Citation Nr: 21062123 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 14-22 665 DATE: October 6, 2021 REMANDED Entitlement to service connection for paroxysmal atrial fibrillation and tachy-brady syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from September 1961 to May 1966. This matter comes before the Board of the Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the Veteran and his spouse testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This case was previously before the Board in February 2019 and April 2021, at which times the issue currently on appeal was remanded for additional development. This case has been returned to the Board for further appellate action. One theory of service connection in this appeal involves the Veteran's assertion that his atrial fibrillation and tachy-brady syndrome are secondary to service-connected disability, namely, his posttraumatic stress disorder (PTSD). See 38 C.F.R. § 3.310. However, the Veteran is also service connected for coronary artery disease (CAD). In this regard, there is inconclusive evidence regarding a possible link between this service-connected disability and the Veteran's atrial fibrillation and tachy-brady syndrome. Pertinent evidence includes a November 2013 VA examination report wherein the examiner diagnosed the Veteran as having atrial fibrillation and tachy-brady syndrome, but not ischemic heart disease (IHD). This was based in part on results of a March 2013 cardiac catherization showing normal coronary arteries. However, a VA examiner in December 2020 reported that the Veteran's IHD was responsible for physical limitations at work based on 2019 and 2013 ECHOS (echocardiograms) (emphasis added). This report suggests that the ECHO findings in 2013 support IHD. A subsequent medical opinion obtained by VA in August 2021 unfortunately does not adequately address the question of a possible nexus between the Veteran's CAD and atrial fibrillation and tachy-brady syndrome. In this regard, the examiner negated a nexus between the Veteran's service-connected PTSD and atrial fibrillation and tachy-brady syndrome. He also reported that the Veteran had multiple risk factors at the time he was diagnosed as having atrial fibrillation and tachy-brady syndrome to include hypertension, obesity, sleep apnea, age, smoking history, gender, and ethnicity. However, he also acknowledged that there were certain underlying conditions which predisposes an individual to acquire atrial fibrillation to include CAD. Notably, he did not acknowledge or comment on the fact that the Veteran is service connected for CAD or discuss this disability as a possible contributing factor as an underlying disease. Accordingly, additional medical clarification is required that addresses service connection for atrial fibrillation and tachy-brady syndrome on a secondary basis in view of the Veteran's service-connected CAD. While the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the appellant's claim so that he is afforded every possible consideration. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's atrial fibrillation and tachy-brady syndrome is at least as likely as not (50% probability or higher) proximately due, caused by or aggravated beyond its natural progression by service-connected disability, namely, his service-connected CAD. 2. After ensuring compliance with the above, readjudicate the claim. If the benefit sought on appeal remains denied, the Veteran should be provided a SSOC. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Shawkey, 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.