Citation Nr: 21010983 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 20-19 593 DATE: February 26, 2021 ORDER Service connection for sinus bradycardia is granted. REMANDED Entitlement to service connection for heart disorder, other than sinus bradycardia, to include valvular heart disease, left anterior fascicular block, diastolic dysfunction, eft ventricular hypertrophy, biatrial dilatation, and atrial flutter. FINDING OF FACT The Veteran’s sinus bradycardia had its onset during active service. CONCLUSION OF LAW The criteria for entitlement to service connection for sinus bradycardia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Coast Guard from July 1955 to July 1988. This matter comes to the Board of Veterans’ Appeals (Board) from a March 2017 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO). The Veteran testified in December 2020 before the undersigned Veterans Law Judge (VLJ); a hearing transcript is associated with the record. Entitlement to service connection for sinus bradycardia is granted. The Veteran seeks service connection for a heart condition, to include sinus bradycardia, which he contends had its onset during his active service. The Board concludes that the Veteran’s diagnosed sinus bradycardia is a current disability that began during his active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service treatment records document a diagnosis of sinus bradycardia on multiple occasions during service, including following October 1971 and October 1973 electrocardiograms (ECGs) and on annual physicals in January 1982 and October 1987, although sinus bradycardia was not noted on the Veteran's April 1988 retirement physical. Similarly, private treatment records from Sentara Family Medicine Physicians and Sentara Cardiology Specialists, as well as a January 2017 VA examination, show the Veteran has a current diagnosis of sinus bradycardia. Thus, the question becomes whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes a January 2017 VA medical opinion, which reflects that the “Veteran had a history of chest pain on July 30, 1985 lasting 1-2 seconds. There were no other medical records pertaining to his heart during service; therefore, to state that the Veteran’s currently diagnosed heart conditions were incurred or caused by the heart condition during service will be resorting to mere speculation.” However, as the Board noted above, the Veteran's service treatment records include multiple diagnoses of sinus bradycardia. Thus, the examiner’s statement that there are no other records relevant to the Veteran's heart condition other than the July 1985 complaint of chest pain is inaccurate. As the January 2017 VA medical opinion is based on an inaccurate basis and does not reflect a thorough review the Veteran's claims folder, the opinion has limited probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (the weight of a medical opinion is diminished where it is based on an inaccurate factual premise). The evidence in favor of the claim includes January 2021 statements from the Veteran's primary care physician and cardiologist. The Veteran’s primary physician noted that the Veteran’s service treatment records showed sinus bradycardia, that the Veteran has been a patient of his for over 27 years, and that the Veteran has had sinus bradycardia throughout those 27 years. The Veteran’s cardiologist opined that the Veteran’s current sinus bradycardia symptoms are more likely than not related to related to his diagnosis of sinus bradycardia during active service, noting that he was diagnosed in service with the same. The clear implication is that the Veteran’s sinus bradycardia is a chronic condition that has persisted since its onset more than thirty years ago. The Board finds that the private medical evidence, the January 2021 statements, are more probative than the VA medical opinion as it reflects an accurate medical history and provides a clear basis for the conclusion reached. See Neives-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The competent, credible and most probative evidence of record reflect that the Veteran’s sinus bradycardia had its onset in service. Therefore the criteria for service connection for sinus bradycardia are met. Accordingly, to this extent only, the claim is granted. REMANDED Entitlement to service connection for heart disorder, other than sinus bradycardia, to include valvular heart disease, left anterior fascicular block, diastolic dysfunction, eft ventricular hypertrophy, biatrial dilatation, and atrial flutter, is remanded. As an initial matter, the Board observes that the scope of the appeal extends to heart conditions beyond the current grant of service connection for sinus bradycardia. VA received a claim in October 2016 for atrial flutter with bradycardia. Also, the April 2017 VA examination report reflects additional diagnoses of valvular heart disease, diastolic dysfunction, mild concentric left ventricular hypertrophy, and biatrial dilation; and the Veteran’s private provider has diagnosed him with persistent atrial flutter and persistent atrial fibrillation. The record shows that the Veteran seeks service connection beyond that for sinus bradycardia. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (“VA is obligated to determine all potential claims raised by the evidence.”); Jarrell v. Nicholson, 20 Vet. App. 326, 332 (2006) (noting that, once the Board has jurisdiction over a claim, it has the authority to address all issues related to that claim, including those not decided by the RO); Bernard v. Brown, 4 Vet. App. 384, 391-92 (1993) (holding that the Board’s inquiry is not limited to specific questions decided by the RO but includes all questions reasonably raised by the record that are necessary to its decision on the matter). Given the above, the Board finds that remand is necessary to decide the remaining part of this appeal. Specifically, remand is necessary for a medical opinion addressing whether the heart conditions, other than sinus bradycardia, are related to in-service cardiac findings or secondary to service-connected sinus bradycardia. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), The current medical evidence is inadequate to fully address these questions. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his heart symptoms since service discharge to include Sentara Family Medicine Physicians, Dr. Lipton, and Dr. Gottimukkala. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain a medical opinion from an appropriate clinician to address the following: (a.) Whether the Veteran has a heart condition, other than sinus bradycardia, to include diagnosed valvular heart disease, diastolic dysfunction, mild concentric left ventricular hypertrophy, biatrial dilation, persistent atrial flutter, and persistent atrial fibrillation, that is at least as likely as not related to service, including any documented chest or cardiac complaints or findings to include sinus bradycardia. (b.) For each heart condition shown, whether it is at least as likely as not proximately due to service-connected sinus bradycardia. (c.) For each heart condition shown, whether it is at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected sinus bradycardia. The opinion should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). 3. Ensure that all VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.D. Anderson, 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.