Citation Nr: 21001398 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 16-59 942 DATE: January 8, 2021 REMANDED Entitlement to service connection for coronary artery disease, ischemic heart disease is remanded. Entitlement to service connection for supraventricular arrhythmias, claimed as rapid ventricular rhythm, is remanded. Entitlement to service connection for atrial fibrillation is remanded. REASONS FOR REMAND The Veteran served in the Air Force from January 1963 January 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran presented testimony at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is on record. In November 2019, the Board remanded the claims for further development, to provide the Veteran a VA examination on the etiology of his disabilities that included consideration of the two reports submitted by the Veteran indicating trichloroethylene’s (TCE) cardiotoxicity and the Veteran’s description of his TCE exposure during service. For reasons set forth below, the Board finds this development has not been completed. 1. Entitlement to service connection for coronary artery disease, ischemic heart disease is remanded. 2. Entitlement to service connection for supraventricular arrhythmias, claimed as rapid ventricular rhythm, is remanded. 3. Entitlement to service connection for atrial fibrillation is remanded. The Veteran seeks service connection for coronary artery disease, ischemic heart disease, as well as supraventricular arrhythmias and atrial fibrillation. The Veteran contends these complications stem from his prolonged exposure to high levels of trichloroethylene (TCE) during his time in the Air Force. The Board finds the claims must again be remanded to ensure the Veteran is provided a VA examination with adequate rationale that complies with the Board’s prior remand directives. The Board first notes the Veteran’s record includes diagnoses for all three of these conditions. A current disability is generally shown by evidence after the claim is submitted or shortly before. See McClain v. Nicholson, 21 Vet. App. 319 (2007) (holding that the requirement a current disability is satisfied when the claimant has the disability at the time the claim for VA disability compensation is filed or during the pendency of the claim and that a claimant may be granted service connection even though the disability resolves prior to VA’s adjudication of the claim); Romanowski v. Shinseki, 26 Vet. App. 289, 294 (2013). Here, a March 2014 privately submitted disabilities benefits questionnaire notes diagnoses of atrial fibrillation and coronary artery disease. A September 2019 letter from a cardiologist notes the presence of cardiac arrhythmias. Thus, the Veteran meets the first requirement of service connection, a present disability, for all three of the claimed conditions. The Board also notes that the Veteran’s in-service exposure to TCE has been recognized and is found to be consistent with the circumstances of his service. Thus, the only question remaining is whether the Veteran’s claimed disabilities are etiologically related to the Veteran’s military service, to include his exposure to TCE. To answer this question, in November 2019 the Board remanded the claims to provide the Veteran a VA examination. The Board requested that the examiner discuss literature submitted by the Veteran indicating TCE’s cardiotoxicity and provide a complete rationale as to whether the Veteran’s heart disabilities are related to his exposure to TCE. The Veteran was provided this examination in January 2020. Unfortunately, the examiner provided a conclusory opinion relying on the absence of evidence in the Veteran’s record and did not address the literature submitted by the Veteran, as requested. Moreover, while lengthy, most of the opinion’s rationale is merely copy and pasted summary information from various medical websites. For these reasons, the Veteran’s January 2020 examination is both inadequate and fails to consider the Board’s prior remand directives. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (“It is the factually accurate, fully articulated, sound reasoning for the conclusion, ... that contributes probative value to a medical opinion.”); Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992); Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). Another VA opinion is required. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The matters are REMANDED for the following actions: 1. Obtain an addendum opinion to determine the etiology of the Veteran’s coronary artery disease, ischemic heart disease, as well as the Veteran’s supraventricular arrhythmias and atrial fibrillation. After careful review of all the evidence, including the two reports submitted by the Veteran in March 2016 and August 2016 indicating TCE’s cardio-toxicity, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability)that the Veteran’s coronary artery disease, ischemic heart disease; supraventricular arrhythmias; and/or atrial fibrillation were caused by or are otherwise etiologically related to his military service, to include the extent of exposure to TCE described by the Veteran at his September 2019 hearing. A complete rationale for any opinion must be provided. A complete rationale is one with clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. Then, readjudicate the claims on appeal. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante 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.