Citation Nr: 21062588 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 17-04 131 DATE: October 8, 2021 REMANDED Entitlement to a separate, compensable rating for an aortic aneurysm is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1965 to July 1969, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal and Vietnam Campaign Medal. This appeal has a prolonged procedural history. Of relevance, the Veteran was awarded service connection for coronary artery disease (CAD) and residual scar status post aortic aneurysm repair in an October 2014 rating decision. He appealed the initial rating assigned for his CAD to the Board, and the appeal was granted in part and denied in part in February 2020. However, the Court of Appeals for Veterans Claims (Court) granted a Joint Motion for Partial Remand in November 2020, and vacated the Board's partial denial of the appeal on the basis that the Board erred in failing to address whether a separate, compensable award for an aortic aneurysm was warranted in this case. In April 2021, the Board remanded the matter for additional development, including the provision of a VA examination which addressed "all signs and symptoms necessary" to evaluate the claimed aortic aneurysm under DCs 7110-7112. The requested examination was provided later that same month. However, the record is in controversy as to whether the Veteran's aortic aneurysm is causally related to his CAD, or whether these conditions constitute the same disability under various diagnoses. 38 C.F.R. § 4.14 (prohibiting the pyramiding of symptoms); October 2014 rating decision (awarding service connection for residual scar status post aortic aneurysm, but not the actual aneurysm); March 2017 VA Form 21-526EZ (pursuing service connection for aortic aneurysm due to claimed Agent Orange exposure); June 2021 VA opinion (opining that the Veteran's aneurysm is not related to his military service); see generally VA and private treatment records (documenting multiple aortic aneurysms but failing to identify the cause thereof). As the Board is not a medical body, clarification is required on this point. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Of note, the Board's April 2021 remand also instructed that the Veteran be afforded the opportunity to authorize VA to obtain private records related to his aortic aneurysm. Requests for such authorization were made in May 2021 and June 2021, but the Veteran did not respond. These records are directly relevant to the pending appeal, such that remand provides further opportunity to obtain them. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (participation in the VA process is a "two-way street."). The matter is REMANDED for the following actions: 1. Contact the Veteran and request that he identify all private providers of medical treatment for his aortic aneurysm since service. Thereafter, request that he provide authorization for release of all identified private medical records to VA, including from the Washington Hospital and St. Joseph's Hospital. All actions to obtain the requested records should be fully documented in the record. The RO must make two attempts to obtain any private records identified, unless the first attempt demonstrates that further attempts would be futile. If private records are identified, but not obtained, the RO must notify the Veteran of (1) the identity of the records sought, (2) the steps taken to obtain them, (3) that the claim will be adjudicated based on the evidence available, and (4) that if the records are later obtained, the claim may be readjudicated. If possible, the Veteran should attempt to obtain the records himself. 2. Schedule the Veteran for an examination to assess the claimed aortic aneurysm. The claims file and a copy of this remand must be made available for review. In particular, the examiner is asked to offer medical opinions as to: a. Indicate whether the Veteran demonstrated an aortic aneurysm (or the residuals thereof) during the period on appeal. Any reported symptoms or residuals must be clearly identified and assessed under DCs 7110 through 7112. b. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran's aortic aneurysm began in service, was caused by service, or is otherwise related to service, including contended in-service exposure to herbicide agents? c. Opine whether it is at least as likely as not that the Veteran's aortic aneurysm was caused or aggravated by his service-connected coronary artery disease (CAD) or the treatment thereof? Here, the examiner must also clearly address whether the Veteran's documented CAD and aortic aneurysms constitute the same disability under various diagnoses. In formulating the opinion, the examiner is advised that the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. [CONTINUED ON NEXT PAGE] A complete rationale should be provided for all opinions or conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.