Citation Nr: A21017183 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 210926-187502 DATE: October 25, 2021 REMANDED Entitlement to service connection for paroxysmal atrial fibrillation is remanded. Entitlement to service connection for right bundle branch block is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1968 to October 1969 and from February 1973 to January 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 12, 2021 rating decision which denied service connection for paroxysmal atrial fibrillation and right bundle branch block. In response to the decision, the Veteran timely submitted VA Form 10182 Notice of Disagreement under the Appeals Modernization Act (AMA) review system. 38 C.F.R. § 19.2. The Veteran elected direct review by a Veterans Law Judge and declined a hearing. Under direct review, evidence submitted after the date of notification of the rating decision and statement of the case is not reviewable by the Board. 38 C.F.R. § 20.301. 1. Entitlement to service connection for paroxysmal atrial fibrillation is remanded. 2. Entitlement to service connection for right bundle branch block is remanded. An August 2021 VA examination diagnosed paroxysmal atrial fibrillation with cardiac ablation. The examiner opined that paroxysmal atrial fibrillation was not related to service because there was no medical evidence of documentation of atrial fibrillation while in service. The Board finds the opinion incomplete. An opinion based on the absence of medical records without consideration of a Veteran's competent reports is incomplete. Buchannan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The examiner noted that there was evidence of right bundle branch block while in service. However, the examiner stated that right bundle branch block was a normal variant, not pathology. The Board finds the opinion incomplete. The examiner did not discuss whether right bundle branch block caused, contributed to, or aggravated paroxysmal atrial fibrillation; or whether right bundle branch block was a congenital or development abnormality that was aggravated or subjected to superimposed disability during service. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Pursuant to the AMA, remand is permitted only to cure pre-decisional errors in VA's duty to assist the Veteran in substantiating the claim. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The August 2021 VA opinion is incomplete. That is a pre-decisional error of the duty to assist. Therefore, remand for a VA examination is necessary. The matters are REMANDED for the following action: Schedule the Veteran for a VA cardiovascular examination with a medical doctor who has not previously examined the Veteran in conjunction with this claim to determine the etiology of any heart disabilities. The examiner must review the claims file and should note that review in the report. The report should discuss the nature and etiology of any heart disability found. A clearly stated rationale with references to the record, diagnostic tests, general medical knowledge, and medical literature should be provided for all opinions. The examiner should: (a.) Confirm that the examiner is a medical doctor who has not previously examined the Veteran in conjunction with this claim. (b.) Diagnose all heart disabilities present and opine whether any heart disorder is a congenital or development abnormality. Discuss right bundle branch block and opine whether that finding represents any disorder or pathology. (c.) Opine whether it is at least as likely as not (50 percent probability or greater) that any heart disability is related to or caused by service. The examiner should discuss the August 2021 VA examiner's finding regarding right bundle branch block. (d.) Opine whether it is at least as likely as not (50 percent or greater probability) that right bundle branch block caused, contributed to, or aggravated any diagnosed heart disability. An opinion based on the absence of medical records without consideration of a Veteran's reports is incomplete. (e.) For any congenital or development abnormality of the heart, opine whether it is at least as likely as not (50 percent or greater probability) that congenital or development abnormality was aggravated during service or subject to superimposed injury during service. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.O., 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.