Citation Nr: 21068289 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 16-00 223A DATE: November 9, 2021 REMANDED Service connection for a heart disorder. REASONS FOR REMAND The Veteran served on active duty from June 1968 to August 1968. He died in September 2016 and the appellant is his surviving spouse. The case is on appeal from a June 2014 rating decision. Most recently, in December 2019, the Board remanded this claim for additional development. Service connection for a heart disorder. The appellant contends that the Veteran had a heart condition due to service. In August 2014, he submitted photographs showing that he played basketball in high school and a letter from a friend. The friend reporting playing sports with the Veteran in high school and denying that he saw him experience heart trouble. In a January 2016 statement, the Veteran denied experiencing heart symptoms prior to service and stated that a service treatment record (STR) indicating relevant symptoms 3 or 4 years prior to service was incorrect. The Veteran's STRs show that his heart and lungs and chest were marked normal during the June 1968 induction examination. In a June 1968 report of medical history, the Veteran marked no for shortness of breath, pain or pressure in chest, palpitation or pounding heart, and high or low blood pressure. He reported that his father was 36 years old and in "OK" health. The STRs include a second report of medical history that is undated, but notes a service length of 21 days. The report is signed by the Veteran and another service member. It is marked "yes" for shortness of breath, pain or pressure in chest, and palpitation or pounding heart. The report indicates that the Veteran's father died at age 42 due to his heart. The report also includes a note that states the Veteran experienced shortness of breath, and pain in chest and palpitation after running a quarter mile "x 3-4 yrs." A June 28, 1968 STR notes the presence of a heart murmur. In July 1968, he was examined to determine if he was medically sound for service. The report noted knowledge of cardiac murmur one year. The report found that he had aortic insufficiency and did not meet the medical fitness standards for induction. The report notes that the condition was not service aggravated. The Veteran was afforded an examination for this claim in May 2014. The examiner reported diagnoses of atherosclerotic cardiovascular disease, coronary artery disease, and congestive heart failure. The examiner found that the Veteran does not have a heart condition incurred in or caused by service. The examiner explained that the Veteran's in-service aortic insufficiency preexisted service and was not aggravated beyond its natural progression by service. Pursuant to a January 2019 Board remand, another opinion was obtained in regard to this claim in July 2019. The examiner found that the Veteran did not have a heart condition incurred in or caused by service. The examiner reported that the Veteran's aortic insufficiency clearly and unmistakably preexisted service and clearly and unmistakably was not aggravated to a permanent degree during service. Pursuant to a December 2019 Board remand, an opinion was obtained for this claim in October 2020 from a doctor of cardiovascular disease. The doctor also found that the Veteran did not have a heart condition incurred in or caused by service. The doctor reported that the Veteran's aortic insufficiency clearly and unmistakably preexisted service and clearly and unmistakably was not aggravated to a permanent degree during service The Board finds that another opinion is warranted for this claim. In this regard, the October 2020 opinion relies exclusively on an absence of evidence in finding both that the condition preexisted service and was not aggravated by service, which is not adequate to meet the clear and unmistakable standard. The claim is REMANDED for the following action: Obtain an opinion from an appropriate VA examiner to determine the nature and etiology of the Veteran's heart conditions. The entire claims file should be reviewed by the examiner. Thereafter, the examiner is to: (a.) Identify all of the diagnosed heart conditions present since April 2013. (b.) For the diagnosed aortic insufficiency, state whether it is undebatable from a medical standpoint that such disorder preexisted the Veteran's entrance into service in June 1968. (c.) If the aortic insufficiency clearly and unmistakably preexisted service, state whether it is undebatable from a medical standpoint whether it was not aggravated during service beyond its natural progression during the service. (d.) For all diagnosed heart conditions other than aortic insufficiency, state whether each condition had its onset during service, within one year of discharge, or was otherwise related to service. (Continued on the next page) (e.) For all diagnosed heart conditions other than aortic insufficiency, state whether each condition was caused or aggravated by aortic insufficiency. Aggravation means an increase in severity beyond the natural progress of the disease. A rationale should be provided for opinions expressed. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jimerfield, David 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.