Citation Nr: 21073053 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 15-32 068 DATE: December 7, 2021 REMANDED Entitlement to service connection for heart condition, claimed as early repolarization to include secondary to service-connected sarcoidosis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1984 to March 1987, and from January 2003 to January 2005. In October 2018, the Veteran testified at a Board hearing. The transcript is of record. 1. Entitlement to service connection for heart condition, claimed as early repolarization to include secondary to service-connected sarcoidosis The Board regrets the additional delay; however, a remand is necessary to ensure compliance with the Board's prior remand instructions and to ensure that due process is met. Stegall v. West, 11 Vet. App. 268, 271 (1998). In an April 2021 remand, the Board requested an addendum opinion that identified the Veteran's heart disorder(s) and discussed the significance of early repolarization, as noted in the March 2001 cardiology report. In July 2021 the VA examiner opined that it is less likely than not that the Veteran has a heart diagnosis as early polarization is normally felt to be a benign finding. However, the examiner noted that recent studies state there is a potential link of early repolarization and sudden cardiac death but only certain types of early repolarization are considered at risk. Thus, the examiner concluded it would be mere speculation to state whether the Veteran's pattern is considered worrisome and should be given a diagnosis as an expert cardiologist evaluation would be necessary. Accordingly, a remand is necessary to obtain an opinion from a qualified cardiologist to determine if the Veteran has a current heart diagnosis. Furthermore, the record includes a December 2019 electrocardiogram and echocardiogram revealing sinus tachycardia, moderate concentric hypertrophy of the left ventricle, grade I (impaired) diastolic dysfunction, mild aortic valve leaflet thickening, and mildly dilated aortic root which was not discussed by the VA examiner. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Obtain an addendum medical opinion from a qualified cardiologist if available. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Determine whether the Veteran has a current heart disorder(s). In answering (a), discuss the following: 1) the significance of the March 2001 cardiology report noting "early repolarization" and 2) the findings of the December 2019 electrocardiogram and echocardiogram revealing sinus tachycardia, moderate concentric hypertrophy of the left ventricle, grade I (impaired) diastolic dysfunction, mild aortic valve leaflet thickening, and mildly dilated aortic root. (b.) For each identified heart disorder, answering the following: (c.) Is it at least as likely as not that any diagnosed heart disorder had its onset during active service, or is related to a disease, event, or injury during service? In answering (c), discuss the significance of the 1986 report of chest pains. (d.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that any heart condition is proximately due to or the result of the Veteran's service-connected sarcoidosis? (e.) If the answer to (d) is negative, is it at least as likely as not that any heart condition is aggravated (i.e., permanently, or temporarily worsened) by sarcoidosis? (f.) If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected disorder. In answering these questions, discuss the Veteran's lay assertions. The examiner is advised that the Veteran is competent to report his symptoms and treatment history. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. (Continued on the next page) A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions. The examiner should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.