 rating decision from the Department of Veterans Affairs (VA) regional office (RO) in Little Rock, Arkansas. In August 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file. Entitlement to service connection for a heart disability is remanded. The Veteran has asserted that he has a current heart condition that is connected to his active service, to include as due to herbicide exposure while deployed in Vietnam. In conjunction with the Veteran’s claim, he underwent a VA ischemic heart examination in July 2012. See VA Ischemic Heart Disability Benefits Questionnaire. The examiner opined that the Veteran did not have ischemic heart disease. Id. In arriving at this conclusion, the examiner cited to: the fact that while the Veteran had asserted that he had a heart attack after separation from active service, there was no medical documentation supporting that assertion; that a July 2012 echocardiogram showed no wall motion abnormalities; and that a subsequent April 2013 echocardiogram also produced normal results. Id. The examiner estimated the Veteran’s metabolic equivalents of task (METs) level as greater than 7 to 10 METs. Id. The Veteran submitted contrasting medical evidence consisting of an Ischemic Heart Disease DBQ completed by his private doctor. See September 2012 Ischemic Heart Disease DBQ. The Veteran’s private doctor diagnosed the Veteran as having both coronary artery disease and fatigue, and acknowledged that the Veteran reported having a heart attack in 1973 after separating from active service. Id. With respect to the results of METs testing, the Veteran’s private doctor indicated that this testing was pending. Id. In response, the RO obtained the Veteran’s medical records from 1974 and requested an addendum opinion from the VA examiner. See February 2016 Compensation and Pension Exam Report. The VA examiner indicated that she had reviewed the Veteran’s additional records from 1974 and reiterated her opinion that the Veteran did not have ischemic heart disease, citing to the fact that the 1974 records indicated that while the Veteran reported to the hospital with chest pain and nausea, he was then diagnosed with gastroenteritis. Id. However, a review of the medical evidence of record reflects that the Veteran has been previously diagnosed with both coronary artery disease and ischemic heart disease. See, e.g., July 2012 Advance Cardiology of Texarkana Treatment Note (noting that the Veteran had a history of coronary artery disease); April 2013 VA Texarkana Clinic Primary Care Note (diagnosing the Veteran with ischemic heart disease); April 2014 Texarkana Clinic Primary Care Note (diagnosing the Veteran with coronary artery disease and hyperlipidemia). Because the record contains conflicting evidence as to whether or not the Veteran has a current heart disability, the Board finds that a new VA examination is warranted to determine the nature and etiology of the Veteran’s claimed heart disability. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006) (holding that an examination is required when (1) there is evidence of a current disability, (2) evidence of an “in-service event, injury or disease,” or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case); Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. After completion of the above development, schedule the Veteran for an additional VA examination in the appropriate specialty to determine the nature and etiology of the Veteran’s claimed heart disability. 3. The electronic claims file, including a copy of this remand, must be made available for the examiner to review. The examination report must include a notation that this record review took place. The Veteran must be interviewed. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. The examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. The examiner is also requested to address the conflicting medical evidence in the record, to include the Veteran’s previous diagnoses of ischemic heart disease and coronary artery disease. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results, the examiner is requested to provide an opinion as to the following questions: (a.) Please identify the nature and etiology of the Veteran’s claimed heart disability, if any. (b.) With respect to any identified heart disability, is it at least as likely as not (i.e. a 50 percent probability or greater) that the disability began during, or is otherwise related to the Veteran’s active duty service, to include exposure to herbicide agents? The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the claim for service connection for the Veteran’s claimed heart disability. If the benefit sought is not granted, the AOJ must then issue a Supplemental Statement of the Case (“SSOC”) and allow the Veteran and his representative an opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Raj, Associate Counsel