Citation Nr: 20022566 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 15-10 633 DATE: April 1, 2020 REMANDED Entitlement to service connection for cardiovascular disability, to include ischemic heart disease, hypertension and peripheral vascular disease, is remanded. Entitlement to service connection for osteoarthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to December 1972. In June 2018, the Board remanded these claims for further development. 1. Cardiovascular disability Remand is necessary for clarification of diagnosis. The Veteran has sought service connection for a heart disability. His September 2011 claim specifically sought service connection for ischemic heart disease. The July 2019 VA examiner opined that the Veteran did not have a diagnosis of ischemic heart disease; however, in the medical opinion section of her report she indicated that he had “evidence of atherosclerotic vascular disease with a prior stroke.” However, she did not mark this diagnosis in the corresponding Heart Compensation and Pension Exam. A diagnosis of atherosclerotic vascular disease is not reflected in the Veteran’s private or VA treatment records. Clarification of the diagnosis is important because under 38 C.F.R. § 3.309(e) the definition of ischemic heart disease includes atherosclerotic cardiovascular disease. As the Veteran’s DD 214 reflects service in Vietnam during the Vietnam era, he is presumed to have been exposed to herbicide agents. See 38 C.F.R. § 3.307(a)(6). Therefore, presumptive service connection based on exposure to herbicide agents is reasonably raised by the record, if a diagnosis of atherosclerotic cardiovascular disease was not in error. 2. Service connection for osteoarthritis is remanded. The Veteran seeks service connection for osteoarthritis. During the July 2019 examination it was reported that he was injured when he was "jumped" on active duty from behind, he threw the guy to the ground, and he got kicked in the head. Service treatment records reflect that in February 1972 he was seen for being kicked in the head. Also, during the July 2019 VA examination, the Veteran contended that exposure to herbicide agents “had a lot to do” with his arthritis. Herbicide exposure has previously been conceded. The Board does not find that there has been substantial compliance with the prior remand directive. See Stegall v. West, 11 Vet. App. 268, 271. The July 2019 VA examiner only provided an opinion of there being no evidence that arthritis began in service. However, this ignores the fact that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). In addition, the examiner provided a long list of events after service with no indication as to their significance; she provided no reasoning or explanation for why she listed these items. Cf. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Summarizing the Veteran’s past medical history is insufficient to constitute an adequate rationale when there is no reasoning as to its significance. Consequently, a remand is necessary to obtain an adequate medical opinion. Finally, the July 2019 VA examination is inadequate because the examiner did not address the Veteran’s contention that exposure to herbicide agents in service resulted in osteoarthritis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain an addendum medical opinion from an appropriate clinician clarifying whether the Veteran has a current diagnosis of atherosclerotic cardiovascular disease. The examiner must specifically address the statement in the July 2019 VA examination that the Veteran had “evidence of atherosclerotic vascular disease with a prior stroke.” A detailed rationale must be provided explaining whether or not this is a current diagnosis. If, and only if, an in-person VA examination is deemed necessary by the examiner to provide an opinion such should be accomplished. 3. After completing directive #1, obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of osteoarthritis. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the February 1972 incident of being kicked in the head. As to any current diagnosis of osteoarthritis the examiner should clarify whether it is related to a complaint identified by the Veteran in the October 1972 Report of Medical History (swollen are painful joints; arthritis, rheumatism, or bursitis; painful our trick shoulder or elbow; recurrent back pain; trick or locked knee). The examiner must also opine whether osteoarthritis is at least as likely as not related to presumed in-service herbicide agent exposure. In addition, the examiner must specifically address whether osteoarthritis at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. If, and only if, an in-person VA examination is deemed necessary by the examiner to provide an opinion such should be accomplished. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board AD 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.