Citation Nr: 20021026 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 18-16 525 DATE: March 24, 2020 REMANDED Entitlement to service connection for the cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1964 to January 1966. He died in April 1977. The appellant is his surviving spouse. This matter was previously before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) denying service connection for the cause of death. The appellant subsequently submitted military personnel records showing that the Veteran served in the Republic of Vietnam from August 1964 to December 1964 in order to support her contention that the Veteran’s death was caused by exposure to herbicide agents in service. Given that these relevant official service department records existed and had not been associated with the claims file when VA first decided in the claim in January 1978, the VA reconsidered the appellant’s original claim. 38 C.F.R. § 3.156(c). In a May 2019 decision, the Board found the Veteran’s January 2017 VA opinion to be inadequate and remanded the claim to obtain an addendum opinion. While the Board regrets the additional delay, further development is required before the Board may address this issue on the merits. Entitlement to service connection for the cause of death is remanded. The Veteran’s death certificate shows that the immediate cause of his death was acute pulmonary edema, due to or as a consequence of cardiac arrhythmia, due to or as a consequence of hypertensive cardiac vascular disease. A VA opinion was obtained in January 2017 regarding whether the Veteran’s hypertensive cardiac vascular disease qualified as a disease presumptively linked to exposure to herbicide agents under 38 C.F.R. § 3.309. While 38 C.F.R. § 3.309 does provide that exposure to herbicide agents is presumptively connected to “ischemic heart disease. . . including, but not limited to . . . atherosclerotic cardiovascular disease including artery disease,” the physician’s opinion considered only whether the Veteran’s hypertensive cardiac vascular disease was coronary artery disease, and not whether it could be considered ischemic heart disease other than coronary artery disease. Therefore, the Board found in its May 2019 decision that this opinion was inadequate to consider whether the Veteran’s cause of death qualified under the full category of ischemic heart disease. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A second VA opinion was obtained in November 2019 addressing whether hypertensive cardiac vascular disease is an ischemic heart disease, and whether the Veteran’s hypertensive cardiac vascular disease was at least as likely as not caused by the Veteran’s exposure to herbicide agents in service. The physician stated that hypertensive cardiovascular disease is not an ischemic heart disease. He also stated that cumulative scientific data from the National Academy of Sciences has determined that there is no positive association between herbicide exposure and hypertensive cardiovascular disease. While the Board finds this examination to be adequate to address the specific issue of presumptive service connection for hypertensive cardiovascular disease due to herbicide exposure, there is no medical opinion of record to date that has addressed direct service connection with regards to all disorders that were either the principal or contributory cause of death. 3.312(a). Further, given that the Veteran’s service treatment records revealed a functional heart murmur and abnormal blood pressure in his November 1963 pre-enlistment examination, the Board, in considering the pertinent statutory and regulatory framework governing the presumption of aggravation, must determine: (1) whether there was a worsening of the disorder during service; and (2) if so, whether there was clear and unmistakable evidence that the increase in severity was due to the natural progress of the disease. See Crowe v. Brown, 7 Vet. App. 238, 245-46 (1994). 38 C.F.R. § 3.306. The Board notes that the January 2017 VA opinion addressed aggravation as to the Veteran’s abnormal blood pressure, but did not address the functional heart murmur. Therefore, the Board finds that the issue must be remanded for an addendum opinion to address these deficiencies. The matters are REMANDED for the following action: 1. Obtain an opinion from the November 2019 physician, if available, or if unavailable from another appropriate clinician, regarding the following questions: a. Was the Veteran’s acute pulmonary edema, cardiac arrhythmia, or hypertensive cardiac vascular disease at least as likely as not (50 percent probability or greater) incurred during or otherwise etiologically related to service, including but not limited to his herbicide exposure? b. Did the Veteran have a heart disorder that clearly and unmistakably (i.e., undebatably) existed prior to his enlistment in-service? c. If so, is there clear and unmistakable evidence that the pre-existing heart disorder was not aggravated (i.e., is it undebatable that the disability did not undergo a permanent increase in severity) during the Veteran's period of active service? If the Veteran's pre-existing heart disorder did undergo a permanent increase in severity, was that permanent increase in severity during service clearly and unmistakably due to the natural progress of the condition? If there was no increase in pathology, that should be clearly set out. In providing the requested opinions, the physician should refer to the pertinent evidence of record, including the Veteran's service treatment records and the lay statements in support of the claim. The physician must provide a complete rationale for any opinions expressed, based on his/her clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the physician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The physician should also reconcile all prior reports, as necessary. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance   with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, 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.