Citation Nr: 20043771 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 15-12 234A DATE: June 29, 2020 REMANDED Entitlement to Dependency and Indemnity Compensation (DIC) based on service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran had active duty service from December 1964 to January 1966 and from April 1969 to June 1970. The Veteran died in July 2014. The Appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2015 rating decision (RD) issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that a hearing was held in August 2018 before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Entitlement to Dependency and Indemnity Compensation (DIC) based on service connection for the cause of the Veteran's death is remanded. The Appellant’s claim was remanded by the Board in March 2019 in order to obtain a medical opinion as to whether the Veteran’s coronary artery disease was at least as likely as not (50 percent or greater probability) related to an event, injury or disease during his active military service, to include a systolic ejection murmur noted on his separation examination. Now of record are November 2019 and January 2020 VA medical opinions addressing the same. Upon review of the January 2020 VA medical opinion, the Board finds that another remand is needed as the Board’s March 2019 remand directives were not substantially complied with in that the Board specifically requested that the sought-after medical opinions be obtained from a physician, and the January 2020 VA medical opinion was obtained from a nurse practitioner. See Stegall v. West, 11 Vet. App. 268 (1998). Additionally, the November 2019 VA Medical Opinion providing two conflicting opinions as noted by the RO in a November 2019 Deferred Rating action. The examiner opined that claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. However, in the rationale portion of the medical opinion, the examiner also indicated it is as likely as not dyslipidemia, hypertension, chronic kidney disease, and impaired fasting glucose, functional murmur was approximately due to or caused by illness or even while on active duty. As such that opinion is inadequate. The matters are REMANDED for the following action: Obtain a medical opinion from a physician for the Appellant’s DIC claim. Upon review of the record including the pertinent medical evidence, as well as this remand, the VA medical examiner is requested to opine as to the following: (a) Is it at least as likely as not that the Veteran’s coronary artery disease was at least as likely as not (50 percent or greater probably) related to an event, injury or illness during his active military service, to include a systolic ejection murmur noted on his separation examination? (b) Is it at least as likely as not (50 percent probability or greater) that any other condition listed as a significant condition contributing to the Veteran’s death (dyslipidemia, hypertension, chronic kidney disease, and impaired fasting glucose) incurred in service, or is related to an event, injury, or disease during the Veteran’s active duty military service, to include a systolic ejection murmur noted on his separation examination? The VA medical examiner’s attention is directed to the Veteran’s May 1970 exit examination indicated a systolic ejection murmur, and an August 1970 EKG less than a year after the examination suggested left ventricular hypertrophy. The Veteran testified, prior to his death, that he had sought treatment for the heart condition since discharge at the Oklahoma City VA Medical Center (VAMC) and continued to have symptoms of chest pain and shortness of breath. The Veteran was eventually diagnosed with coronary artery disease in July 1998 after a myocardial infarction. Additionally, the Appellant has provided evidence that left ventricular hypertrophy may be related to the development of coronary artery disease. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.R. Fey, 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.