Citation Nr: 21065804 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-19 322A DATE: October 27, 2021 REMANDED Entitlement to service connection for a cardiovascular disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1971 to March 1973, including overseas service in Vietnam. The Veteran appealed an April 2014 rating decision by the Agency of Original Jurisdiction (AOJ). The Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The April 2021 Board decision remanded the claim for an examination and opinion to determine the nature and etiology of the Veteran's heart condition. The April 2021 Board decision specifically noted current complaints of tachycardia, angina, and hypertension. See October 2017, March 2020, and August 2021 treatment records. There are also general notations of chest pain. See June 2016 treatment records. Specifically, the April 2021 Board decision noted a study indicating a possible link between hypertension and exposure to herbicide agents used during the Vietnam War. The June 2021 examiner did not find any current diagnosis. See also September 2021 opinions. However, the June 2021 examiner did not comment on the noted chest pains, tachycardia, angina, or hypertension documented in medical treatment records during the period on appeal. Therefore, the Board finds remand is required for another opinion that considers the current medical records noting current heart related symptoms. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his alleged cardiovascular condition, to include chest pains, hypertension, angina, and tachycardia, that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's cardiovascular condition. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician should identify all heart conditions present at any point during the period on appeal, to include chest pains, hypertension, angina, and tachycardia. If any heart related symptoms are not attributable to a diagnosis, any functional loss should be described. Then, for each identified condition and/or functional loss present, the reviewing clinician is asked to respond to the following inquiry: Is it at least as likely as not that the Veteran's heart condition was incurred in, or otherwise related, to his time on active service, to include in-service exposure to herbicide agents? (The reviewing clinician must consider the January 1974 notation of chest pains in the service treatment records (STRs)). In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.