Citation Nr: 21003562 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 13-16 406 DATE: January 22, 2021 REMANDED Entitlement to service connection for chest pain to include as secondary to hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1985 to February 1989. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO or AOJ). In November 2016, the Veteran testified before the undersigned Veterans Law Judge in a Video Conference Board Hearing. A transcript of that hearing is of record. This case was previously before the Board in August 2020 when it was remanded for additional development. It has now returned to the Board for further appellate action. Unfortunately, the Board finds that further action in this appeal is warranted, even though such will, regrettably, further delay an appellate decision on this matter. A remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon the VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the August 2020 Remand, the Board deemed the April 2019 VA medical opinion inadequate for purposes of adjudicating the Veteran’s claim because (1) the rationale focused on causation and not aggravation; (2) the rationale used speculative and equivocal language; and (3) the examiner relied on the absence of records to render a negative opinion. An addendum opinion, as opposed to an examination, was requested. The remand indicated that an examination should be scheduled if deemed necessary. In August 2020, the AOJ attempted to contact the Veteran to schedule a VA examination. After three attempts, the VA examination was subsequently cancelled due to the Veteran’s failure to schedule an appointment. However, the AOJ did not forward the Veteran’s file to a VA examiner to attempt to provide an addendum opinion. There is also no indication that an in-person examination was necessary to address the questions presented by the Board in the Remand. Thus, this matter must be remanded to obtain an addendum opinion. The matters are REMANDED for the following action: Obtain a VA opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s diagnosed chest pain. An examination should be scheduled only if such is deemed necessary. After reviewing the claims file, to include copies of the August 2020 Remand and the Remand herein, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran’s chest pain: a. was proximately due to her service-connected hypertension or medications used to treat this disability. b. underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability or medications used to treat this disability. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. Rationale must be provided for all requested opinions. Discussion and citation of supporting medical treatise/research would be very helpful. If the examiner concludes that an opinion cannot be offered without resort to mere speculation, the examiner must address whether research in the medical literature might assist him/her in providing the medical opinion requested in this matter, and if so, such research in the medical literature must be conducted. The examiner must also indicate whether any use of the phrase “without resorting to mere speculation” reflects the limitations of knowledge in the medical community at large as opposed to the limits of his/her knowledge and expertise in particular. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith, 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.