Citation Nr: 21007074
Decision Date: 02/08/21	Archive Date: 02/08/21

DOCKET NO. 16-61 694
DATE: February 8, 2021

REMANDED

Entitlement to service connection for a heart condition is remanded.

REASONS FOR REMAND

The Veteran served on active duty from May 1952 to May 1956.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded by the Board several times, most recently in March 2020. 

1. Entitlement to service connection for a heart condition is remanded.

Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. The March 2020 remand specifically instructed the agency of original jurisdiction (AOJ) to obtain an opinion from either a cardiologist or qualified behavioral health provider. The AOJ obtained an addendum opinion in November 2020 from the same clinician that created the previous medical opinions, a physician’s assistant who is not a cardiologist or a qualified behavioral health provider. Moreover, the March 2020 remand instruction specifically defined aggravated by as “any increase in disability,” but the November 2020 medical opinion used the incorrect “aggravated beyond its natural progression” standard. Although the Board regrets the additional delay, another remand is required.  Stegall v. West, 11 Vet. App. 268, 271 (1998). 

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from either a cardiologist or qualified behavioral health provider regarding the etiology of the Veteran’s cardiac disability. If it is not possible to obtain an opinion from a specialist, the AOJ should document such a finding, and may then obtain an opinion from another clinician. The clinician must provide the following opinions:

(a.) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed cardiac condition was incurred in or is otherwise related to service, to include the stress and anxiety the Veteran experienced as an air traffic controller bringing aircraft, including some aircraft whose radar and communications devices had been damaged in combat, back to base during the Korean War?

(b.) If the answer to the question above is no, is it at least as likely as not (50 percent or greater probability) that any currently diagnosed cardiac condition is (i) proximately due to or (ii) aggravated by (defined as any increase in disability) the Veteran’s service-connected psychiatric disorder, to include any posttraumatic stress disorder (PTSD) and anxiety disorder? The clinician is advised that a January 2021 brief by the Veteran’s representative cited an article finding that posttraumatic stress disorder (PTSD) is a risk factor for coronary heart disease among Vietnam Veterans (Posttraumatic Stress Disorder and Incidence of Coronary Heart Disease: A Twin Study,  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823367/) and a May 2018 brief cited an article finding that anxiety disorders are prevalent in coronary artery disease patients (Screening for anxiety disorders in patients with coronary artery disease, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601013/). 

Any opinion offered must be supported by a complete rationale.   

2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	A. Budd, 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.