Citation Nr: 20021695 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 11-01 807 DATE: March 26, 2020 REMANDED Entitlement to service connection for a heart disorder is remanded. Entitlement to service connection for a gastrointestinal disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 2005 to November 2011. The Veteran passed away in November 2018. The Appellant is the Veteran’s wife. At the time of his death, the Veteran had multiple service connection claims pending. In May 2019, the Appellant submitted a VA Form 21-534EZ, Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefits, in addition to a request to be a substitute claimant in the Veteran’s pending appeal. In a July 2019, decision, the United States Court of Appeals for Veterans (Court) granted the Appellant’s substitution request. The Board finds that July 2019 decision notifying the Appellant that substitution was granted is in accordance with the provisions of 38 U.S.C. § 5121A; 38 C.F.R. §§ 3.103(b)(1), 3.1010(e)(1). In a June 2019 decision, the Court vacated the March 2018 Board decision denying the Veteran’s service connection claims for a heart disorder and gastrointestinal disorder. The Court found that the most recent VA opinion from August 2017 was inadequate. The Veteran submitted multiple medical articles addressing the connecting between psychiatric disorders and heart conditions and gastrointestinal disorders. The Court determined that the August 2017 VA examiner failed to adequately discuss the articles before providing a negative opinion. The Court noted that the July 2017 Board remand ordered the VA examiner to consider the conflicts in the previous June 2017 VA opinion, noting there was no evidence to support a relationship between PTSD and the Veteran’s service connection claims, and the negative June 2016 VA opinion. As noted in the July 2017 remand, the medical articles provided evidence of a connection that needed to be addressed. Consequently, the August 2017 VA examiner should have addressed this conflict and failed to provide an adequate explanation. Thus, a new opinion is necessary. Additionally, the Court remanded the case for the Veteran to receive a new VA examination for his disabilities. The Court noted that an in-person examination was necessary, and a supplemental opinion was inadequate. However, as the Veteran has passed away, the Board finds that a supplemental opinion will meet the directives set forth by the Court. The matters are REMANDED for the following action: 1. Return the Veteran’s claims file to the examiner who provided the August 2017 VA opinion so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must opine as to the following: a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s heart disorder was proximately due to the result of his service connected PTSD. b.) Whether it is at least as likely as not that the Veteran’s heart disorder was aggravated beyond its natural progression by his service-connected PTSD. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Although an independent review of the claims file is required, the examiner should specifically address the following medical articles submitted by the Veteran: 1. The article “PTSD may increase heart disease risk in older men” which provides a link between stress and coronary artery heart disease in risk factors were common in people with PTSD. 2. The article from the U.S. Department of Health and Human services noting “significant health problems are more likely to occur in individuals with PTSD than in those without the disorder, particularly hypertension, asthma, and gastrointestinal problems.” The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. The examiner must discuss each article submitted by the Veteran in the rationale and should not state there is no evidence to support a causative relationship. should If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Return the Veteran’s claims file to the examiner who provided the August 2017 VA opinion so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must opine as to the following: a.) Whether it is at least as likely as not that the Veteran’s gastrointestinal disorder was proximately due to the result of his service connected PTSD. b.) Whether it is at least as likely as not that the Veteran’s gastrointestinal disorder was aggravated beyond its natural progression by his service-connected PTSD. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Although an independent review of the claims file is required, the examiner should specifically address the following medical articles submitted by the Veteran: 1. The article “PTSD and Physical Health” which stated there was some evidence that PTSD was related to gastrointestinal disorders. 2. The article from the U.S. Department of Health and Human services noting “significant health problems are more likely to occur in individuals with PTSD than in those without the disorder, particularly hypertension, asthma, and gastrointestinal problems.” 3. The article “Reliving Trauma” nothing that gastrointestinal distress was common in individuals with PTSD. 4. The article “Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative health effects and possible interventions” that stated people who experienced trauma have higher rates of serious illnesses including gastrointestinal disorders. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. The examiner must discuss each article submitted by the Veteran in the rationale and should not state there is no evidence to support a causative relationship If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Brunot, 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.