Citation Nr: 21012791 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-30 346 DATE: March 5, 2021 REMANDED Service connection for an aortic valve disability is remanded. Service connection for scarring of the left leg is remanded. REASONS FOR REMAND The Veteran had active service from March 1968 to January 1970. This appeal was most recently before the Board of Veterans’ Appeals (Board) in September 2020, when it remanded the claim for service connection for an aortic valve disability to obtain a medical opinion addressing whether the Veteran’s bicuspid aortic valve, which is congenital in nature, is a defect or a disease. An opinion was obtained in January 2021, but the examiner’s response to this question was that the condition was “congenital”, which does not clarify whether the congenital condition is a defect or a disease. The examiner otherwise indicates that the Veteran’s entrance examination did not show a heart murmur or other heart defect, suggesting that the bicuspid aortic valve is too a defect. Contrarily, the examiner states that a bicuspid aortic valve is an example of congenital heart disease. The examiner additionally refers to the Veteran’s bicuspid aortic valve as a “disease or defect”. The examiner’s opinion is thus too vague to provide an answer to the question of whether the bicuspid aortic valve is a defect or a disease. To the extent that the opinion was intentionally vague, the examiner did not provide an explanation as to why a more definitive assessment could not be rendered. As such, the Board finds that there has not been substantial compliance with its September 2020 remand directives, and a remand of the Veteran’s claim is again necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board determined that the Veteran’s claim for service connection for scars is inextricably intertwined with the claim for service connection for an aortic valve disorder. See Harris v. Derwinski, 1 Vet. App. 180 (1991). As the claim for service connection for an aortic valve disorder is being remanded, so must the claim for service connection for scars. The matters are REMANDED for the following action: Request an addendum opinion from the cardiologist who provided the January 2021 opinion. If the January 2021 cardiologist is unavailable to offer such opinion, an opinion should be sought from another VA cardiologist. The examiner must provide the following opinions, answering each question exactly as it is written. (a.) Is the Veteran’s bicuspid aortic valve a congenital disease or a congenital defect? A “defect” is a structural or inherent abnormality or condition that is more or less stationary in nature. A “disease” is any deviation from or interruption of the normal structure or function of any part, organ, or system of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. After opining as to whether the Veteran’s bicuspid aortic valve is a congenital disease or a congenital defect, the examiner should answer either (b.) or (c.) below. If the examiner is unable to determine whether the Veteran’s bicuspid aortic valve is a congenital disease or congenital defect, for example as a result of the limitations of current medical research on the subject, the examiner should fully explain why such an opinion cannot be offered. (b.) If, and only if, the Veteran’s bicuspid aortic valve is a congenital defect, then opine whether the Veteran has additional disability due to an in-service disease or injury superimposed upon his aortic valve abnormality. (c.) If, and only if, the Veteran’s bicuspid aortic valve is a congenital disease, then opine whether the disability (i) clearly and unmistakably existed prior to his active service and (ii) clearly and unmistakably was not aggravated by service, to include the Veteran’s exposure to herbicide agents or his service-connected CAD. The examiner should address the apparent progression of the Veteran’s CAD and whether any of these additional diagnoses caused or aggravated the aortic valve disability. (signature next page) MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Flynn, 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.