Citation Nr: 21027415 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 13-18 773 DATE: May 5, 2021 REMANDED Entitlement to service connection for a cardiovascular disorder, to include as due to exposure to toxic herbicide agents and as secondary to diabetes mellitus is remanded. INTRODUCTION The Veteran served on active duty from January 1966 to December 1968, with service in the Republic of Vietnam. He is the recipient of the Purple Heart Medal and Combat Infantryman's Badge. In November 2020, the United States Court of Appeals for Veterans Claims (Court) granted a joint motion for partial remand and returned the case to the Board for action consistent with the joint motion. REASONS FOR REMAND While additional delay is unfortunate, the Board finds further development is required before the Veteran's claim is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the course of an April 2015 decision, the Board found a new VA examination was necessary in order to assist in determining the etiology of the Veteran's claimed cardiovascular disability. In particular, the Board instructed the examiner to conduct any required testing in order to confirm or rule out the presence of an ischemic heart disease (IHD), and also comment on the etiology of any non-ischemic heart disabilities. The examiner was asked to state whether any non-ischemic heart disability diagnosed in the course of the appeal period was either incurred in service, caused by his service-connected diabetes mellitus, or aggravated by his service-connected diabetes mellitus. The Veteran subsequently underwent a VA heart conditions examination in August 2015, wherein he was diagnosed with both sinus tachycardia and a first-degree atrioventricular (AV) block. Following that examination, the examiner provided medical opinions. The RO subsequently obtained addendum medical opinions from a second VA examiner, who had not previously examined the Veteran, in April 2016. For numerous reasons, the Board finds the above-noted VA examination and medical opinions to be insufficient. Initially, the Board notes the August 2015 VA examiner failed to conduct any additional testing to confirm the presence of IHD, as instructed. Rather, the examiner relied upon a September 2014 electrocardiogram and echocardiogram. Further, the examiner found the Veteran's diagnosed sinus tachycardia was less likely than not incurred in service but failed to provide any explanation for how or why they came to this conclusion. The August 2015 examiner failed to provide any opinions as to the Veteran's diagnosed first-degree AV block. As noted in the November 2020 joint motion, the April 2016 VA examiner provided a negative secondary medical opinion addressing the Veteran's diagnosed first-degree AV block, but failed to provide a rationale to support that opinion. The examiner also failed to provide an aggravation opinion addressing the Veteran's first-degree AV block. Further, though the examiner indicated the Veteran's first-degree AV block was less likely than not incurred in service, the examiner failed to discuss whether the disability could have been consequentially related to his conceded herbicide exposure. Based upon the foregoing insufficiencies, the Board finds a new VA examination and medical opinions are necessary in order to achieve substantial compliance with the April 2015 remand instructions. Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by a Cardiologist with sufficient expertise to determine the etiology of any heart disability diagnosed in the course of the appeal period. All evidence must be made available to and reviewed by the examiner. The physician is asked to conduct any required testing, such as an exercise stress test, electrocardiogram, echocardiogram, or x-ray to determine whether the Veteran has an ischemic heart disease. If the examiner is unable to, or concludes that such required testing is not necessary, he or she should be directed to clearly explain why that is so. Following an examination of the Veteran and a review of the relevant records and lay statements, the examiner should state whether any non-ischemic cardiovascular disability present during the period of the claimto specifically include both sinus tachycardia and first-degree AV blockis at least as likely as not (a 50 percent probability or greater): a) etiologically related to the Veteran's service, to include his conceded herbicide exposure therein; b) was caused by his service-connected diabetes mellitus; or c) was worsened to any degree by his service-connected diabetes mellitus. The examiner must provide a complete rationale for all opinions offered. If the examiner is unable to provide any requested opinion, he or she should explain why. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.