Citation Nr: 20021524 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 15-14 224 DATE: March 26, 2020 REMANDED Entitlement to service connection for residuals of a myocardial infarction is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to June 1993. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decisions by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded this matter in July 2018 in order to obtain a VA opinion addressing whether the use of Proton Pump Inhibitors caused or aggravated the Veteran’s coronary artery disease and eventual myocardial infarction. There has been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). However, for reasons discussed below, further development is required. Entitlement to service connection for residuals of a myocardial infarction is remanded. The Veteran contends that residuals of a myocardial infarction were caused by active service, to include secondary service connection to medication used to treat his service-connected hiatal hernia with gastroesophageal disease. The Veteran’s representative argued that the Veteran’s claimed disability may have been caused or aggravated by his service-connected hypertension in a February 2020 statement. A review of the claims file indicates that the Veteran raised a similar contention in October 2012. In November 2012, a VA examiner opined that the Veteran’s heart condition was less likely than not proximately due to or the result of his service-connected hypertension. However, no opinion was provided as to whether the Veteran’s service-connected hypertension aggravated the claimed disability. An opinion that a disability is not related to or associated with another disability is not adequate to address the aggravation factor. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The examiner did not discuss whether the Veteran’s current disability was aggravated by his service-connected disability. For these reasons the November 2012 VA examination is inadequate. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate examiner regarding the Veteran’s myocardial infarction. After reviewing the claims folder, including a copy of this remand, the examiner must state whether it is at least as likely as not (50 percent probability or more) that: (a.) The Veteran’s myocardial infarction was caused by the service-connected hypertension. (b.) The Veteran’s myocardial infarction was aggravated (worsened) by the service-connected hypertension. 2. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. 3. A clear explanation for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner is unable to provide an opinion he or she should explain why. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.