Citation Nr: 21021696
Decision Date: 04/13/21	Archive Date: 04/13/21

DOCKET NO. 14-09 065A
DATE: April 13, 2021

REMANDED

Entitlement to service connection for bicuspid aorta is remanded.

REASONS FOR REMAND

The Veteran served on active duty from July 1974 to July 1977, and from December 1990 to April 1991.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. A notice of disagreement (NOD) was received in March 2013, a statement of the case (SOC) was issued in February 2014, and a substantive appeal was timely received in September 2014.

The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in April 2017. A transcript of the hearing has been associated with the Veteran’s electronic claims file. In February 2018 and January 2020, the Board remanded the appeal to the RO for additional development.

1. Entitlement to service connection for bicuspid aorta is remanded.

In the January 2020 Remand, the Board noted that the Veteran was afforded a VA examination in May 2018 and an opinion was obtained but contained internally inconsistent findings. In a September 2019 addendum to the May 2018 VA examination, the examiner opined that it is clear and unmistakable that the Veteran entered service in December 1990 with a pre-existing heart condition, as the Veteran was diagnosed with a bicuspid aorta in 1981.  The examiner then opined that it is “less likely than not” that bicuspid aorta is etiologically related to symptomatology noted in service, to include the claimed stress of Special Forces service and training, and that “based on the evidence of record, there is insufficient evidence to establish a nexus, with greater than 50% probability, between the claimed condition and any time spent in military service.”  The Board found that a question posed in the prior remand directives was not appropriately answered.  Therefore, an addendum opinion was necessary.

On Remand, in a January 2020 addendum opinion, Dr. F.H. opined in part, “[b]ased on the evidence of record, it is LESS LIKELY than not, with less than 50% probability, that this pt's pre-existing heart condition was permanently aggravated beyond its natural progression during the 4-month period of service from December 1990 to April 1991.” (Emphasis added). Once again, Dr. F.H. utilized the incorrect standard in addressing the Board’s question and therefore another addendum opinion is necessary. 

The matter is REMANDED for the following action:

Return the January 2020 addendum to Dr. F.H. for a clarifying addendum opinion.  Dr. F.H. opined in part, “[b]ased on the evidence of record, it is LESS LIKELY than not, with less than 50% probability, that this pt's pre-existing heart condition was permanently aggravated beyond its natural progression during the 4-month period of service from December 1990 to April 1991.” (Emphasis added). Dr. F.H. is again asked whether it is his opinion based on the evidence of record, it is CLEAR AND UNMISTAKABLE that the Veteran’s pre-existing heart condition was not permanently aggravated beyond its natural progression during the 4-month period of service from December 1990 to April 1991.

 

TANYA SMITH

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	Edwin B. Esmenda, 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.