Citation Nr: 21075208 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 19-26 425 DATE: December 17, 2021 REMANDED Entitlement to service connection for a heart disability, claimed as coronary artery disease (CAD), is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1951 to March 1955. The appeal comes before the Board of Veterans' Appeals (Board) from a June 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a heart disability, claimed as coronary artery disease (CAD) is remanded. VA has previously conceded that the Veteran was exposed to asbestos while on active duty. Service connection has been established for asbestosis with restrictive lung disease and pleural plaques. The Veteran asserts that a heart disability is either directly related to active duty or secondary to service-connected asbestosis with restrictive lung disease and pleural plaques. The service medical records show that in September 1952, the Veteran was treated for pains in the heart. The service separation examination report indicates that the Veteran had a normal heart and vascular system. In April 2002, the Veteran underwent a total cardiopulmonary bypass at a private facility. The preoperative diagnosis was severe coronary artery disease. The postoperative diagnosis was severe coronary artery disease and severe sclerotic calcific disease in all coronary systems. At a January 2018 VA examination, the examiner indicated that the Veteran had a diagnosis of atherosclerotic cardiovascular disease. In response to the question, "[p]rovide the etiology, if known, of each of the Veteran's heart conditions, including the relationship/causality to other heart conditions," the examiner answered that the Veteran had atherosclerotic heart disease and a coronary artery bypass graft in 2002. The examiner stated that continuous medication was required for control of the Veteran's heart condition. The examiner stated that the Veteran had chronic congestive heart failure. Later in the examination report, the examiner opined that the claimed condition was less likely than not incurred in or caused by service. The examiner then stated that the Veteran's symptoms were subjective only, and there was no objective evidence of a chronic condition. The Board finds the January 2018 VA examination report to be contradictory. At one point in the examination report, the examiner stated that the Veteran had atherosclerotic cardiovascular disease. At another point, the examiner stated that the Veteran's claimed condition was less likely than not due to service as there was no objective evidence of a chronic condition. Those statements are inherently contradictory. The Board further notes that no opinion was given regarding any possible relationship between the heart condition and asbestosis with restrictive lung disease and pleural plaques. In light of the treatment records which show the Veteran's total cardiopulmonary bypass and the contradictions present within the January 2018 VA examination report, remand is required to provide the Veteran a VA examination which adequately addresses any relationship between the claimed heart condition and either service or service-connected asbestosis with restrictive lung disease and pleural plaques. The matters are REMANDED for the following action: 1. With any necessary authorization from the Veteran, obtain all of the relevant outstanding treatment records. All attempts to locate records must be documented in the claims file. 2. Then, schedule the Veteran for a VA examination to determine the etiology of a heart disability, claimed as coronary artery disease. The examiner must review the record and must note that review in the report. All appropriate tests or studies should be accomplished, and all clinical findings should be reported in detail. The examiner should diagnose all heart disabilities shown by the record or found on examination, and should reconcile that diagnosis with the previous VA examination. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that a heart disability, to include coronary artery disease, had its onset in or is otherwise related to service, or manifested within one year following separation from service. The examiner should discuss the significance of the September 1952 complaint of heart pain during service. The examiner should also opine whether it is at least as likely as not (50 percent probability or greater) that a heart disability, to include coronary artery disease, was caused by the service-connected disabilities, to specifically include asbestosis with restrictive lung disease and pleural plaques. The examiner should further opine as to whether it is at least as likely as not (50 percent probability or greater) that a heart disability, to include coronary artery disease, has been aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected disabilities, to specifically include asbestosis with restrictive lung disease and pleural plaques. If it is determined that there is another likely etiology for the heart disability, that should be stated. A complete rationale for all opinions expressed should be clearly provided. In particular, the examiner is requested to discuss the articles submitted by the Veteran: "Pulmonary Diseases and the Heart" by MeiLan K. Han, MD, MS, Vallerie V. McLaughlin, MD, Gerard J. Criner, MD, and Fernando J. Martinez, MD, MS; "Study: Risk of Stroke, Cardiovascular Disease Increases with Asbestos Exposure" by Tim Povtak; "Asbestosis" by Linda Molinari; "Cardiovascular Disease Linked to Asbestos" by Brenda Duplantis; "Occupational Exposure to Asbestos and Cardiovascular Related Diseases: A Meta-Analysis" by Yi Rong, Xin Luo, Zhihong Zhang, Xiuqing Cui, Yuewei Liu, and Weihong Chen; "Asbestos and Heart Disease" by Faith Anderson. The examiner must consider the Veteran's statements and all lay statements regarding onset in service and statements regarding the continuity of symptomatology during and since service. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Layton, 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.