Citation Nr: 21025748 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 16-22 026 DATE: April 28, 2021 REMANDED Entitlement to service connection for a heart condition, to include carotid heart disease and hypertension is remanded. REASONS FOR REMAND The Veteran had active service from October 1976 to October 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). This case was previously before the Board in July 2020 when it was remanded for additional development. Specifically, the AOJ was directed to obtain the results of the EKG and echocardiogram as documented in the November 2019 VA medical opinion. If in the event a search of the record showed that these tests had not been scheduled, then the AOJ was instructed to schedule the Veteran for an EKG and echocardiogram. The record indicates that in December 2019, the scheduling of the Veteran’s echocardiogram had been “discontinued” due to his failure to respond to the mandated scheduling effort. The record indicates that efforts were made to contact the Veteran by phone and by letter. Records from July 2020 refer to a relocation of the Veteran’s records and treatment facility, which suggest that VA may have had the wrong contact information when it tried to schedule the November 2019 EKG. Reference is also made to the October 2020 VA medical opinion that notes an EKG that was ordered in July 2020. Reports from that test, if it was performed, are not of record. Accordingly, a remand is needed to ensure substantial compliance with the July 2020 remand directives. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In a July 2020 letter, the Veteran was asked to complete the appropriate release forms to allow VA to obtain his private treatment records. Copies of the release forms (VA Form 21-4142 and VA Form 21-4142a) were included with the letter. The Veteran returned a completed form for the release of treatment records from Medical City Denton in February 2021. However, the request could not be filed as the release did not contain the Veteran’s handwritten signature as required by the provider. Thus, as the matter is being remanded, the Veteran should be afforded another opportunity to provide the information and releases necessary to obtain any outstanding private treatment records, to include Dr. R. P., Dr. S. Z., cardiologist, Dr. K. R., Methodist Sugar Land Hospital, and Medical City Denton. The October 2020 VA medical opinion stated that the Veteran’s costochondritis, amongst other in-service reports of chest pain, atypical angina, and smokers cough, did not contribute or cause the Veteran’s diagnosed hypertension and carotid artery disease. The Veteran is service-connected for costochondritis. The issue of secondary service connection with respect to the Veteran’s heart condition, to include carotid heart disease and hypertension, and costochondritis has thereby been reasonably raised by the record. See Bailey v. Wilkie, No. 19-2661, 2021 U.S. App. Vet. Claims LEXIS 13, at 20-22 (Vet. App. Jan. 6, 2021) (finding that entitlement to secondary service connection was reasonably raised by the record). To that end, the Board finds that the VA opinion did not sufficiently address the question of aggravation, and that a Remand is required. Finally, in Remanding this matter again, the Veteran is reminded that “it is the veteran’s ‘general evidentiary burden’ to establish all elements of his claim.” Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). VA “is required to reject a disability claim if the claimant fails to put forth sufficient evidence showing that he suffered an injury or incurred a disease during service.” Holton v. Shinseki, 557 F.3d 1362, 1370 (Fed. Cir. 2009). Although VA has a duty to assist, this duty is not “a one-way street.” Wood v. Derwinski, 1 Vet. App. 190, 191 (1991). The matters are REMANDED for the following action: 1. The AOJ should obtain outstanding VA treatment records to include the results of an EKG and/or echocardiogram ordered in July 2020. 2. If there is no record of an EKG and/or echocardiograms being conducted in July 2020, the AOJ should schedule the Veteran for these tests. Attempts to schedule the tests should be clearly set forth in the record. 3. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and private (non-VA) health care providers who have treated him for his heart condition to include carotid heart disease and hypertension, to include Dr. R. P., Dr. S. Z., cardiologist, Dr. K. R., Methodist Sugar Land Hospital, and Medical City Denton. The Veteran should be requested to sign any necessary authorization for release of private treatment records to the VA, and appropriate steps should be made to obtain any identified records. 4. After all of the above development is completed, then schedule the Veteran for a new examination by an appropriate clinician to determine the nature and etiology of any heart condition, to include carotid heart disease and hypertension. After reviewing the claims file and examining the Veteran, the examiner should address the following: (a) Identify/diagnose any heart condition, to include carotid heart disease and hypertension existing at any time during the appeal period. (b) For each identified heart condition, to include carotid heart disease and hypertension, state whether it is at least as likely as not (50 percent or greater probability) that such disability i. had its onset in service or is/was otherwise etiologically related to service. The Veteran’s in-service reports of chest pain to include diagnoses of a muscle strain, atypical angina, and smokers cough, and a possible heart attack in August 1977, October 1982, November 1993, May 1998, June 1998, and September 1998 service treatment records should be addressed. The Veteran’s post-service diagnoses of carotid heart disease and hypertension, and reports of atypical chest pain should also be addressed. ii. was proximately due to a service-connected disability, to include costochondritis. iii. underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability to include costochondritis. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and he/she must provide the reasons why an opinion would require speculation. The examiner must indicate whether there is any further need for information or testing necessary to make a determination. Additionally, the examiner 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. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith, 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.