Citation Nr: 21071714 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-00 992 DATE: December 1, 2021 REMANDED Service connection for a heart disability, to include as due to herbicide exposure, is remanded. Service connection for stroke residuals, to include speech impairment, as secondary to a heart disability is remanded. A compensable rating for service-connected bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to August 1970. This matter is on appeal from a June 2016 (notice was sent in July 2016) rating decision. In September 2020, the Veteran testified regarding it at a hearing before the undersigned. The Board of Veterans' Appeals (Board) remanded it for additional development in February 2021. At this time, the Board recharacterizes the first and second issues comprising this matter. Up until now they have been styled as service connection for atrial fibrillation, to include a stroke (claimed as a heart condition) and for speech impairment secondary to atrial fibrillation, to include a stroke. Styling them as service connection for a heart disability and for stroke residuals, to include speech impairment, as secondary to a heart disability more accurately reflects the Veteran's assertions. It further is more encompassing, and thus to his benefit. Unfortunately, another remand for additional development is necessary. Heart Disability The Veteran contends he has a heart disability due to his herbicide exposure while serving in the Republic of Vietnam. In its February 2021 remand, the Board directed that he undergo a VA medical examination complete with opinion addressing this contention. The examination took place in June 2021 and resulted in a diagnosis of supraventricular arrhythmia, or more particularly atrial fibrillation. Hypertrophic cardiomyopathy (HCM), though not specifically diagnosed, also was acknowledged. The directed opinion followed in July 2021. An addendum opinion additionally was rendered in August 2021. These opinions were against service connection. As support for them, it was explained that atrial fibrillation is a common arrhythmia and typically is multifactorial in etiology. It usually is not attributable to a single factor, in other words. It further was explained that HCM typically is due to longstanding hypertension. Unfortunately, the aforementioned opinions are inadequate. The supporting explanations simply are too terse for the Board to perform a fully informed adjudication. They note typical etiologies for the Veteran's atrial fibrillation and HCM, and therefore imply his presentation of these diagnoses follows what is considered typical. Yet discussion, rather than just implication, in this regard is required given the medical evidence. A June 2016 statement from the Veteran's private cardiologist indeed notes that he does not have the traditional risk factors to explain his heart conditions, including atrial fibrillation. Also of potential import is an August 2021 VA treatment record reflecting that both of the Veteran's sisters also have this condition. The Board lacks the ability to weigh the above, as only a medical professional is qualified to do so. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The supporting explanations for the opinions further did not even mention the Veteran's in-service herbicide exposure. Discussion in this regard is crucial given his contention about the etiology of his heart disability. The Board observes that neither of his relevant diagnoses constitute ischemic heart disease, for which service connection can be established as presumptively due to herbicide exposure. Yet service connection still may be established directly as due to such exposure. Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). The June 2016 statement indeed continued by indicating there is evidence of an association between exposure to chemicals and heart disease and acknowledging that the Veteran's conditions "could possibly be associated with his previous [herbicide] exposure." To cure the inadequacies identified in the previous opinions, a new VA medical opinion is needed. Barr v. Nicholson, 21 Vet. App. 303, 311-312 (2007). Stroke Residuals As contended by the Veteran, the medical evidence confirms his February 2015 stroke was due to his atrial fibrillation. His stroke was secondary to his heart disability, in other words. It follows that his stroke residuals also are secondary to his heart disability. Whether service connection is warranted for these residuals therefore is contingent upon, or inextricably intertwined with, whether service connection is warranted for a heart disability. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The appropriate course of action is to defer adjudication of service connection for stroke residuals pending resolution of service connection for a heart disability. Bilateral Hearing Loss The Veteran last underwent a VA medical examination for his service-connected bilateral hearing loss in February 2017. In October 2020, he testified that this disability continued to worsen. Comparing the pure tone thresholds from the aforementioned examination to those from a September 2020 private medical examination (interpreted from graphical to numerical format) confirms some worsening. The Board's February 2021 remand directed that the test used to obtain speech discrimination percentages at that private examination be ascertained. Unfortunately, the response received is that it was not the required Maryland CNC. The private examination therefore is inadequate for rating purposes. To adequately assess the current severity of the Veteran's bilateral hearing loss, then, a new VA medical examination is needed. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). All Issues To ensure the opinions and examination directed herein are as fully informed as possible, attempts should be made beforehand to obtain the Veteran's updated VA treatment records and any outstanding private treatment records identified as relevant to his heart, stroke residuals whether speech impairment or otherwise, and hearing loss. The Board finally emphasizes that in remanding this matter, it makes no expressed or implied determination as to the credibility of any statements of record. This matter is REMANDED for the following action: 1. Follow established procedure for obtaining the Veteran's updated VA treatment records and any outstanding private treatment records identified as relevant to his heart, stroke residuals whether speech impairment or otherwise, or hearing loss. 2. After completing paragraph 1, arrange for a qualified VA clinician to review the claims file and opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's atrial fibrillation, HCM, and any other diagnosis present near or since February 2016 is related: (a) to his herbicide exposure during service or (b) to his service otherwise. A detailed explanation is required to support each opinion. This means that relevant medical principles and/or medical literature should be discussed as it relates specifically to the Veteran, as shown by the medical and lay (non-medical) evidence. In this regard, comment on the June 2016 statement from his private cardiologist would be of considerable assistance in adjudicating this matter. A citation or copy for any medical literature referenced finally must be provided. 3. Also after completing paragraph 1, arrange for a qualified VA clinician to interview and examine the Veteran to determine the current severity of his bilateral hearing loss. 4. Then readjudicate this matter, ensuring service connection for a heart disability is resolved before service connection for stroke residuals. If any issue remains denied, whether wholly or partially, follow established procedure for returning it to the Board. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becker 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.