Citation Nr: 21070658 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 13-30 969A DATE: November 24, 2021 REMANDED The issue of service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran had active service from April 1963 to August 1963. This matter is before the Board of Veterans' Appeals (Board) after a May 2021 United States Court of Appeals for Veterans Claims (Court) joint motion for remand (JMR) that vacated the Board's July 2020 decision. The Board had denied service connection for the Veteran's cause of death when it determined that the Veteran's service-connected disabilities did not cause or contribute to his death. The Court found that the April 2020 VA medical opinion does not substantially comply with the July 2019 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the Court determined that the April 2020 VA examiner failed to provide a well-reasoned medical explanation for the opinions provided. See Bloom v. West, 12 Vet. App. 185 (1999). In accordance with the May 2021 JMR, the issue of service connection for the Veteran's cause of death is remanded for a new VA medical opinion that substantially complies with the July 2019 Board remand directives. The issue of service connection for the Veteran's cause of death is remanded. The matter is REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: The issue of service connection for the Veteran's cause of death was previously remanded by the Board in July 2019 for a VA medical opinion, which was provided in April 2020. The examiner opined that no nexus can be established between the one-time temporary heart murmur detected in-service, in July 1963, and the heart problems diagnosed many years later. Instead, the examiner stated that the medical evidence shows that the murmur was temporary, noted that the August 1963 medical evaluation board examination did not show any heart murmur or any heart problems, and that post-service medical records have been silent for heart problems for decades. The examiner stated that there is no medical evidence to support that the Veteran complained of, sought medical care for, or had been diagnosed with any heart problems shortly after discharge. Given the Court's remand directives through the agreement of the parties in the May 2021 JMR, the April 2020 VA examiner must provide a more-reasoned medical explanation for the opinions provided, apart from addressing the in-service heart murmur, the examiner, generally, opined that the ventricular fibrillation, hypertension, and congestive heart failure conditions were not due to the Veteran's service. However, the examiner did not provide any rationale for this opinion and appears to have relied on the opinion by another medical provider, Dr. H., as to what caused the Veteran's cardiovascular disease, without providing his own well-reasoned medical explanation. The examiner also listed risk factors and other facts but did not relate those to his negative nexus opinion that the in-service heart symptoms did not cause the fatal heart condition. For these reasons, the April 2020 VA medical opinion did not substantially comply with the Board's July 2019 remand instructions. Therefore, remand is required to obtain a new VA medical opinion that substantially complies with the Board's July 2019 remand instructions. Stegall, 11 Vet. App. at 271. THE REMAND DIRECTIVES FOLLOW. 2. Obtain any outstanding VA and private medical records and associate them with the claims file. 3. RETURN THIS MATTER to the examiner who provided the April 2020 VA medical opinion. If the examiner is no longer available, schedule a file review an appropriately-qualified examiner, to determine the nature and etiology of the Veteran's causes of death, including ventricular fibrillation, hypertension, and congestive heart failure. The Veteran's claims file, to include a copy of this Remand, must be reviewed by the examiner. The examination report should reflect that this review was done. Based upon a review of the relevant evidence of record, history provided by the Appellant, and sound medical principles, the VA examiner MUST provide the following opinions: (a.) Identify whether any of the Veteran's causes of death, including ventricular fibrillation, hypertension, and congestive heart failure, were incurred in-service or caused by an in-service injury, event, or illness, to include the in-service heart murmur. (b.) The examiner MUST discuss the heart murmur detected in-service, in July 1963. Specifically, the examiner MUST discuss the in-service heart murmur in the context of his causes of death and opine as to any potential relationships between the in-service heart murmur and the conditions which caused his death. (c.) If the examiner determines that the in-service heart murmur was transitory or did not otherwise cause or result in the conditions that caused the Veteran's death, the examiner MUST provide a complete and full explanation as to the reasons for any opinion provided. (d.) The examiner is ADVISED that any opinion which solely relies on the August 1963 STR showing no heart murmur or any heart problems AND/OR the lack of post-service medical records showing no heart problems for many years after discharge from service, IS NOT ADEQUATE. (e.) The examiner MUST discuss all risk factors and any other facts and provide an explanation as to any potential relationships between the Veteran's in-service heart symptoms and the conditions which caused his death. (f.) If the examiner determines that the Veteran's causes of death, including ventricular fibrillation, hypertension, and congestive heart failure, were not incurred in-service or caused by an in-service injury, event, or illness, to include the in-service heart murmur, to the extent possible, provide an opinion(s) as to the likely causes of the conditions, which caused his death. (g.) The examiner is ADVISED that a complete and full explanation MUST be provided for all opinions provided. (h.) The examiner is ADVISED that all opinions provided MUST include an original and well-reasoned medical explanation. (i.) The examiner is ADIVSED that any opinion provided, which relies AND/OR merely restates any previously provided opinion IS NOT ADEQUATE. The examiner MUST review the entire record in conjunction with rendering the requested opinions. In addition to any records that are generated because of this Remand, the VA examiner's attention is drawn to the following: * The July 1963 STR showing a grade I pulmonic systolic heart murmur. * The August 1963 Report of Board of Medical Survey showing a normal physical examination, outside of the Veteran's dermatological symptoms, and a normal chest x-ray. * The January 1992 VA medical record showing a diagnosis of atypical chest pain. No murmurs were noted. * The April 1996 private medical record showing a diagnosis of congestive heart failure. * The May 1996 private medical record showing a complaint of chest tightness and a diagnosis of an ischemic heart condition. * The January 2001 VA pulmonary note showing that the Veteran reported a history of smoking but that he has not smoked for 30 years. * The April 2001 death certificate showing the Veteran's causes of death as ventricular fibrillation, hypertension, and congestive heart failure. * The June 2004 letter provided by VA Dr. G.B.H. showing that risk factors of diabetes, hypertension, obesity, and dyslipidemia led to the Veteran's cardiovascular disease. * The October 2013 heart conditions Disability Benefits Questionnaire. * The June 2016 Board hearing testimony. * The April 2021 VA medical opinion. A thorough explanation must be provided for the opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, s/he should expressly indicate this and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. The examiner is advised that by law, the mere statement that the claims folder was reviewed, and/or the examiner has expertise is not sufficient to find the examination/opinion sufficient. 4. Following the review and any additional development deemed necessary, re-adjudicate the claim. Should the claim not be granted in its entirety, issue an appropriate supplemental statement of the case (SSOC), and forward the claim to the Board for adjudication. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). (CONTINUED ON THE NEXT PAGE.) The claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Timothy T. Emmart The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.