Citation Nr: 20021095 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 15-19 367 DATE: March 24, 2020 REMANDED Entitlement to service connection for a heart disability. REASONS FOR REMAND The Veteran served on active duty from January 1964 to December 1967. This appeal is before the Board of Veterans’ Appeals (Board) from a June 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In March 2018, the Veteran testified during a Board hearing in Atlanta, Georgia, before the undersigned Veterans Law Judge. A transcript is included in the claims file. In August 2018 the Board remanded the remaining issue on appeal with instruction to obtain relevant records and an opinion from a VA medical examiner. The issue is again before the Board. Entitlement to service connection for a heart disability The Veteran claims service connection for a heart disability. Unfortunately, an additional remand is necessary to adjudicate his claim. Service treatment records reflect that at a September 1964 cardiology consultation, the Veteran was diagnosed with rheumatic heart disease with mitral insufficiency, class I. In its August 2018 remand, the Board instructed the VA examiner to opine as to whether the Veteran’s current cardiovascular disability was at least as likely as not related to service, “to include whether or not it is etiologically related to the mitral insufficiency diagnosed during active service.” A January 2020 opinion was obtained from a VA examiner. The examiner opined that the Veteran’s mitral insufficiency was less likely than not incurred in service. The examiner noted the September 1964 diagnosis in a summation of the facts but did not reference the diagnosis in the rationale. Moreover, the examiner confusingly stated in the rationale that “there was no mitral insufficiency murmur noted on examination in service.” The Board finds that the January 2020 VA medical opinion is inadequate and did not fully comply with the instructions in the Board’s August 2018 remand. An additional remand is therefore necessary to obtain an adequate opinion. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any additional medical evidence that may have come into existence but has not been associated with the record. 2. Return the file to the January 2020 VA examiner, or if unavailable to another qualified examiner. The claims file must be reviewed by the examiner. The examiner should offer a clarification opinion as to whether it is at least as likely as not (i.e. 50 percent probability or more) that the Veteran’s current heart disability, to include mitral insufficiency, is related to the mitral insufficiency diagnosed in service in September 1964. In so doing, the examiner must explain in detail why or why not a current diagnosis of mitral insufficiency would be related to the mitral insufficiency noted in September 1964. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any 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. 3. After completing the above, and any other development deemed necessary, readjudicate the appeal. If any benefit sought remains denied, provide an additional supplemental statement of the case to the Veteran, and return the appeal to the Board. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Gallagher, 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.