Citation Nr: 21011784 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 11-28 988 DATE: March 2, 2021 REMANDED Entitlement to service connection for cardiac dysfunction and cardiac arrhythmia, to include as secondary to service-connected kidney disease, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1951 to February 1952. He died in October 2013. The appellant is his widow and has been recognized as the substitute claimant. This matter is before the Board on appeal from an October 2009 Department of Veterans Affairs (VA) rating decision. In May 2014 and July 2018, the matter was remanded for additional development. The July 2018 Board remand also addressed service connection claims for hydronephrosis, hypertension, and anemia. A December 2020 rating decision granted the Veteran service connection for hydronephrosis, hypertension, and anemia, resolving those matters. Entitlement to service connection for cardiac dysfunction and cardiac arrhythmia, to include as secondary to service-connected kidney disease, is remanded. The previous [July 2018] remand instructed that the AOJ should arrange for any further development of medical evidence in this matter deemed necessary in light of the award of service connection for renal dysfunction, chronic renal failure, and end stage renal disease. The AOJ ordered a new VA medical opinion to determine the etiology of the Veteran’s claimed cardiac dysfunction/arrhythmia. In a December 2020 medical opinion based on review of the record, the consulting provider (a physician assistant in general practice) opined that the Veteran’s cardiac dysfunction/arrhythmia was less likely than not (less than 50 percent probability) proximately due to or the result of his service-connected condition. The provider stated that all available medical records were reviewed, and the available medical records refer to “arrhythmia”, however there is no documented established diagnosis of a cardiac condition. The provider stated that without a documented specific diagnosis, any medical opinion regarding etiology would be mere speculation. The Board finds the December 2020 VA provider’s opinion inadequate for rating purposes and based on inaccurate factual history. A review of the claims file found that the Veteran’s VA treatment records include assessments of sinus tachycardia and heart murmur; on October 2012 VA treatment, e.g., the assessment was sinus tachycardia, and the Veteran reported that tachycardia was common for him after dialysis. Additionally, a September 2008 statement from a treating non-VA physician states that the Veteran suffered from advanced chronic renal failure, anemia, hypertension, and cardiac arrhythmia. Because the December 2020 opinion was based upon an inaccurate medical history, it is inadequate for rating purposes, and another advisory medical opinion that considers complete and accurate history is needed. The matter is REMANDED for the following: Arrange for the Veteran’s record to be forwarded to an appropriate clinician [in internal medicine or cardiology], other than the December 2020 medical opinion provider, for review and an advisory medical opinion regarding the likely etiology of the Veteran’s claimed cardiac dysfunction and arrhythmia. The opinion should respond to the following: Identify the likely etiology for each cardiac dysfunction or arrhythmia disability shown by the record during the pendency of this claim (i.e., since it was filed). Specifically, is it at least as likely as not (a 50 percent or greater probability) that it was caused or aggravated by (the opinion must address aggravation) the Veteran’s service-connected kidney disease (and its treatment)? The consulting provider must explain the rationale for all opinions in detail, citing to supporting clinical data and medical principles as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Schechner, 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.