Citation Nr: 21069715
Decision Date: 11/19/21	Archive Date: 11/19/21

DOCKET NO. 12-03 588
DATE: November 19, 2021

REMANDED

Entitlement to service connection for a heart condition is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Army from June 1963 to December 1971.

In June 2013, the Veteran was provided a hearing with the undersigned Veterans Law Judge.  A transcript of the hearing has been associated with the record.

The claim was brought before the Board in November 2014, July 2016, December 2017, and December 2019, and was remanded for further development.  

In March 2021, the Board remanded this matter to obtain a VA medical opinion as to whether the Veteran's heart condition was caused by or aggravated by his service-connected diabetes.  The Board again remanded this matter in July 2021 and August 2021 to obtain VA medical opinions as to whether the Veteran's heart condition was caused by or aggravated by his service-connected diabetes.

Remand is again necessary to address contentions raised by the Veteran's attorney in a November 2021 letter.

Entitlement to service connection for a heart condition is remanded.

In November 2021, the Veteran's attorney submitted medical literature, including two articles entitled "Impact of hyperinsulinemia and hyperglycemia on valvular interstitial cells - A link between aortic heart valve degeneration and type 2 diabetes" and "Metformin attenuates cardiac fibrosis by inhibiting the TGF1 -Smad3 signalling pathway."  These articles suggest a connection between a heart condition and diabetes.  The Board requires a medical opinion or comment on the Veteran's submitted medical literature.  See Colvin v. Derwinski, 1 Vet. App. 171 (1991).  Therefore, remand is required to obtain an addendum VA opinion which addresses these articles.

Also in the November 2021 letter, the Veteran's attorney challenged the qualifications of the VA examiners who provided October 2020 and June 2021 VA medical opinions.  The Court of Appeals of Veterans Claims has held that, once a request is made for information as to the competency of the examiner, the veteran has the right, absent unusual circumstances, to the curriculum vitae (CV) and other information about qualifications of a medical examiner.  See Francway v. Wilkie, 940 F.3d 1304, 1308 (Fed. Cir. 2019).  Therefore, the Board also requests that the Veteran and his representative be provided with information about the qualifications of the VA medical examiners as they have requested, including, if available, CV or resume.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's heart condition is at least as likely as not proximately due to service-connected diabetes, or aggravated beyond its natural progression by service-connected diabetes.

(a.) The examiner must discuss two articles submitted by the Veteran's attorney, entitled "Impact of hyperinsulinemia and hyperglycemia on valvular interstitial cells - A link between aortic heart valve degeneration and type 2 diabetes" and "Metformin attenuates cardiac fibrosis by inhibiting the TGF1 -Smad3 signalling pathway."

(b.) The examiner must include citations to any medical literature used to support the opinion.

2. Contact the VA examiners who provided the October 2020 and June 2021 VA medical opinions regarding the Veteran's heart condition.  Ask the examiners to provide a copy of their resume or CV, or other listing of qualifications.  Upon receipt of such, associate it with the record and provide the Veteran and his representative a copy.  If the requested information is not obtainable, the Veteran and his representative should be notified and the reasons for such should be documented in the record.

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Casey, 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.