Citation Nr: A21019770 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 200827-106195 DATE: December 13, 2021 REMANDED Entitlement to service connection for a heart disability, to include coronary artery disease (CAD) and tachycardia, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1988 to September 1991, with service in southwest Asia. The Board notes that the rating decision on appeal was issued in August 2020. By way of procedural history, in February 2018, the Veteran elected the modernized review system and selected the Higher-Level Review lane. 38 C.F.R. § 19.2(d). An April 2018 AMA rating decision was then issued that considered the evidence of record as of the date VA received the RAMP election form. The Veteran timely appealed this rating decision to the Board in August 2018 and requested an Evidence Submission review. A May 2019 Board decision remanded the issue on appeal. The AOJ then conducted a Supplemental Claim Review and issued the May 2019 rating decision confirming the prior denial. The Veteran timely appealed this rating decision to the Board in June 2019 and requested Direct Review of the evidence considered by the AOJ. A March 2020 Board decision again remanded the issue on appeal, and the August 2020 rating decision confirmed the prior denial. Evidence in the record suggests that the Veteran has been diagnosed with multiple heart conditions; therefore, the Board will broadly construe the issue of service connection for coronary artery disease (CAD) as a claim for service connection for a heart disability, to include CAD and tachycardia. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). Entitlement to service connection for a heart disability, to include coronary artery disease (CAD) and tachycardia is remanded. The issue of entitlement to service connection for a heart disability is remanded to correct a duty to assist error that occurred prior to the August 2020 rating decision on appeal. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication. The Veteran asserts that he has a heart disorder that is related to his active duty, to include exposure to chemicals such as jet fuel and diesel gas. In the alternative, the Veteran asserts his heart disorder is due to unexplained chronic Gulf War illness. The Agency of Original Jurisdiction (AOJ) obtained a VA examination in July 2020. The examiner noted a diagnosis of CAD, and opined that the Veteran's CAD was less likely due to military service. As part of the rationale, the examiner referenced that the Veteran's treatment records show no complaints of chest pain while on active duty nor on his separation examination, and blood pressure readings were normal. Additionally, the examiner noted that according to a congressionally mandated report on Gulf War veterans' health, an evaluation of the long-term, human health effects associated with exposure to selected environmental agents, pollutants, and synthetic chemical compounds believed to have been present during the Gulf War revealed 15,000 veterans that did not find greater self-reporting of coronary heart disease among Gulf War veterans. The Board finds the July 2020 examiner failed to provide an adequate rationale to support his medical opinion. In this regard, the examiner merely referenced the findings of a mandated report while failing to articulate how, from a medical standpoint, specifically this Veteran's CAD is unrelated to his exposure to fuels during service. Ultimately, the examiner did not explain the extent, if at all, the study would bear on this case. Accordingly, an addendum opinion is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a qualified medical professional, other than the July 2020 examiner, to determine the etiology of any heart condition, to include CAD and tachycardia. Prior to drafting the opinion, the electronic claims file must be made available to the examiner for review of the case, to include this remand. A notation to the effect that this record review took place should be included in the report of the examiner. For each diagnosed heart condition of record, the examiner is requested to provide an opinion, based upon review of the service and post-service treatment records, the lay statements of record, and any examination findings, as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed heart condition of record, to include CAD and tachycardia, had its onset in service or was caused by, or is otherwise etiologically related to, the Veteran's active military service, to include exposure to chemicals such as jet fuels, and diesel and regular gas. If yes, why? If no, why not? (b.) If the examiner finds the Veteran does not have a diagnosis of CAD and/or tachycardia, it must be explained why not. 2. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Russell, Tangela 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.