Citation Nr: 21023208 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-49 975 DATE: April 20, 2021 REMANDED Entitlement to service connection for a heart condition (claimed as prolapsing mitral valve and aortic ectasia) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1981 to May 1982, April 1986 to September 1993, December 1998 to September 2015. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in October 2020. A transcript of the hearing is of record. Entitlement to service connection for a heart condition (claimed as prolapsing mitral valve and aortic ectasia) is remanded. The Board finds further development is required before a decision can be made regarding the Veteran’s claim. In May 2017, a VA examiner opined that the Veteran’s claimed conditions, including irregular heartbeat, heart murmur, and chest pain, clearly and unmistakably pre-existed her service and clearly and unmistakably were not aggravated by her service. In support of the opinion, the examiner essentially stated the Veteran did not have a current diagnosis, noting that there were symptoms reported but no diagnosis, that an echocardiogram was normal and did not show evidence of mitral valve prolapse, and treatment notes from a cardiologist who treated the Veteran in 2015 did not document symptoms of a heart condition. However, the Veteran’s service entrance examinations prior to her multiple periods of active duty do not clinically note any heart trouble. In light of this, the Board finds the examiner failed to provide an adequate rationale for the conclusion that the Veteran’s heart condition pre-existed her service. In addition, as the examiner’s rationale suggests the Veteran does not have a current diagnosis, it is unclear whether the cardiac hypertrophy noted on February 2016 and May 2017 echocardiograms were considered. Therefore, the Board finds remand for a new medical opinion necessary. In addition, during the October 2020 Board hearing, the Veteran reported her belief that her heart condition may be related to her service-connected obstructive sleep apnea as she reported that a cardiologist told her the thickening of her heart was due to sleep apnea and that the CPAP machine prescribed for her sleep apnea helps relieve her heart symptoms. Thus, on remand, an opinion as to whether her heart condition is secondary to her sleep apnea should be obtained. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records for the period from October 2017 to the present. 2. After obtaining any additional records, obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any currently diagnosed heart condition, including cardiac hypertrophy. The Veteran’s claims file must be made available to the examiner for review. An examination should only be scheduled if the examiner deems one is necessary for providing the requested opinions. Following a review of the Veteran’s claims file, the examiner is asked to respond to the following: (a) Identify all heart conditions diagnosed during the pendency of the appeal, including cardiac hypertrophy. (b) For any heart condition identified, is it at least as likely as not related to an event, injury, or disease incurred during her period of service from September 1981 to May 1982, including any treatment received therein? (c) (1) Is there clear and unmistakable evidence that a heart condition pre-existed the Veteran’s entry into her period of service from April 1986 to September 1993? (2) For any heart condition that clearly and unmistakably pre-existed this period of service, is there clear and unmistakable evidence that such condition was not aggravated by this period of service? (3) For any heart condition that either did not clearly and unmistakably pre-exist this period of service or was not clearly and unmistakably aggravated by this period of service, please state whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed heart condition(s) had its onset during this period of service, or was otherwise caused by this period of service. (d) (1) Is there clear and unmistakable evidence that a heart condition pre-existed the Veteran’s entry into her period of service from December 1998 to September 2015? (2) For any heart condition that clearly and unmistakably pre-existed this period of service, is there clear and unmistakable evidence that such condition was not aggravated by this period of service? (3) For any heart condition that either did not clearly and unmistakably pre-exist this period of service or was not clearly and unmistakably aggravated by this period of service, please state whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed heart condition(s) had its onset during this period of service, or was otherwise caused by this period of service. In providing the opinions requested in (b) through (d), the examiner should consider and address the Veteran’s heart troubles, including heart murmur, irregular heartbeat, and noted enlargement of ventricles/pleural thickening of left pleural cavity (documented in a March 1991 record), noted in her service treatment records. The examiner should also consider and address the Veteran’s in-service diagnosis of mitral valve prolapse and prolapsing mitral valve leaflet syndrome. (e) For any heart condition that either did not clearly and unmistakably pre-exist service or was not clearly and unmistakably aggravated by service, please state whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed heart condition(s) was caused by or proximately due to her service-connected obstructive sleep apnea. (f) For any heart condition that either did not clearly and unmistakably pre-exist service or was not clearly and unmistakably aggravated by service, please state whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed heart condition(s) was aggravated (i.e., worsened beyond natural progression) by her service-connected obstructive sleep apnea. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Sorisio 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.