Citation Nr: 19173294 Decision Date: 09/19/19 Archive Date: 09/19/19 DOCKET NO. 13-03 427A DATE: September 19, 2019 REMANDED Entitlement to service connection for a disability manifested by chest pain. REASONS FOR REMAND The Veteran had active duty from June 1979 to September 1979 and from December 1982 to May 1992, to include service in the Southwest Asia Theater of Operations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. Jurisdiction over the Veteran’s file has subsequently been transferred to the RO in Baltimore, Maryland. The Veteran seeks service connection for a disability manifested by chest pain. He reports a history of chest pain, stemming from just below the right collar bone, in and since service. See Claim (July 31, 2010); Statement (January 30, 2012). In July 2011, the Veteran was diagnosed with sleep apnea following polysomnogram. See VA treatment record (July 28, 2011). In July 2012, a VA examiner opined that the Veteran’s current sleep apnea is not related to service. In September 2017, the Board remanded the issue of entitlement to service connection for a disability manifest by chest pain for a VA examination to address the nature and etiology of his reported chest pain. At that time, the Board noted that the July 2012 VA Gulf War Examination failed to address the Veteran’s report of chest pain in and since service, instead focusing on his sleep apnea. The Board’s remand directed the examiner to Veteran’s symptoms—namely episodic chest pain and cough—are attributable to a known clinical diagnosis. During the February 2018 VA examination, the Veteran denied current chest pain, but gave a history of coughing with episodic sternum pain. The examiner diagnosed chronic cough but found no evidence of a disability manifested by chest pain. The Board finds that the February 2018 medical opinion is inadequate as the examiner failed to address whether the Veteran’s episodic chest pain constitutes a current disability and whether such disability is attributable to a known clinical diagnosis. Accordingly, reexamination is needed to ensure both an adequate medical opinion and compliance with the directives of the September 2017 remand. The matters are REMANDED for the following action: Provide the Veteran with a VA examination by an appropriate medical professional. The examiner is to review the pertinent evidence, including the Veteran’s lay assertions regarding his symptomatology, and undertake any indicated studies. Then, based on the results of the examination, the examiner is asked to address each of the following questions: (a) Please state whether the symptoms of the claimed condition (specifically, episodic chest pain and chronic cough) are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? (c) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (d) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any service-connected disability(ies)? (f) If not caused by another medical condition, has any disorder been aggravated (made permanently worse or increased in severity) by any service-connected disability(ies)? If yes, was that increase in severity due to the natural progress of the disease? In answering all questions (a) to (f), please articulate the reasons underpinning your conclusions. That is, (1) identify what facts and information, whether found in the record or outside the record, support your opinion, and (2) explain how that evidence justifies your opinion. A report of the examination should be prepared and associated with the Veteran’s VA claims file. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joshua Castillo, 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.