Citation Nr: 20007635 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 19-08 915 DATE: January 29, 2020 REMANDED Entitlement to service connection for a heart condition, to include bradycardia with pacemaker and sick sinus syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1973 to June 1977 and from January 1991 to June 1991. He also served in the United States Army Reserve. The Veteran appeals a February 2015 Rating Decision (RD) by the Agency of Original Jurisdiction (AOJ). The Veteran contends he had chest pain during service and that his heart condition is due to his service-connected hypertension. See March 2019 VA Form 9. The February 2015 VA examiner submitted a negative nexus opinion. However, the opinion was conclusory and did not address direct service connection. A direct service connection opinion is important here since the Veteran had treatment for chest related issues during active service. See September 1976 and March 1991 Service Treatment Records (STRs). The VA examiner noted the Veteran was diagnosed with an “implanted automatic implantable cardioverter defibrillator.” The VA examiner’s opinion simply stated the Veteran’s bradycardia is less as likely as not “proximately due to or the result of hypertension” and “not aggravated beyond its natural progression by his/her service connected hypertension.” The VA examiner went on to state the Veteran’s bradycardia “is from sick sinus syndrome, not from hypertension.” This opinion suggests the Veteran may have other diagnosed heart related conditions, to include sick sinus syndrome, that may be directly service connected or secondary to his service-connected hypertension. In light of this evidence, the Board will expand the scope of the Veteran’s claim to encompass any heart condition, to include bradycardia with a pacemaker and sick sinus syndrome. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009); Brokowski v. Shinseki, 23 Vet. App. 79, 85 (2009). The VA examiner also noted the medication taken for the Veteran’s heart condition include a list of high blood pressure medication. It is unclear whether the VA examiner considered the impact the Veteran’s hypertension medication had on his heart condition. As such, remand is required for a VA examination to clarify the Veteran’s diagnosed heart conditions and address their etiologies in light of the above theories of entitlement. Additionally, prior Board decisions noted the Veteran had United States Army Reserve service. See December 2013 Board Decision. The Veteran’s STRs of record also include treatment records and examinations for dates outside of the Veteran’s active duty periods of service. There are limited Service Personnel Records (SPRs) available that allow the Board to verify the Veteran’s periods of Reserve service to include any period of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA). Such periods are important here because the medical records, marked as STRs, note a diagnosis of bradycardia and an abnormal EKG not long after the Veteran’s second period of active service. See October 1996 STRs. Therefore, remand is required to obtain any outstanding SPRs and STRs. The matter is REMANDED for the following action: 1. Obtain any outstanding Service Personnel Records (SPRs) and STRs that are not already of record, to specifically include records for Army Reserve service after the Veteran’s initial period of active duty service. 2. Thereafter, schedule the Veteran for an examination to determine the nature and etiology of his heart condition, to include bradycardia with pacemaker and sick sinus syndrome. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. After the record review and examination of the Veteran, the examiner should identify all heart conditions present. Then for each identified condition, the examiner is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran’s heart condition was incurred in, or is otherwise related, to his time on active service, to include complaints of chest pain therein? Is it at least as likely as not that the Veteran’s heart condition was CAUSED by his service-connected hypertension, to include any medication taken for hypertension? Is it at least as likely as not that the Veteran’s heart condition was AGGRAVATED by his service-connected hypertension, to include any medication taken for hypertension? Is it at least as likely as not that the Veteran’s heart condition is the result of a disease or injury incurred during a period of ACDUTRA or an injury incurred during a period of INACDUTRA? In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Zheng, 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.