Citation Nr: 21066397 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 16-13 228 DATE: October 29, 2021 REMANDED Entitlement to service connection for a cardiovascular condition, to include atrial fibrillation, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to January 2001. This matter is before the Board of Veterans' Appeals (Board) on appeal of a July 2012 rating decision of the Chicago, Illinois, Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in March 2020. In an October 2020 correspondence, the Veteran was notified that the transcript was not complete and was given the opportunity to request another hearing. He did not respond to the letter. In December 2020, the Board denied the issue noted above. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a Joint Motion for Partial Remand (JMR) dated in July 2021, the Court vacated the Board's decision of the appealed issue and remanded the claim to the Board for compliance with the terms of the JMR. In its JMR, the Court noted that while the 2012 medical examination report showed that the VA examiner considered the etiology of the Veteran's diagnosed cardiovascular condition in her opinion, the VA examiner did not consider the pathophysiology prior to concluding that the Veteran's condition was not a medically unexplained chronic multisymptom illness (MUCMI). The Court noted its holding in Stewart v. Wilkie, 30 Vet. App. 383, 390 (2018). In Stewart, the Court addressed the meaning of MUCMI. 38 C.F.R. § 3.317(a)(2)(ii) defines a MUCMI, in part, as a diagnosed illness without conclusive pathophysiology. It also says a chronic multisymptom illness of partially understood etiology and pathophysiology will not be considered medically unexplained. The Court interpreted this language as meaning that an illness is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive and that a multisymptom illness is not a MUCMI where both the etiology and the pathophysiology of the illness are partially understood. In Stewart, the Court found that the Board's conclusion that the Veteran's asthma was not a MUCMI because asthma had a "partially understood etiology" was flawed because in order to find the asthma was not a MUCMI, the Board also had to find that the pathiophysiology was partially understood. The Court also held that the determination of whether an illness is "medically unexplained" is particular to the claimant in each case. Additionally, in the July 2021 JMR, the Court stated that the 2012 VA examiner did not consider favorable evidence of record reflecting that the Veteran had experienced chest pain while in service, as consistent with the Court's holding in Ardison v. Brown, 6 Vet. App. 405, 407 (1994). In Ardison, the Court found that an examination conducted during the remission phase of the condition did not "accurately reflect the elements of the present disability." Further, the Court noted that a medical opinion is adequate when it is based upon consideration of the Veteran's prior medical history and examinations and describes the disability in sufficient detail so that the Board's "'evaluation of the claimed disability will be a fully informed one.'" Id. (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991)). In July 2021 JMR, the Court noted evidence to which the 2012 VA examiner did not consider, to include a September 9, 1993 Radiologic Consultation Request/Report, a September 9, 1993 Inpatient Treatment Record, a September 13, 1993 Progress Note and a September 21, 1993 Health Record Complaining of Chest Pains. The Court remanded the claim and stated that the Board was required to obtain a new examination that discussed both the etiology and pathophysiology of the Veteran's cardiovascular condition, consistent with Stewart. The Court also stated that the examiner should consider the above-mentioned evidence relating to chest pain. Based on the foregoing, and to comply with the JMR, further action in connection with the service connection claim concerning the Veteran's cardiovascular condition, to include atrial fibrillation, is warranted. A remand for a new examination and opinion is necessary, as the 2012 VA etiology opinion did not discuss whether the pathophysiology of the Veteran's claimed cardiovascular condition was fully or partially understood. The matters are REMANDED for the following action: Schedule the Veteran for a VA medical examination to determine the nature and etiology of his claimed disability of a cardiovascular condition. The entire claims file must be reviewed by the examiner. Based on the examination results, the examiner is asked to provide an expert medical opinion on each of the following questions: a) Is the etiology of the Veteran's cardiovascular condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole. b) Is the pathophysiology of the Veteran's cardiovascular condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. c) If both the etiology and pathophysiology are partially or fully understood, is it at least as likely as not (at least an approximate balance of positive and negative evidence) that the cardiovascular condition was incurred in or otherwise related to, his active service? In rendering an opinion, the examiner is requested to consider the evidence noted by the Court, to include a September 9, 1993 Radiologic Consultation Request/Report, a September 9, 1993 Inpatient Treatment Record, a September 13, 1993 Progress Note and a September 21, 1993 Health Record Complaining of Chest Pains, all found in the Veteran's Service Treatment Records. The examination report must include a complete rationale for all opinions expressed. The Board recognizes the practical difficulties of scheduling examinations in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Evans, Anna-Lisa M. 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.