Citation Nr: 20046090 Decision Date: 07/09/20 Archive Date: 07/09/20 DOCKET NO. 19-31 439 DATE: July 9, 2020 REMANDED Entitlement to service connection for bilateral carotid artery disease, claimed as ischemic heart disease due to in-service tactical herbicide exposure or the service-connected coronary artery disease is remanded. Entitlement to service connection for thoracic aortic aneurysm, claimed ischemic heart disease as due to in-service tactical herbicide exposure or the service-connected coronary artery disease is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to July 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2019 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Since the RO issued its Statement of the Case in August 2019, new evidence, including medical articles, has been associated with the claims file. This evidence is relevant to the issues on appeal. As this evidence was associated with the file prior to certification of the appeal to the Board and the Veteran requested AOJ review, the issue must be remanded for the issuance of a Supplemental Statement of the Case (SSOC). 38 C.F.R. § 19.31. The Board noted that the Veteran also submitted new evidence, specifically private treatment records, after certification to the Board. The Veteran contends that his bilateral carotid artery and thoracic aortic aneurysms, are related to his service-connected coronary artery disease. In May 2019, the Veteran underwent VA examinations in furtherance of his claims. The examiner stated that his claimed conditions were less than likely than not related to his service-connected conditions. However, the examiner did not address whether his conditions were aggravated by his service-connected condition. Based on the new evidence submitted and the Veteran’s contentions, the Board finds that a medical opinion is needed to address the etiology of his conditions and determine whether the Veteran’s ischemic heart disease: bilateral carotid artery and thoracic aortic aneurysm conditions are related to his service-connected coronary artery disease, to include whether they were aggravated by this disability. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to: (a.) Whether the Veteran’s bilateral carotid artery and thoracic aortic aneurysms, are (1) a form of ischemic heart disease; (b.) Whether it is at least as likely as not (50 percent probability or greater) that the bilateral carotid artery and thoracic aortic aneurysms had their clinical onset during service or are due to an event or incident of the Veteran’s period of active service, to include his presumed exposure to tactical herbicides. In answering this question, the examiner must take into account the Veteran's personal circumstances and how the recognized risk factor(s) apply in his particular case. The examiner may not rely solely on the fact that the Veteran's carotid artery and thoracic aortic aneurysms are not on the presumptive list of diseases associated with herbicide exposure. (c.) Whether it is at least as likely as not, (50 percent probability or greater), that the carotid artery or thoracic aortic aneurysms were (A) caused or (B) aggravated beyond their normal progression by the service-connected coronary artery disease. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. The Veteran’s claims should be readjudicated based on the entirety of the evidence. If the benefit sought on appeal is not granted, the Veteran should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. For the issue on appeal, the SSOC should consider any new evidence received since the last Statement of the Case (SOC). M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. V. Palatt, 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.