Citation Nr: 21076861 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-41 696 DATE: December 28, 2021 REMANDED Entitlement to service connection for bronchitis is remanded. Entitlement to service connection for a heart condition is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from July 1978 to August 1998. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the Board at a hearing held by the undersigned in August 2019. A transcript of the hearing is of record. Subsequently, the Board reopened the Veteran's claim for service connection for a heart condition and remanded it in December 2019 for further development. The Board also remanded the Veteran's claim for service connection for bronchitis in the December 2019 decision. The Board's December 2019 decision also remanded for further development matters seeking service connection for a neck condition, left and right wrist conditions, left and right shoulder conditions, a right knee condition, left and right ankle conditions, a headache condition, a mental health condition, and a bilateral foot condition. A March 2021 rating decision awarded service connection for all of these disabilities. Therefore, the appeals of the matters seeking service connection for these conditions have been resolved, and the Board will not further address these issues in this decision. 1. Entitlement to service connection for bronchitis is remanded. Following the December 2019 remand of this claim to obtain a VA examination and opinion, the Veteran was afforded a VA examination in March 2021. The examiner remarked that there is no diagnosis of bronchitis because the condition has resolved. The VA examiner then provided a negative opinion in March 2021 and stated there is no pathology to render a diagnosis. However, a review of the March 2021 VA examination report and opinion illustrates that the examiner did not address the diagnoses of acute bronchitis in the record, which are close in time to the Veteran's July 2014 claim for service connection for bronchitis. The Veteran was diagnosed with acute bronchitis in April 2013 and February 2014. Furthermore, the Board notes that an October 1998 chest X-ray showed mild chronic bronchitis. Thus, the Board concludes an additional Board remand is necessary to obtain a VA examination and opinion that addresses the evidence of bronchitis in close proximity to the appeal period. In addition, upon remand, the Veteran should be afforded an additional opportunity to submit a VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) for records from Dr. R.G. since February 2016. 2. Entitlement to service connection for a heart condition is remanded. Following the December 2019 remand, a VA examiner opined in September 2020 that it is less likely than not that the Veteran's heart condition was incurred in or caused by the Veteran's service. In support of the opinion, the VA examiner noted the Veteran's in-service reports of chest discomfort, but the examiner stated she was unable to find a confirmed cardiac diagnosis in the service treatment records. Furthermore, the examiner stated she was unable to find any medical literature supporting the development of heart disease after poison sumac exposure. However, a review of the opinion and rationale illustrates that the examiner did not address whether the Veteran's current heart condition is related to the in-service complaints of chest discomfort, irrespective of there being no diagnosed heart condition while he was in service. Furthermore, the examiner noted that she was unable to find any medical literature supporting the development of heart disease after poison sumac exposure, but she did not provide a full rationale regarding this aspect of the requested opinion. Thus, an additional remand is required to obtain a VA opinion in order to adequately evaluate the claim. In addition, upon remand, the Veteran should be afforded an additional opportunity to submit a VA Form 21-4142 for records from Dr. R.G. since February 2016. The matters are REMANDED for the following actions: 1. Request that the Veteran submit a fully completed and signed VA Form 21-4142 for each health care provider from whom he would like VA to obtain records, to include the health care provider for whom he submitted a VA Form 21-4142 in February 2016 (Dr. R.G.). Inform him that the February 2016 21-4142 has expired and can no longer be used to obtain the records, and that in order for VA to obtain the records he must submit a new VA Form 21-4142. Encourage him to submit to VA any relevant private records if such submission does not burden him. If any of the records requested are unavailable, clearly document the claims file to that effect and notify the Veteran of any inability to obtain these records, in accordance with 38 C.F.R. § 3.159(e). 2. After completing the development requested in item 1, provide the Veteran an appropriate VA examination (or telehealth interview, if an in-person examination is not feasible) to determine the nature, extent, and etiology of any bronchitis. The electronic claims file must be made available to the examiner for review in connection with the examination. All indicated tests should be conducted, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. After reviewing the claims file, the examiner should address the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's bronchitis is related or attributable to his military service, to include exposure to poison sumac in Panama and the various locations of his in-service jumps? In providing this opinion, the examiner is requested to address the Veteran's diagnoses of acute bronchitis in April 2013 and February 2014 and the October 1998 chest X-ray showing mild chronic bronchitis and whether such diagnoses are related to his military service. In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must 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. 3. After completing the development requested in item 1, obtain a medical opinion from a qualified clinician for the Veteran's heart condition claim. The electronic claims file must be made available to the clinician for review in connection with the request for an opinion. If the reviewing clinician determines that an in-person examination (including via telehealth interview) is needed in order to answer the questions posed, then such should be scheduled. After reviewing the claims file, the reviewing clinician should address the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's heart condition, diagnosed as coronary artery disease, is related or attributable to his military service, to include exposure to poison sumac in Panama and/or reports of chest discomfort in service? In addressing this question, the reviewing clinician is requested to consider the August 2008 private treatment record that contains the notation that the Veteran "is known to us for coronary artery disease for approximately 10 years now." In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must 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. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Breitbach, 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.