Citation Nr: 18159989
Decision Date: 12/21/18	Archive Date: 12/20/18

DOCKET NO. 14-16 685
DATE:	December 21, 2018
REMANDED
Entitlement to service connection for the cause of the Veteran’s death is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 1964 to August 1966.  He died in June 2010 and the Appellant is the Veteran’s surviving spouse.  This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2011 rating decision by the Department of Veterans Affairs (VA). 
1. Entitlement to service connection for the cause of the Veteran’s death is remanded.
The Appellant’s claim was most recently remanded in March 2018 to obtain a medical opinion.  At the time of the Veteran’s death, he was not service-connected for any disabilities.  His June 2010 death certificate discloses that his immediate cause of death was hypertensive cardiovascular disease.  Noting that the Veteran’s induction examination was abnormal for the heart, the Board asked the examiner to state whether the Veteran had a pre-existing heart condition when entering service.  The Board also noted notations of chest pain and sleepiness during service and wanted to know whether these symptoms were manifestations of a heart disorder.  As the Veteran served in the Republic of Vietnam, the Board also instructed the examiner to opine as to whether the Veteran’s death from hypertensive vascular disease was related to his exposure to toxic herbicides during service.  The Board specifically stated in its remand instructions that the examiner should provide a fully articulated rationale for their findings.  
In a September 2018 medical opinion, the examiner provided a thorough explanation as to why the Veteran did not have a pre-existing heart condition when entering service and why the complaints in service are not representative of a heart disorder.  However, when opining regarding a link to toxic herbicide exposure, the examiner provided no explanation when denying such a link.  
Consequently, the Board concludes that there has not been substantial compliance with its previous remand.  See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999).  Another VA medical opinion is necessary to answer the question originally posed regarding whether the Veteran’s hypertensive vascular disease is related to his exposure to toxic herbicides during service.  The opinion must include a fully articulated rationale.
The Board acknowledges that in a December 2018 statement, the Veteran’s representative requested an aggravation opinion regarding the Veteran’s heart condition.  However, as the VA examiner has already found that the Veteran did not have a heart condition upon entry into service, an aggravation opinion is unwarranted.
 
The matter is REMANDED for the following action:
Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s hypertensive vascular disease is at least as likely as not related to the Veteran’s exposure to toxic herbicides during service.  The opinion must include a fully articulated rationale.

 
B.T. KNOPE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Borman, Associate Counsel