Citation Nr: A21016905 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 200129-65144 DATE: October 19, 2021 REMANDED Entitlement to service connection for a cardiac disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1962 to August 1965. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2019 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the January 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, and 60 days following the Board hearing. 38 C.F.R. § 20.302(a). In March 2021, the Veteran had a virtual hearing before the undersigned Veterans Law Judge. A hearing transcript has been associated with the record. Additional evidence was not associated with the record following the hearing and the 60 day period following the hearing to submit such evidence has expired. Service Connection Cardiac Disorder The Veteran seeks entitlement to service connection for a cardiac disorder. Specifically, the Veteran asserts that his cardiac disorder was caused by in-service exposure to toxins, aviation fuel and exhaust fumes, and other chemicals during his active service. See generally Board hearing testimony, March 31, 2021 and October 31, 2019 submission. The Board notes that the record establishes that the Veteran has been diagnosed with a cardiac disorder. The Board notes that the Veteran was afforded a VA examination for his claimed cardiac disorder in October 2019, and an October 2016 private Ischemic Heart Disease Benefits Questionnaire (DBQ) report have been associated with the claims file. In November 2019, the VA examiner opined that the Veteran's cardiac disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In this regard, the examiner noted that the Veteran asserted his cardiac disorder symptoms began during active service, to include irregular heart rate and hypertension. However, after a review of the claims file, the examiner noted she was unable to locate or find any evidence of hypertension or irregular heart rhythm, on exit physical examination or during active service. The Board finds the October 2019 VA opinion inadequate to decide the claim. In this regard, the examiner failed to adequately address the Veteran's statements and contentions regarding the onset and continuity of his symptoms; his assertions that in-service exposure to hazardous conditions, toxins, chemicals, and fumes resulted in his heart disorders; and relied solely on the absence of evidence in the Veteran's service treatment records as a basis for denial. See Smith v. Derwinski, 2 Vet. App. 137, 140 (1992); see also Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007). Moreover, the October 2019 VA examiner failed to provide supporting rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, the Board finds the October 2016 private heart DBQ incomplete to decide the claim as the private physician did not provide an opinion as to the nature and etiology of his claimed heart disorder. Based on the foregoing, the Board finds that a VA addendum opinion must be obtained to determine the nature and etiology of the Veteran's claimed heart disorder. The failure to provide an adequate VA examination is a pre-decisional duty to assist error. The matter is REMANDED for the following action: Schedule the Veteran with an appropriate clinician for a VA examination to determine the etiology of his claimed cardiac disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for physical examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the Veteran's cardiac disorder had its onset during any period of service, or is otherwise related to such period of service, to include exposure to environmental hazards or waste, toxins, chemicals, contaminated groundwater and/or aviation fumes at Naval Station Alameda? A RATIONALE FOR ALL OPINIONS EXPRESSED SHOULD BE PROVIDED. The examiner must reconcile any conflicting medical evidence of record. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond gi ven medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page) The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.