Citation Nr: 20009826 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 15-27 851 DATE: February 5, 2020 REMANDED Entitlement to service connection for arteriosclerosis, to include as secondary to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1969 to May 1971. In February 2018, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. In August 2018, the Board remanded the claim in order to provide the Veteran with a VA examination to help determine the likely etiology of any currently diagnosed arteriosclerosis. Specifically, the Board asked the examiner to consider the NAS IOM’s Veterans and Agent Orange: Update 2012, concluded that there was “limited or suggestive” evidence of an association between herbicide exposure and CVAs/strokes. See Nat’l Acad. of Sci., Inst. of Med., Veterans & Agent Orange: Update 2012; see also Notice, 79 Fed. Reg. 20,308 - 20,313 (2014). An additional remand is necessary to obtain and addendum medical opinion and to ensure compliance with the Board’s remand directives. In May 2019, the Veteran underwent VA examinations for central nervous system and neuromuscular diseases, heart conditions, and artery and veins conditions. The examiner opined that the Veteran did not have a diagnosis of a heart disease, to include ischemic heart disease and explained that prior notations of the diagnoses were not supported by the evidence. The examiner further opined that the diagnosed CVA/stroke and/or arteriosclerosis were less likely than not related to service because no symptoms were noted during service and the conditions were not recognized as presumptive due to exposure to herbicide agents. In a January 2020 informal hearing presentation, the Veteran’s representative correctly noted that the examiner did not address the NAS IOM’s Veterans and Agent Orange as required by the Board. Moreover, the Board notes that the opinion was based on the premise that the Veteran’s disabilities were not recognized as presumptive disabilities due to herbicide agent exposure, contradictory to the Court’s holding in Polovick, which found that the Board erred in denying a claim for brain tumor finding that the disease was not noted in the “Limited Evidence of No Association” category in the 2002 Agent Orange Update. See Polovick v. Shinseki,23 Vet. App. 48 (2009). Accordingly, the Board finds the opinion inadequate in its current form and a new addendum opinion is necessary prior to deciding the claims on the merits. Given these deficiencies, an additional remand is necessary because there was no compliance with the Board’s August 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Thereafter, obtain addendum medical opinions from an appropriate VA examiner to help determine the likely etiology of any currently diagnosed arteriosclerosis. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After review of the record, the examiner is asked to respond to the following: Provide an opinion whether any currently diagnosed arteriosclerosis is at least as likely as not (50 percent or higher probability) related to his conceded exposure to herbicide agents in Vietnam. (Continued on the next page)   The rationale cannot rely on the fact that breast cancer is not noted in the “Limited Evidence of No Association” category in the 2002 Agent Orange Update; Rather, explain with complete rationale why arteriosclerosis is or is not related to exposure to herbicide agents. In addition, specifically consider NAS IOM’s Veterans and Agent Orange: Update 2012, which concluded that there was “limited or suggestive” evidence of an association between herbicide exposure and CVAs/strokes. See Nat’l Acad. of Sci., Inst. of Med., Veterans & Agent Orange: Update 2012; see also Notice, 79 Fed. Reg. 20,308 - 20,313 (2014). 3. Thereafter, ensure that there has been substantial compliance with the requested addendum questions, and then readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Yaffe, 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.