Citation Nr: 20045034 Decision Date: 07/07/20 Archive Date: 07/07/20 DOCKET NO. 16-25 277 DATE: July 7, 2020 REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service connection for mitral valve disease, claimed as a heart condition, is remanded. Entitlement to service connection for gastritis and esophagitis, claimed as a stomach condition, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from December 1975 to May 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the appeal was previously remanded in September 2018 in order to further develop the Veteran’s claims. 1. Entitlement to service connection for hypertension is remanded. 2. Entitlement to service connection for mitral valve disease, claimed as a heart condition, is remanded. In its prior remand, the Board sought medical opinions on whether the Veteran's hypertension and mitral valve disease might be related to prolonged exposure to aircraft noise. Additionally, the Veteran submitted information regarding a study that indicated that exposure to aircraft noise over many years may increase risks or heart disease and stroke. Unfortunately, the opinions obtained on remand are conclusory and offer an inadequate explanation for their findings. The October 2019 VA examiner’s opinions on the Veteran's hypertension and mitral valve disease indicates that such disabilities are not caused by exposure to G Force exposure or exposure to aircraft noise. The examiner's rationale indicates that the study did not make “positive conclusions with conclusion,” noting that the study concluded that “[e]xposure to aircraft noise over many years may increase risks of heart disease and stroke, although more studies are needed to establish how much the risks associated with road traffic noise may be explained by air pollution,” which is not specific or provides a direct correlation. While the examiner ultimately rules out the relationships in question, the Board finds that the blanket, absolute conclusion arrived out is simply too conclusory. Opinions must be accompanied by a reasonable rationale and thus the Board further finds that remand for additional explanation and/or clarification in support of the opinions is necessary. 3. Entitlement to service connection for gastritis and esophagitis, claimed as a stomach condition, is remanded. The Board regrets the additional delay, but an additional remand is necessary as there has not been substantial compliance with the mandates of the September 2018 remand order. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). The September 2018 remand requested a VA examination to address causation and aggravation of the Veteran’s stomach condition by the Veteran’s back disorder, to include medications taken to relieve symptoms of his back disorder. However, the October 2019 VA examiner did not address this theory of contention in their opinion and rationale. Therefore, an additional remand is also required as to this issue as there has not been substantial compliance with the June 2017 remand. See Stegall, 11 Vet. App. at 271. 4. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. In the September 2018 remand, the Veteran's claim for entitlement to a TDIU was remanded because the file did not have sufficient documentation about the Veteran's occupational history. Given this, the agency of original jurisdiction (AOJ) was directed to provide the Veteran a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) from the Veteran, in addition to any other evidence relevant to the issue of entitlement to a TDIU. The AOJ properly attempted this development when it sent the Veteran a request for requested information. The Veteran submitted a new VA Form 21-8940, however he failed to provide the needed employment information in response to this request. Given that the information is required to make a determination on entitlement to a TDIU, the Veteran's claim is again remanded to obtain information about his occupational history. The Veteran is notified, however, that although VA has a duty to assist the Veteran in substantiating his claims, that duty is not a one-way street and it is important that he make efforts to assist VA in gathering and presenting evidence relevant to his claim. Woods v. Gober, 14 Vet. App. 214, 224 (2000); see also Hurd v. West, 13 Vet. App. 449, 452 (2000). The Board further notes that as the additional development requested as to the other claims on appeal may impact the TDIU claim, any decision with respect to TDIU should be deferred pending the completion of this development. The matters are REMANDED for the following action: 1. Provide an addendum opinion that adequately addresses the nature, extent, and etiology of the Veteran’s hypertension and mitral valve disease. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: (a) Provide an opinion as to whether the Veteran’s mitral valve disease is at least as likely as not (a 50 percent or greater probability) etiologically related to service, to include exposure to high G-forces during years of active service as an aircraft loadmaster and exposure to aircraft noise; and (b) Provide an opinion as to whether the Veteran’s hypertension is at least as likely as not (a 50 percent or greater probability) etiologically related to service, to include exposure to high G-forces during years of active service as an aircraft loadmaster and exposure to aircraft noise. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 2. Provide the Veteran an appropriate VA examination to determine the nature, extent, and etiology of any stomach disorder. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: (a) Identify and diagnose any current (at any point during appeal period) stomach disorder; (b) For each diagnosed stomach disorder, provide an opinion as to whether the stomach disorder at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active duty, or at least as likely as not was caused or aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected back disability to include medications taken for the Veteran’s back disability. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Obtain a completed VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) from the Veteran, in addition to any other evidence relevant to the issue of entitlement to a TDIU. 4. Thereafter, readjudicate the issues on appeal. If the benefits sought on appeal are not granted to his satisfaction, the Veteran should be furnished an appropriate Supplemental Statement of the Case, provided the requisite opportunity to respond, and the case should thereafter be returned to the Board for further appellate action. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. R. Montalvo, 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.