Citation Nr: 21009125 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 18-28 756 DATE: February 19, 2021 REMANDED Entitlement to service connection for ventricular tachycardia and atrial fibrillation, including as due to herbicide agent and/or ionizing radiation exposure or as secondary to service-connected ischemic heart disease is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision. The Board remanded the matter in August 2018 and September 2020 for further development. Entitlement to service connection for ventricular tachycardia and atrial fibrillation, including as due to herbicide agent and/or ionizing radiation exposure or as secondary to service-connected ischemic heart disease is remanded. The Board regrets the delay in rendering a decision on this claim, but finds that another remand is necessary to obtain a supplemental medical opinion. More specifically, the November 2020 VA medical opinion concludes that the Veteran’s atrial fibrillation is not caused by Agent Orange. In this regard, the opinion states that “[t]his is accepted medical knowledge and practice” and that “[t]here are no current, widely accepted, peer-reviewed studies confirming Agent Orange as a cause of atrial fibrillation.” While the Board may consider the extent to which a scientific theory is accepted in the scientific community when evaluating the evidence of record, it may not demand a level of acceptance greater than the level of proof required by the benefit-of-the.-doubt-rule. Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). On remand, the November 2020 VA examiner should be asked to clarify whether in stating there are no “widely accepted, peer-reviewed studies” supporting a link between herbicide exposure and atrial fibrillation, there is any medical support for such a relationship. If so, the examiner should explain why any statistical or medical studies considered by the examiner are found to be persuasive or unpersuasive, among any other relevant factors. See Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009). The Board is aware that the November 2020 VA examiner found that the Veteran has not had atrial fibrillation or ventricular tachycardia since cardiac ablation procedures were performed in 2003 and 2011. The examiner should still be asked to clarify whether the Veteran has any current residuals of the ablation procedure. The Board also notes that the Veteran has a separate appeal regarding a claim for a stroke, and the record raises the issue of whether it may be secondary to his atrial fibrillation. See May 2019 Board Remand. Thus, even if the Veteran does not currently have atrial fibrillation, the issue of whether his history of that condition may be service connected is not moot. The matter is REMANDED for the following action: 1. Add to the file any outstanding VA treatment records pertaining to the Veteran dated since November 2020. 2. Request the medical professional who rendered November 2020 opinion to provide a supplemental opinion regarding the Veteran’s atrial fibrillation/ventricular tachycardia, as specified below. If that examiner is not available, a different medical professional may provide the requested opinion. The examiner is asked to address the following: (A) Whether the Veteran has any current residuals of the 2003 and 2011 cardiac ablation procedures to treat his ventricular tachycardia and atrial fibrillation. (B) Whether it is at least as likely as not (50 percent probability or greater) that any current atrial fibrillation and/or ventricular tachycardia was caused by the Veteran’s presumed exposure to an herbicide agent such as Agent Orange. In rendering the opinion, the examiner should state whether any medical studies or articles have been reviewed that may provide support for such a relationship. The November 2020 VA medical opinion states that there are no “widely accepted, peer-reviewed studies” supporting a link between atrial fibrillation/ventricular tachycardia and Agent Orange exposure, but does not clarify whether the examiner reviewed any studies or medical literature that may support such a link, but found them unpersuasive. (Continued on next page)   Accordingly, the opinion should explain why any scientific or medical studies or articles on the subject that have been considered are found to be persuasive or unpersuasive, among any other factors the examiner deems relevant to the opinion. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, Associate 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.