Citation Nr: 21012518 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 13-04 952 DATE: March 4, 2021 REMANDED Entitlement to service connection for a chronic condition to account for chest pain, to include as secondary to an acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran had active service from January 1974 to June 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by Department of Veterans Affairs (VA) Regional Office (RO). In October 2015, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the claims file and reviewed accordingly. This appeal, which originally had several more issues, was previously before the Board in January 2016, February 2018, and May 2019, at which times it was remanded for additional development. This claim has since been returned to the Board. While on remand, the Veteran’s service connection claims for PTSD and hypertension were granted in full, with the PTSD being afforded a 100 percent evaluation for the entire appeal period. Because the Veteran’s claim for a total disability rating based on individual unemployability (TDIU) was premised solely on PTSD, the TDIU issue is rendered moot. The Veteran claim that he suffers from a disability manifested by chronic chest pain that began in military service and has continued to present day. At the October 2015 Board hearing, the Veteran testified that he first noticed onset of chest pain in military service, but he did not seek out treatment at that time. Post-service treatment records in August 2010 show that the Veteran has continually complained of chest pain, being variously diagnosed with pleurisy, costochondritis, and non-obstructive coronary artery disease. The Veteran was provided with a VA examination September 2020. The VA examiner diagnosed the Veteran to have non-obstructive coronary artery disease and chest pain of a musculoskeletal origin. The examiner opined that the Veteran’s coronary artery disease was unrelated to the complaints of chest pain throughout the appeal period. More specifically, the examiner indicated that the chest pain was of musculoskeletal origin. The examiner went on to opine that the Veteran’s musculoskeletal condition was unrelated to the Veteran’s service-connected psychiatric disability since it cannot cause or aggravate something with a skeletal origin. However, the examiner did not explain that conclusion or address whether the chest pain condition could have had its onset in service, as the Veteran reported at his October 2015 Board hearing. Thus, the Board finds that the Veteran’s claims file should be returned for an addendum opinion. The examiner should provide a complete rationale for any opinions rendered. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records for inclusion in the electronic claims file. 2. Thereafter, seek an addendum medical opinion from an appropriate clinician to address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's chest pain, apparently of musculoskeletal origin, and characterized in records as pleurisy and/or costochondritis, is of such a nature that it is at least as likely as not that it had its onset in service, or is otherwise related to an in-service disease or injury. In addition, the reviewer should explain the basis for the conclusion that PTSD did not cause or aggravate the Veteran’s chest pain condition. The question of both causation and aggravation needs to be addressed. For the limited purpose of providing the medical opinions, the credibility of the Veteran’s lay statements may be assumed. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. The claims file should be provided to the person giving the opinions. (Continued on the next page)   The examiner should provide a complete rationale for any conclusions expressed. 3. Readjudicate the appeal. M. E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Dodd, Ryan 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.