Citation Nr: 21077634 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 10-00 011 DATE: December 30, 2021 REMANDED Entitlement to service connection for a heart disability is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army on active duty from October 1969 to February 1978. This appeal comes to the Board of Veterans' Appeals (Board) from an August 2008 rating decision by the Veterans Benefits Administration (VBA). The Board remanded this matter in June 2015, April 2017, March 2019 and October 2020 for additional development including obtaining medical opinions on the extent to which each of the Veteran's service-connected disabilities caused or aggravated each of the Veteran's heart disabilities. While VBA obtained several VA examinations of addressing theories of direct and secondary service connection, the opinions in the record on secondary service connection focus on causation without adequately addressing aggravation. The Board specifically requested opinions on aggravation and asked for opinions that considered whether each service-connected disability aggravated each heart condition with consideration of reduced activity levels. See, e.g. March 2019 Board remand order. The August 2019 VA examiner offered a negative opinion regarding aggravation on the basis that reduced activity levels alone would not cause the Veteran's heart conditions without explaining why a reduction in activity levels would not make the heart conditions worse. The March 2021 VA examiner offered a negative opinion regarding aggravation of the heart conditions by asthma without addressing pertinent medical literature cited by the Veteran's representative, which the Board directed the examiner to address. See September 2020 appellate brief. Therefore, the Board must remand this matter again to ensure VBA substantially complies with the remand directives and obtains adequate opinions. In addition to the VA examination deficiencies, remand is necessary to ensure VBA fulfills its duties to assist the Veteran in obtaining outstanding relevant records and provide the Veteran with an initial decision considering additional evidence. While VBA obtained an addendum opinion from a VA examiner in September 2021, VBA did not issue a rating decision or supplemental statement of the case addressing the opinion. The Veteran has the right to have VBA review the additional evidence and issue a decision on it in the first instance. See 38 C.F.R. § 20.1305(c). While VBA has made a formal finding that some of the Veteran's service records are missing and unobtainable, the Veteran's representative has requested that the Board remand this matter and make additional attempts to locate the missing records. See December 2021 Appellate Brief; July 2008 VA Memorandum. In a September 2008 letter, the Veteran's representative indicated the missing service medical records may be located at the Indianapolis VA Regional Office. On remand, VBA should work with the Veteran and his representatives to determine if there is any additional information that may help VBA locate the missing records before readjudicating the claim. The Board REMANDS this matter for the following actions: 1. VBA should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records, to include any missing service medical records, which may be located at the Indianapolis VA Regional Office. VBA should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran's claims file. 2. After associating all outstanding relevant records with the Veteran's claims file, VBA should obtain a medical opinion on the extent to which each of the Veteran's service-connected disabilities may have aggravated the Veteran's heart disabilities. The Veteran's service-connected disabilities include osteoarthritis of the lumbar spine, radiculopathy of the upper and lower extremities, asthma, fibromyalgia, cervical spine degenerative disc disease with bilateral cervical myelopathy, bilateral foot disabilities, allergic rhinitis, and tinnitus. The medical professional should opine whether it is at least as likely as not (at least an approximate balance of negative and positive evidence) that each of the Veteran's service-connected disabilities aggravated each the Veteran's heart disabilities. Temporary aggravation may suffice for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner should consider whether the Veteran's reduced activity levels and treatment (e.g. medications) for the service-connected disabilities aggravated the heart conditions as well. The examiner is directed towards the medical literature cited to in the Veteran's September 2020 appellate brief. K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Duffy 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.