Citation Nr: 21073259 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-16 595A DATE: December 8, 2021 REMANDED Entitlement to service connection for a heart disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from August 1969 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2014 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). The Board previously remanded this matter for further development in June 2021; and has advanced this case on the docket pursuant to 38 U.S.C. § 7107(b)(3). 38 C.F.R. § 20.900(c). 1. Entitlement to service connection for a heart disorder is remanded. The Veteran asserts entitlement to service connection for a heart disorder, claimed variously as ischemic heart disease and atherosclerotic cardiovascular disease. In the prior remand, the Board noted that according to an April 2016 VA heart examination the Veteran was diagnosed with "atherosclerotic cardiovascular disease," but did not manifest a heart disorder that qualified as "ischemic heart disease" within the accepted medical definition. Instead, the examiner stated the Veteran manifested a non-ischemic atrial septal defect based on a prior cardiac catheterization which detected a congenitally "small" valve resulting in around 50 percent occlusion. The Board also noted that service connection may not be granted for congenital defects. 38 C.F.R. §3.303(c). Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). In such cases, compensation may only be awarded in the event that an additional service-connected disability is superimposed upon a congenital defect. Quirin v. Shinseki, 22 Vet. App. 390 (2009). However, service connection may be granted for a congenital disease, as opposed to a defect, if it is incurred or aggravated by service. See Winn v. Brown, 8 Vet. App. 510, 516 (1996). As such, the Board remanded the claim to the AOJ in order to afford the Veteran an additional VA heart examination, and to obtain an opinion regarding whether the Veteran's heart disorder was a congenital defect or disease, and if a disease, whether it was caused or aggravated by his active service. The Veteran was afforded this examination in September 2021. However, the examiner noted that the Veteran left before the examination was completed, stating he "was upset because I was unable to find evidence of a condition he claimed in the file." The examiner opined that the Veteran's heart disorder was not due to his service but did not address the congenital nature of the Veteran's heart disorder or provide a supporting rationale besides noting the Veteran terminated the examination early. The AOJ also attached a medical treatise from the CDC describing a congenital atrial septal birth defect as a hole in the wall that divides the upper chambers of the heart. This article did not address the 2014 examiner finding of a congenitally small valve that resulted in 50 percent occlusion. The Veteran's failure to fully comply with and participate in the examination is equivalent to not reporting for the examination. Normally, "when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record." 38 C.F.R. § 3.655(b). However, in this case, the Board cannot decide the claim without further expert opinion regarding the precise diagnosis and ischemic or congenital nature of the Veteran's heart disorder, as well as whether it was caused or aggravated by his active service. Therefore, remand for an addendum opinion, which does not require the Veteran's participation, is warranted. The matters are REMANDED for the following action: 1. Attach all VA and relevant private treatment records to the claims file. 2. Then, forward the claims file to an appropriate VA clinician for an addendum opinion regarding the nature and etiology of the Veteran's heart disorder. After reviewing the claims file, the examiner is asked to identify by diagnosis any heart disorders present during the appeal period, and to clarify whether such disorder(s) are ischemic (as defined in 38 C.F.R. § 3.309(e)) or congenital in nature, and if congenital, to specify whether it is a congenital defect or congenital disease. The examiner is asked to address the April 2016 VA examiner's diagnosis of both atherosclerotic cardiovascular disease and an atrial septal defect, as well the notation of a congenitally small valve resulting in 50 percent occlusion. If the Veteran's heart disorder is determined to be a congenital disease, the examiner is asked to opine whether it at least as likely as not (50 percent or greater probability) was caused or aggravated by the Veteran's active service. If the Veteran's heart disorder is determined to be neither ischemic nor a congenital disease, the examiner is asked to opine whether it at least as likely as not (50 percent or greater probability) first manifested in or is otherwise due to his active service. Supporting rationale must be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, the examiner should state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. C. Schumacher, Associate 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.