Citation Nr: 20069578 Decision Date: 10/27/20 Archive Date: 10/27/20 DOCKET NO. 16-55 339 DATE: October 27, 2020 REMANDED Entitlement to service connection for a heart disorder, to include as due to herbicide exposure is remanded. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1968 to December 1972. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. 1. Entitlement to service connection for a psychiatric disorder ,to include PTSD, is denied. Remand is required to obtain substantial compliance with the prior Board remand. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In the prior remand, the Board directed the examiner to provide an opinion regarding whether there were other non-PTSD psychiatric disorders. If not, the examiner was to address the prior diagnoses of depressive disorder and insomnia. A December 2019 VA examination and opinions were provided. The examiner determined that PTSD was the only diagnoses of record. The examiner did not, however, address the other diagnoses of record. 2. Entitlement to service connection for a heart disorder, to include as due to herbicide exposure, is remanded. Remand is required for an adequate VA examination. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The December 2019 VA examiner opined that the Veteran did not have a definitive diagnosis of ischemic heart disease as the Veteran only had an abnormal 3 lead ECG with no additional cardiac evaluation. The examiner stated that there was no mention of a heart condition in the Veteran’s STRs or any other documented cardiac condition or hypertrophy. The examiner also stated that the Veteran was diagnosed with left ventricular hypertrophy but that it was not a condition related to herbicide exposure. The examiner, however, did not properly address the December 2014 Report of Consultation and Examination. The 2014 Report noted that the Veteran had random chest pain, dyspnea, and heavy legs, slightly irregular heart sounds, and his ECG screening which demonstrated ST-T segment changes consistent with and suggestive of ischemic heart disease. The Report also noted a suggestion of a prior silent myocardial infarction. The examiner did not address the significance, if any, this evidence had on the medical opinion. The Board also finds that the nexus opinion regarding the Veteran’s diagnosed left ventricular hypertrophy was inadequate. The examiner’s only rationale was that left ventricular hypertrophy was not a condition related to herbicide exposure. The Board finds the examiner’s statement was conclusory and unsupported by medical evidence. As such, remand is required to obtain an adequate VA opinion. The matters are REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 2. Contact the appropriate VA Medical Centers and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 3. After any additional records are associated with the claims file, provide the Veteran with an examination regarding the etiology of any heart disorder, to include as due to herbicide exposure. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his active service to include where he alleged, he was exposed to Agent Orange. (a.) The examiner is asked to identify all diagnosed heart disorder(s). The examiner must determine if the Veteran was properly diagnosed, at any point, with ischemic heart disease or left ventricular hypertrophy. The examiner must address the December 2014 Report of Consultation and Examination which noted: (1) the Veteran’s symptoms of random chest pain, dyspnea, heavy legs, and irregular heart sounds; (2) an irregular ECG; and (3) evidence of possible prior silent myocardial infarction. (b.) The examiner must opine whether it was at least as likely as not (50 percent or greater degree of probability) that each diagnosed heart disorder, had onset in, or is otherwise relate to, military service, to include as due to herbicide exposure. 4. After any additional records are associated with the claims file, obtain an addendum opinion from the 2019 VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. First, the examiner must provide an opinion regarding whether it there are diagnoses of depressive disorder and/or insomnia. If not, the examiner must address the prior diagnoses of record. Second, if there are such diagnoses, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the depressive disorder and/or insomnia had onset in, or is otherwise related to, active service. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ashley Ki 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.