Citation Nr: 21007096 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 13-02 431 DATE: February 8, 2021 REMANDED Entitlement to service connection for sinus tachycardia is remanded. Entitlement to service connection for chronic bronchitis is remanded. Entitlement to service connection for asthma is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Air Force from January 1977 to May 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2016. This case was previously before the Board in November 2016, April 2018, and September 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. 1. Entitlement to service connection for sinus tachycardia is remanded. The prior Board remand directed the Agency of Original Jurisdiction (AOJ) to obtain an opinion regarding whether the Veteran has, or had during the pendency of this claim, any heart condition manifesting in sinus tachycardia, and whether such a heart condition is secondary to the Veteran’s service-connected respiratory conditions. The VA opinion, which the AOJ obtained in October 2020, concluded that there is insufficient evidence to warrant a diagnosis of an acute or chronic “heart condition-tachycardia” or its residuals. The examiner noted normal pulses documented on medical records, no cardiac evaluation on record to support such a claim, and no treatment for tachycardia to support this conclusion. However, the Veteran has submitted private treatment records documenting sinus tachycardia and complaints of her heart racing and palpitations since she filed this claim in July 2009. The Veteran’s private records also contain several diagnostic tests including doppler imaging, cardiac catheterizations, and echocardiograms. Finally, the Board notes the VA examiner did not take into account the Veteran’s report, corroborated by medical records, that during a September 2015 heart surgery, an emphysematic bleb was encountered that required resection. For these reasons, the October 2020 VA opinion is inadequate and fails to fulfill the Board’s directives. Therefore, a remand is required to obtain an adequate opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (remand by Board confers upon claimant, as a matter of law, the right to compliance with remand order). 2. Entitlement to service connection for chronic bronchitis is remanded. 3. Entitlement to service connection for asthma is remanded. The October 2020 VA examiner declined to provide opinions regarding whether asthma and chronic bronchitis is caused or aggravated by the Veteran’s service-connected respiratory disabilities based on a finding that there is insufficient evidence to warrant a diagnosis of either disability. However, the Veteran’s private treatment records indicate diagnoses of asthma and asthmatic bronchitis in 2009 and 2010, and the Veteran’s VA treatment records show prescriptions for asthma medications in 2013; the examiner did not address any of these records in concluding there is no current diagnosis. Therefore, this opinion is inadequate, and a remand is necessary to obtain a new opinion. The Board notes the July 2020 supplemental statement of the case stated service connection was not available for giant bullous emphysema, asthma, or chronic bronchitis because the Veteran was already service-connected for the pneumothorax disability. Although separate ratings cannot be assigned for coexisting respiratory conditions listed in diagnostic codes 6600 through 6817 and 6822 through 6847, the regulations do not prohibit the award of service connection for more than one respiratory disability. See 38 C.F.R. § 4.96. Such should be considered when readjudicating these issues on remand. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician to determine whether any current heart condition manifesting in sinus tachycardia is related to the Veteran’s military service. Following thorough review of the claims file, the examiner should identify all current cardiovascular conditions manifesting in sinus tachycardia since July 2009, when the Veteran first filed this claim for service connection. For each cardiovascular condition identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that each cardiovascular condition is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected respiratory disabilities, either individually or in combination. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the cardiovascular condition prior to aggravation by the service-connected disabilities. Please note, causation and aggravation are separate concepts and must be addressed independently. If no current cardiovascular condition is identified, the examiner should opine whether the sinus tachycardia, both as noted in medical records and as reported by the Veteran in complaints of heart racing and palpitations, is a symptom of one or more of the Veteran’s service-connected respiratory disabilities. The examiner should specifically address the Veteran’s private treatment records submitted in January 2010 and June 2016. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Forward the claims file to an appropriate clinician to determine whether asthma and/or chronic bronchitis is related to the Veteran’s military service. Following review of the claims file, the examiner should opine whether the Veteran has or had asthma and chronic bronchitis during the pendency of this appeal (since July 2009). If the examiner concludes the Veteran does not have a current diagnosis of asthma and/or chronic bronchitis, the examiner must provide an opinion regarding whether the diagnoses in the record were made in error, resolved, or progressed to a different respiratory disability. Then, the examiner should provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the asthma, chronic bronchitis, and/or other respiratory disability began in or is otherwise caused by the Veteran’s active service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that any respiratory disability identified is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected pneumothorax disability and giant bullous emphysema, either individually or in combination. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the asthma, chronic bronchitis, and/or other respiratory disability prior to aggravation by the service-connected disabilities. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner should specifically address the Veteran’s private and VA treatment records treating asthma and chronic bronchitis, as well as the Veteran’s lay statements regarding symptoms since onset. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Josey, 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.