Citation Nr: 21027412 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 15-17 989 DATE: May 5, 2021 REMANDED Entitlement to service connection for a heart disability is remanded. Entitlement to service connection for degenerative arthritis, to include degenerative joint disease of the left hand, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1973 to April 1974. The Veteran also had reserve service and periods of active duty of training (ACDUTRA) and inactive duty for training (INACDUTRA). In October 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge at the local Regional Office. A transcript of the hearing is associated with the claims file. In February 2018, the Board remanded the remaining issues on appeal for further development. Unfortunately, the Board finds that another remand is necessary as further development is needed prior to adjudicating the appeal. For clarification purposes, the Board has recharacterized the issue of service connection for degenerative arthritis to specifically include left hand degenerative joint disease as this appears to be the Veteran's primary diagnosis. The Board also remanded the issues of entitlement to service connection for an acquired psychiatric disability and posttraumatic stress disorder (PTSD) as well as entitlement to a total disability rating based on individual unemployability (TDIU). However, in a February 2019 rating decision, service connection for the Veteran's psychiatric disability, diagnosed as PTSD, and a TDIU were granted; representing a full grant of the benefits sought on appeal. 1. Entitlement to service connection for a heart disability is remanded. The Board previously remanded this issue to afford the Veteran a VA examination with etiological opinion. The August 2018 VA examiner found that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The only rationale provided was that the Veteran was out of service in 1974 and had no complaints of chest pain until 2001 when he had stent placed. There was no evidence in service record of heart problems. Therefore, the examiner concluded that in their opinion the Veteran's heart condition is not directly related to his military service. However, the examiner failed to address the reports of in-service chest pain as directed by the Board. In this regard, a February 1974 clinical record showed that the Veteran complained of chest pain. Moreover, upon discharge in March 1974, the Veteran reported shortness of breath and chest pain. Thus, as the examiner failed to consider all the relevant evidence of record, this opinion is inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Accordingly, in order to comply with the Board's prior remand, an addendum opinion is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Moreover, importantly, the record shows that the Veteran receives continuing treatment at the VA. The February 2019 supplemental statement of the case (SSOC) indicates that VA treatment records from May 2013 to January 2019 were reviewed. However, all of these records have not been associated with the claims file. The most recent records in the claims file date from September 2016. In light of the need to remand, the Veteran's VA clinical records from September 2016 to the present should be associated with the record. 2. Entitlement to service connection for degenerative arthritis, to include degenerative joint disease of the left hand, is remanded. In its prior remand, the Board also reopened this issue and remanded for the agency of original jurisdiction (AOJ) to consider on the merits. Without doing any further development, the AOJ reconsidered the claim in the February 2019 SSOC. However, as the Board previously noted, the Veteran suffered a gunshot wound to the left hand and is service-connected for a residual muscle injury. Importantly, an October 2013 treatment record indicates that the Veteran has degenerative joint disease, which may possibly be separately rated, associated with this injury. As such, an examination with opinion is necessary to determine whether the Veteran's left hand degenerative joint disease is due to the in-service gunshot wound, or associated with and/or secondary to the service-connected left hand muscle injury. The matters are REMANDED for the following action: 1. Obtain VA clinical records from September 2016 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's heart disability. The examiner must review the claims file. Thereafter, the examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder is related to the Veteran's military service to include reports of chest pain in service. The examiner must provide a detailed rationale for the opinion rendered. In proffering the opinion, the examiner must address the in-service 1974 reports of chest pain. 3. Schedule the Veteran for a VA examination with an appropriate clinician regarding the etiology of his left hand degenerative joint disease. The examiner must review the claims file. The examiner must opine whether the Veteran's left hand degenerative joint disease is at least as likely as not (a) related to service, including the in-service gunshot wound; (b) associated with and/ or proximately due to (in whole or in part) the service-connected muscle injury to the left hand; or (c) aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by the service-connected muscle injury to the left hand. The examiner must provide a detailed rationale for the opinions rendered. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.N. Moats 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.