Citation Nr: 21076912 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-49 982A DATE: December 28, 2021 REMANDED Entitlement to service connection for a heart condition is remanded. REASONS FOR REMAND The Veteran had active duty service from December 1971 to December 1975, and from February 1991 to March 1991. This matter comes before the Board of Veterans' Appeals (Board) from a September 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that a hearing was held in July 2021 before the undersigned Veterans Law Judge. A transcript of that hearing is of record. 1. Entitlement to service connection for a heart condition is remanded. The Veteran raises a secondary theory of entitlement for service connection, claiming that his currently diagnosed coronary artery disease (CAD) is proximately due to, and/or aggravated by his now service-connected obstructive sleep apnea (OSA) disability. See November 2019 Statement in Support of Claim. In support thereof, the Veteran submitted medical literature, as well as a nexus opinion from Dr. D.B.F. Jr. opining that his current diagnosed heart condition is more likely than not related to his OSA. See October 2019 private medical opinion; November 2019 Correspondence (medical literature). However, the aforesaid medical opinion lacks a well-reasoned rationale, and therefore, the Board does not find it adequate to decide the Veteran's claim. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion). Alternatively, as VA has yet to consider this theory of entitlement, given the aforesaid evidence of a current diagnosis, a service-connected disability, and a medical association between the two, the Board finds that a remand is warranted here to assess the same. See Robinson v. Mansfield, 21 Vet. App. 545, 553 (2008); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: Obtain an addendum medical opinion upon remand for the Veteran's claimed for heart condition. It is left to the discretion of the VA examiner as to whether an in-person medical examination is needed. Upon review of the pertinent evidence of record, to include this remand, as well as indicated below, the VA examiner is requested to opine as to the following: a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed heart condition is related to his chest pains in service connection. Specific attention is requested to the Veteran's testimony that the chest pains in service continued after he separated, as close in time as 6 months after his separation, and ultimately culminating in his 1997 heart attack. Note that the lack of documented treatment in service, or a long period after, while probative, cannot serve as the sole basis for a negative finding. The Veteran's lay contentions must be considered and weighed in making the determination. b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed heart condition is proximately due to, and/or aggravated beyond its natural progression by his service-connected obstructive sleep apnea disability, to include any treatments prescribed for that disability? Note that aggravation in this context means any incremental increase in the non-service-connected disability (i.e., any additional impairment of earning capacity) caused by the service-connected disability. The VA examiner should specifically address the medical literature submitted by the Veteran in support of the claim, as well as the private medical opinion by Dr. D.B.F. Jr. See VBMS, document titled "Medical Treatment Record - Non-Government Facility," receipt dated November 25, 2019; VBMS, document titled "Correspondence," receipt dated November 19, 2019. For all requested medical opinions, the VA examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.