Citation Nr: 21074457 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-37 868 DATE: December 15, 2021 REMANDED Entitlement to service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from February 1963 to January 1987 with verified service in the Republic of Vietnam. The Veteran died in August 2013. The Appellant is his surviving spouse. This matter is before the Board of Veterans' Appeals (the Board) on appeal from a June 2016 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The rating decision denied service connection for the cause of the Veteran's death. The Appellant's Notice of Disagreement (NOD) was received in September 2016. The Statement of the Case was issued in November 2016, and the Appellant's VA Form 9, Substantive Appeal to the Board was received in July 2017. In August 2021, the Appellant and her representative appeared before the undersigned Veterans Law Judge (VLJ) for a Board virtual hearing. The transcript is of record. Entitlement to service connection for the cause of the Veteran's death. The Appellant seeks service connection for the cause of the Veteran's death. The Veteran died in August 2013. His death certificate lists the cause of death as congestive cardiomyopathy and paroxysmal ventricular tachycardia. At the time of his death, the Veteran had no service-connected disabilities. At the August 2021 Board hearing, the Appellant testified that the Veteran was diagnosed with coronary artery disease (CAD), and that she believes that his CAD caused his congestive cardiomyopathy and paroxysmal ventricular tachycardia, thereby causing his death. In support of her contentions, the Appellant submitted a medical article on cardiomyopathy, listing CAD as one of the causes. VA laws and regulations provide that if a veteran was exposed to an herbicide agent during service (in this case, the Veteran is presumed exposed based on his confirmed service in the Republic of Vietnam), certain listed diseases, including CAD, are presumed to be related to that herbicide exposure; and, absent affirmative evidence to the contrary, service connection is granted on a presumptive basis. 38 U.S.C. § 1116 (a)(1); 38 C.F.R.§ 3.309 (e). In November 2016, VA obtained a medical opinion. The VA examiner indicated that it is less likely than not the Veteran's congestive cardiomyopathy was proximately due to aggravated by hypertension. The VA examiner noted that the Veteran had multiple risk factors for developing heart disease and was noted to have CAD. In August 2018, the VA obtained an additional opinion, indicating that CAD was only 30-40 percent obstructive and would not predispose to ventricular tachycardia. However, these opinions are incomplete to the extent that they did not adequately address CAD. The Veteran's April 2007 VA treatment note indicates that he had a cardiac CT completed and was diagnosed with moderate to severe CAD, and neither opinion addressed whether the Veteran's CAD caused his cardiomyopathy. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). As such, an addendum medical opinion is necessary. Additionally, the Appellant testified that the Veteran was treated at a private facility in Loma Linda, CA. These complete records have not been associated with the claims file. As such, on remand the RO is instructed to make all necessary attempts to obtain these records and associate them with the claims file. Therefore, a remand is necessary to obtain all outstanding private treatment records and complete an addendum VA medical opinion addressing the nexus question between the Veteran's CAD and his cause of death. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). The matter is REMANDED for the following action: 1. After obtaining the necessary authorization, obtain all outstanding private treatment records related to the Veteran's cardiac disabilities, particularly private treatment records from Loma Linda. Associate these, and any outstanding VA records with the claims file. 2. Obtain a posthumous addendum VA medical opinion on the likely etiology of the Veteran's causes of death. The VA examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand. The VA examiner is requested to opine as to: (a.) Whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran's CAD materially contributed to his causes of death, including whether it caused or materially contributed to, his death-causing congestive cardiomyopathy and paroxysmal ventricular tachycardia. (b.) In providing this opinion, the VA examiner is requested to address the Veteran's April 2007 VA treatment note containing a moderate to severe CAD diagnosis. (c.) In providing this opinion, the VA examiner is requested to address the article titled "Dilated Cardiomyopathy (DCM), previously submitted by the Appellant. (d.) The VA examiner is required to provide a full rationale for all conclusions reached. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kuksova, Kseniya 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.