Citation Nr: 21014891 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 13-28 180A DATE: March 16, 2021 REMANDED The appeal for dependency and indemnity compensation (DIC) based on service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1963 to July 1985. He died in August 2010. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, and has subsequently been transferred to the RO in Philadelphia, Pennsylvania. The appellant testified before a different Veterans Law Judge in March 2017 and a transcript of the proceedings has been obtained and associated with the claims file. The Veterans Law Judge before whom the Appellant testified is no longer at the Board; in an October 2020 letter from the Board, the Appellant was given an opportunity to have a new hearing. In October 2020, the Board received a waiver of a new hearing before a new Veterans Law Judge, thus the Board will proceed with the appeal. This matter was previously remanded by the Board in May 2018 and June 2019. As explained below, as additional development is warranted, this issue is returned to the agency of original jurisdiction (AOJ) for further consideration. Service connection for the Veteran's cause of death is remanded. VA obtained an addendum medical opinion in January 2020 based on the June 2019 Board remand. Despite the additional and regrettable delay, another remand is required in order to obtain the full medical opinion previously requested by the Board. Unfortunately, the January 2020 addendum medical opinion does not provide additional explanation or rationale for the prior conclusions but instead simply restates the prior rationale and conclusions in different words. The Board has determined that this new medical opinion still does not reach the crux of Appellant’s assertions for why the Veteran’s cause of death merits service connection. The Board also notes that, while the examiner noted the entirety of the file was reviewed, no comment or explanation was provided for why the medical research articles cited to by the Appellant do not apply to this Veteran’s case and the Board is unable to reach a conclusion in this case without some explanation from a medical professional for why that medical research does not or could not apply to this specific Veteran’s death. For these reasons a remand is required to obtain another VA medical opinion. The matters are REMANDED for the following action: 1. Please note that this Appellant’s case has been advanced on the docket and, by law, ALL remanded claims must be processed expeditiously. 2. The AOJ should obtain a medical opinion from a qualified medical physician (to EXCLUDE the prior examiner/physician) that answers the following: (a.) Based on a review of the claims file and a complete review of the Veteran’s medical records, and the appellant and her representative’s contentions , the VA examiner is asked to opine whether it is AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) that the Veteran’s service-connected hypertensive cardiovascular disease with atrial fibrillation and transient ischemic attacks was a contributory cause of death due to its impact on vital organs or his peripheral vascular disease. In essence, the Appellant has asserted that the Veteran’s service-connected hypertension and cardiovascular disease made his other conditions, which ultimately led to the Veteran’s death, worse or aggravated. The examiner is specifically asked to address in the opinion rendered the following medical research articles cited to by the Appellant and her representative in there February 2017 and August 2018 briefs (cited below for your convenience). The examiner MUST address any research articles as they apply or do not apply to this specific Veteran’s case. (b.) Peripheral Artery Disease-Legs, MEDLINE PLUS, https://medlineplus.gov/ency/article/000170.htm (last visited Feb. 14, 2017). (c.) Elizabeth Selvin & Thomas Edinger, Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States: Results From the National Health and Nutrition Examination Survey, 1999-2000, CIRCULATION (July19,2004), available at http://circ.ahajoumals.org/content/l10/6/738. (d.) A. Makin et al, Peripheral Vascular Disease and Hypertension: a Forgotten Association?, 15 J. OF HUMAN HYPTERTENSION 447, 452 (2001), available at http://www.nature.com/jhh/joumal/vl5/?7/Pdf/1001200a.pdf. (e.) What is High Blood Pressure?, Am. HEART Ass’N, http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/What-is-High-Blood-Pressure_UCM_301759_Article.jsp#.WKMrQNIrLcs (last visited Feb. 14, 2017). (f.) Joosten et al. Associations between Conventional Cardiovascular Risk Factors and Risk of Peripheral Artery Disease in Men, 308(16) JAMA: THE JOURNAL OF THE AM. MED. ASS’N 1160-1667 (October 24, 2012) (available at https://jamanetwork.com/journals/jama/fullarticle/1386609). The Board recognizes that the complex and intertwined nature of the medical questions involved requires significant work on the part of the medical examiner and the AOJ and regrets the need to remand the case to the AOJ. However, the Board is unable to adjudicate the claims until the requested information is provided. Therefore, the Board must ask the VA examiners and the AOJ to ensure compliance with the above directives (that is, full and thoroughly explained answers to each of the questions) to avoid additional delays in adjudication. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Williams, 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.