Citation Nr: A21019447 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 210812-178464 DATE: December 7, 2021 REMANDED Service connection for coronary artery disease (CAD) (claimed as heart disease/heart attack), including as secondary to the service-connected asbestosis, is remanded. Service connection for hypertension, including as secondary to the service connected asbestosis, is remanded. Service connection for right lower extremity venous insufficiency, including as secondary to the service-connected asbestosis, is remanded. Service connection for left lower extremity venous insufficiency, including as secondary to the service-connected asbestosis, is remanded. Service connection for right upper extremity peripheral neuropathy, to include as due to diabetes mellitus, is remanded. Service connection for left upper extremity peripheral neuropathy, to include as due to diabetes mellitus, is remanded. Service connection for right lower extremity peripheral neuropathy, to include as due to diabetes mellitus, is remanded. Service connection for left lower extremity peripheral neuropathy, to include as due to diabetes mellitus, is remanded. REASONS FOR REMAND 1. Service Connection for CAD 2. Service Connection for Hypertension 3. Service Connection for Right Lower Extremity Venous Insufficiency 4. Service Connection for Left Lower Extremity Venous Insufficiency 5. Service Connection for Right Upper Extremity Peripheral Neuropathy 6. Service Connection for Left Upper Extremity Peripheral Neuropathy 7. Service Connection for Right Lower Extremity Peripheral Neuropathy 8. Service Connection for Left Lower Extremity Peripheral Neuropathy The Veteran, who is the appellant, served on active duty from October 1960 to October 1963. These matters are before the Board of Veterans' Appeals (Board) on appeal from a June 2021 Appeals Modernization Act (AMA) rating decision that considered the evidence of record on those dates. The Veteran timely appealed the rating decision to the Board by selecting the AMA Evidence Submission lane for evaluation by a Veterans Law Judge of new evidence that was submitted within 90 days of the December 2020 Notice of Disagreement. In this case, the Veteran has specifically contended that CAD, hypertension, and bilateral lower extremity venous insufficiency was caused by the service-connected asbestosis. See December 2020 claim. For the reasons explained below, the VA medical opinion that was provided prior to the rating decision is inadequate and the failure to ensure an opinion that is based on a correct legal standard and accurate facts creates a pre-decisional duty to assist error. A June 2021 VA medical opinion reflects that the VA examiner stated that CAD, hypertension, and bilateral lower extremity venous insufficiency was unrelated to the service-connection chronic obstructive pulmonary disease (COPD) with asbestosis. The June 2021 VA examiner indicated that CAD, hypertension, and bilateral lower extremity venous insufficiency were not "commonly or directly caused by COPD or asbestosis." The Board finds that the June 2021 VA examiner's rationale regarding secondary service connection is inadequate as it did not address whether the Veteran's current CAD, hypertension, and bilateral lower extremity venous insufficiency are etiologically related to the service-connected asbestosis alone (rather than the service-connected COPD with asbestosis). In addition, the June 2021 VA examiner did not offer an opinion as to whether the current CAD, hypertension, and/or bilateral lower extremity venous insufficiency was worsened beyond its normal progression by the service-connected asbestosis. As such, the Board finds that the inadequacy of the June 2021 VA medical opinion constitutes a pre-decisional duty to assist error requiring remand to obtain a new VA medical opinion. Further, as any currently diagnosed bilateral upper and/or lower extremity peripheral neuropathy may be a symptom of the CAD, hypertension, and/or bilateral lower extremity venous insufficiency, the RO committed a pre-decisional duty to assist error when it decided those issues without obtaining adequate CAD, hypertension, and bilateral lower extremity venous insufficiency medical opinions. The matters are REMANDED for the following action: Request that a VA medical professional review the electronic file and provide the VA medical opinions requested below regarding the claimed CAD, hypertension, and bilateral lower extremity venous insufficiency. The relevant documents in the electronic file should be reviewed by the VA examiner. The VA examiner should note such review in the requested medical opinion. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for an examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a) Is it at least as likely as not (i.e. 50 percent probability or greater) that the current coronary artery disease, hypertension, and/or bilateral lower extremity venous insufficiency was caused by the service connected asbestosis? b) Is it at least as likely as not (i.e. 50 percent probability or greater) that the current coronary artery disease, hypertension, and/or bilateral lower extremity venous insufficiency was worsened beyond its normal progression by the service-connected asbestosis? E. BLOWERS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Tenney, 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.