Citation Nr: 21073317 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 19-13 153 DATE: December 8, 2021 REMANDED Service connection for a heart disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1964 to June 1967 with more than one year of service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge in February 2021. This matter was remanded by the Board in May 2021 for additional development. 1. Service connection for a heart disability is remanded. The Veteran contends that his heart disability is due to Agent Orange exposure during his service in the Republic of Vietnam. See Hearing Testimony, February 2021; see also Correspondence, July 2018 and March 2019. The Board notes that the Veteran served in Vietnam for one year and one day. Therefore, exposure to Agent Orange is presumed. The Veteran's medical treatment records show diagnoses including atrial fibrillation, ventricular tachycardia, valvular heart disease, left bundle branch block, and congestive heart failure. In connection with the Board's May 2021 remand, the Veteran underwent a VA examination in September 2021. The examiner noted the Veteran's diagnoses of supraventricular arrythmia, ventricular arrhythmia, and valvular heart disease; however, the examiner ultimately opined that such was less likely than not related to his military service. The examiner reasoned that there is no evidence proving that the Veteran has ischemic heart disease or evidence that links his existing heart conditions to Agent Orange exposure. The examiner continued that it was less likely than not that his current heart conditions had their onset or are otherwise related to Agent Orange exposure. The Board finds that the May 2021 opinion is insufficient to adjudicate the Veteran's claim for service connection for a heart disability as the examiner failed to provide sufficient rationale supporting the conclusions provided. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Board notes that the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Given that the medical evidence of record fails to adequately address the issues raised, a new opinion is necessary. The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit additional medical opinion evidence addressing whether there is a relationship between the Veteran's heart conditions and his service, to include Agent Orange exposure. 2. Forward the claims file to a qualified medical professional for an opinion to determine the nature, onset, and etiology of the Veteran's heart disabilities. It is left to the examiner's discretion whether to schedule the Veteran for an in-person examination (or telehealth interview, records review, etc., if an in-person examination is not feasible) for the above listed disabilities. The VA examination report must include a discussion of the Veteran's medical history and lay report as to the onset of his symptoms. The examiner should offer comments, an opinion, and a supporting rationale that address the following: Is it at least as likely as not that any of the Veteran's heart disabilities were incurred in, aggravated by, or are otherwise etiologically related to the Veteran's active-duty service? Is it at least as likely as not that any of the Veteran's heart disabilities are related to his presumed in-service Agent Orange exposure? In reaching a conclusion, the VA examiner must acknowledge and discuss the lay and medical evidence of record. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sara Leigh, Attorney Advisor 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.