Citation Nr: 21022521 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 16-57 127 DATE: April 16, 2021 REMANDED Entitlement to service connection for atrial fibrillation, to include as due to exposure to herbicide agents, or in the alternative, as secondary to service-connected myelodysplastic syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1968 to March 1970. The Veteran is deceased; the appellant is his surviving spouse and the substituted claimant. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019 and July 2020, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) for additional development and it has since returned for further appellate review. Regretfully, the Board finds that remand is necessary prior to final adjudication. The appellant contends that the Veteran had atrial fibrillation that was caused by his active duty service, to include as due to exposure to herbicide agents, or in the alternative, is related to his service-connected myelodysplastic syndrome. In September 2020, an addendum VA medical opinion was obtained addressing the appellant’s contentions. Concerning presumptive theory of entitlement, the examiner opined that atrial fibrillation is not considered related to exposure to Agent Orange, but did not provide a rationale to support this finding. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Concerning direct service connection, the examiner opined that the separation examination did not reveal onset of atrial fibrillation. A review of the February 1970 report of medical history held at separation indicates the Veteran’s report of having had high blood pressure. In their opinion, the examiner noted that blood pressure could contribute to the exacerbation of atrial fibrillation. Thus, an addendum VA medical opinion is needed. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Concerning secondary service connection, the examiner opined that the Veteran’s atrial fibrillation was not caused or aggravated beyond its normal progression by service-connected myelodysplastic syndrome. In support of this finding, the examiner noted that additional medical documentation, such as the Veteran’s hospital stay, is needed to determine whether the Veteran’s atrial fibrillation was aggravated beyond its natural progression by myelodysplastic syndrome. Although there are medical treatment records available in the claims file, to the extent there are any missing hospital stay records, the Board finds that such records should be obtained to allow the examiner to provide a proper medical opinion. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Ask the appellant to identify all outstanding treatment records relevant to the Veteran’s claim, to include all the hospital stay records until the Veteran’s death. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the appellant identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the appellant of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that atrial fibrillation had its onset in service or otherwise related to the Veteran’s conceded exposure to herbicide agents? (b.) Whether it is at least as likely as not (50 percent probability or greater) that atrial fibrillation onset during service or is otherwise related to an in-service injury, event, or disease, to include the February 1970 report of medical history where the Veteran reported having had high blood pressure. (c.) Whether atrial fibrillation is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected myelodysplastic syndrome. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. M. C. WILSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.