Citation Nr: 19158570 Decision Date: 07/29/19 Archive Date: 07/29/19 DOCKET NO. 19-04 156 DATE: July 29, 2019 REMANDED Entitlement to service connection for a heart disability, to include as due to herbicide agent exposure and/or service-connected diabetes mellitus, type II (diabetes), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1968 to February 1972, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran asserts that his heart condition is due to herbicide agent exposure. Additionally, the evidence of record raises the issue of his heart disability being related to his service-connected diabetes. See March 2017 VA Form 21-526EZ and October 2018 VA medical opinion. The Veteran was afforded VA examinations in April 2017 and April 2018, with a medical opinion rendered in October 2018. The Veteran has a current diagnosis of chronic congestive heart failure and is service-connected for diabetes. Additionally, his exposure to herbicide agents is conceded due to his Vietnam service. To this end, even if a disease or condition is not a presumptive disorder for which the Veteran is entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. Rucker v. Brown, 10 Vet. App. 67, 71 (1997) (Ramey v. Brown, 9 Vet. App. 40, 44 (1996); Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). However, the only medical opinion of record, the October 2018 VA examiner’s opinion, is inadequate for rating purposes, as she provided no direct opinion on congestive heart failure due to herbicide agent exposure and failed to address the aggravation prong of secondary service connection for congestive heart failure as related to diabetes. Thus, on remand, an addendum opinion that adequately address all theories of entitlement are warranted. Any outstanding VA treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Then obtain an addendum opinion from an examiner other than the October 2018 VA examiner addressing the etiology of the Veteran’s heart disability. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. The examiner should address the following: For diagnosed chronic congestive heart failure, please opine on whether it is at least as likely as not (50 percent or greater probability) that such disability: (a) had its onset in service or is otherwise related to service, to include presumed herbicide agent exposure therein; (b) is proximately due to or a result of his service-connected diabetes; or (c) has been aggravated (worsened beyond natural progression) by his service-connected diabetes. In addressing question (a), the examiner must not rely solely on the fact that the disease is not eligible for presumptive service connection. Moreover, please note that inquires (b) and (c) require two opinions: one for proximate causation and one for aggravation. Please also note that it is not necessary that diabetes be service-connected, or even diagnosed, at the time his heart disability is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.