Citation Nr: 21008909 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-21 851 DATE: February 18, 2021 REMANDED Entitlement to service connection for a heart disability, to include congestive heart failure, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1968, including service in the Republic of Vietnam. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia, which, inter alia, confirmed and continued the previous denial of service connection for a heart disability. In August 2018, the Board found that new and material evidence had been received to reopen the previously denied claim of entitlement to service connection for a heart disability, and remanded the claim for further evidentiary development, to include a VA examination. In October 2020, the Board remanded this matter for an addendum opinion, which was received in December 2020. As discussed below, the development has not been substantially completed. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a heart disability, to include congestive heart failure, is remanded. In October 2020, the Board remanded this matter, in part, to obtain an opinion addressing whether any of the Veteran’s claimed heart disabilities are directly related to his exposure to Agent Orange. The Board found that the July 2020 examiner failed to adequately address whether the Veteran’s heart disability was caused by Agent Orange exposure during active duty and found that the examiner based the negative opinion on the absence of complaints, treatment, or diagnosis of a heart disability during service; however, the examiner failed to consider whether the development of the Veteran’s heart disability after service was related to Agent Orange exposure. An addendum opinion was obtained in December 2020; however, the opinion is also inadequate. Specifically, the examiner stated that the Veteran does not have coronary artery disease or other heart disabilities classified as ischemic heart disease that could be related to Agent Orange exposure during service. The examiner did not specifically address the Veteran’s current heart diagnoses and whether any of his current diagnoses are due to Agent Orange. The Board acknowledges that ischemic heart diseases are subject to service connection on a presumptive basis for veterans exposed to Agent Orange. 38 C.F.R. § 3.309(e). However, for cases involving presumed herbicide exposure, even if the claimed condition is not included on the list of diseases presumptively service-connected due to herbicide exposure, the veteran may still claim a disability as directly caused by herbicide exposure. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). As such, on remand, the examiner must be asked to provide an addendum opinion with rationale addressing whether the Veteran’s current heart disabilities and/or diagnoses are related to his Agent Orange exposure during service. The matters are REMANDED for the following action: Obtain an addendum medical opinion regarding the nature and etiology of the Veteran’s current heart disability. Access to records in the Veteran’s electronic claims file should be made available to the examiner for review in connection with the opinion. The examiner should identify all heart disabilities found on examination and diagnosed since March 2013. (Continued on the next page)   For any diagnosed heart disability, the examiner should provide opinions addressing whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability was incurred in service or is otherwise causally related to the Veteran’s active service or any incident therein, to include his presumed exposure to Agent Orange. The examiner must specifically address whether the disability is due to or related to Agent Orange exposure. The examiner is advised that it is insufficient to conclude that a heart disability was not directly caused by herbicide exposure solely because it is not on the list of diseases presumptively associated with herbicide exposure. The examiner should provide a rationale for all opinions rendered, including reference to the pertinent evidence of record. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda G. Alderman 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.