Citation Nr: 21029218 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 17-66 925 DATE: May 12, 2021 ORDER The previously denied claim for entitlement to service connection for supraventricular arrhythmia (claimed as atrial fibrillation) is reopened. REMANDED Entitlement to service connection for supraventricular arrhythmia (also claimed as atrial fibrillation), to include as secondary to hypertension, is remanded. FINDINGS OF FACT 1. In an October 2013 rating decision, the Agency of Original Jurisdiction (AOJ) previously considered and denied a claim for service connection for supraventricular arrhythmia (claimed as atrial fibrillation). 2. The Veteran was notified of the October 2013 rating decision and of his appellate rights, but he did not appeal. Also, the VA did not receive new and material evidence within one year of the issuance of the rating decision. 3. Evidence received after the October 2013 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for supraventricular arrhythmia. CONCLUSIONS OF LAW 1. The October 2013 rating decision denying service connection for supraventricular arrhythmia (claimed as atrial fibrillation) is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156, 20.201, 20.302, 20,1103. 2. The evidence submitted since the October 2013 rating decision is new and material, and the issue of entitlement to service connection for supraventricular arrhythmia is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1999 to August 2005. This matter comes to the Board of Veterans' Appeals (Board) from an October 2016 rating decision issued by AOJ, which reopened and then denied the Veteran's claim for service connection for arrhythmia. In December 2020, a Board hearing was conducted. The hearing transcript has been associated with the Veteran's file. Claim to Reopen The questions for the Board are whether the last decision issued by the AOJ for entitlement to service connection for supraventricular arrhythmia (arrhythmia) is final. If so, whether new and material evidence has been received since that final decision that warrants reopening of his entitlement claim. The Board finds that new and material evidence has been received that warrants reopening of the Veteran's arrhythmia claim. To reopen a claim that has been denied by a final decision, the claimant must present new and material evidence with respect to the claim. 38 U.S.C. § 5108. "New evidence" means existing evidence not previously submitted to VA. 38 C.F.R. § 3.156 (a). "Material evidence" means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. There is a low threshold for determining whether evidence raises a reasonable possibility of substantiating a claim. Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). Also, new and material evidence is not required as to each previous unproven element of a claim to reopen. Shade, 24 Vet. App. at 120. In October 2013, the AOJ issued a rating decision denying service connection for arrhythmia. The AOJ concluded that the Veteran's arrhythmia neither occurred in nor was caused by service. Secondary service connection for this issue was not discussed in the rating decision. A search of the record does not show the Veteran appealed the decision or submit new and material evidence related to the claim within a year of being notified it was denied; thus, the Board finds the AOJs October 2013 rating decision is final. 38 U.S.C. § 7105(c). Since the October 2013 rating decision, new and material evidence has been added to the record that relates to his service connection claim for arrhythmia. The Veteran recently testified that he observed irregular heartbeats during service, which he now identifies as arrhythmia. See December 2020 VA DBQ at 3. He testified that after he was diagnosed with arrhythmia, he learned to recognize the signs and symptoms of arrhythmias and associates some in-service experiences with them. Id. at 3, 5. Without addressing the merits of the evidence, the Board finds this new evidence goes to the issues of whether the Veteran's arrhythmia began during service and, if so, whether there is a nexus between his condition and service. Considering lay observations of possible arrhythmia during service were not evaluated by the AOJ at the time of the October 2013 rating decision, this evidence raises a reasonable possibility of substantiating the Veteran's claim. Also, during a VA disability examination for his service-connected hypertension, the examiner remarked that hypertension is linked to the development of arrhythmia. See August 2016 VA DBQ Hypertension at 1, 2. Although the Veteran has recently asserted there is a link between his arrhythmia and service-connected hypertension, the examiner's remarks provide medical evidence that goes to the issue of whether the Veteran's hypertension proximately caused or aggravated his arrhythmia. Considering entitlement to service connection on a secondary basis was not evaluated by the AOJ at the time of the October 2013 rating decision, this evidence raises a reasonable possibility of substantiating the Veteran's claim. In sum, the VA has obtained new and material evidence that goes to the issues of an in-service incurrence and a nexus. The evidence also raises the theory of entitlement to service connection on a secondary basis, which has not been evaluated by the AOJ before. Thus, the Veteran's claim for service connection for arrhythmia is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). REASONS FOR REMAND Entitlement to service connection for service connection for arrhythmia (also claimed as atrial fibrillation), to include as secondary to hypertension, is remanded. Although the Board regrets the delay, the Veteran's claim must be remanded for a new medical opinion before the Board is able to decide on the merits. The examiner who prepared the September 2016 VA medical opinion limited her discussion to whether the Veteran's diagnosed supraventricular arrhythmia is secondary to his service-connected hypertension. See VA DBQ at 5, 6. Considering the Veteran has reported observing irregular heartbeats during service, the Board cannot make a fully informed decision on the claim without an opinion that addresses whether arrhythmia is directly related to his service. Ardison v. Brown, 6 Vet. App. 405, 407 (1994). The Board notes that even though the examiner discussed whether the Veteran's service-connected hypertension caused his diagnosed arrhythmia, she did not address whether it was aggravated by hypertension. El Amin v. Shinseki, 26 Vet. App. 136 (2013). Because the September 2016 medical opinion is not sufficient for the Board to evaluate and decide the Veteran's arrhythmia claim, a new VA disability examination is warranted. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his diagnosed supraventricular arrhythmia. The examiner must review the claims file. The examiner is asked to provide a response to the following: a. Is the Veteran's supraventricular arrhythmia at least as likely as not (50 percent or greater probability) related to his service? b. Is the Veteran's supraventricular arrhythmia at least as likely as not (50 percent or greater probability) proximately due to his service-connected hypertension? c. Is the Veteran's supraventricular arrhythmia at least as likely as not (50 percent or greater probability) aggravated, i.e., worsened beyond its natural progression, by his service-connected hypertension? Provide a rationale to support the opinion(s). The examiner, in coming to his or her conclusion, is asked to comment on the following: i. Discuss the Veteran's testimony that he observed rapid or irregular heartbeats during service and, based on his ability to recognize arrhythmias now believes he had experienced arrhythmias during service. ii. Address the remarks by a VA examiner in the August 2016 VA DBQ that hypertension is linked to the development of arrhythmia. iii. Address the September 2016 VA medical opinion that concluded the Veteran's supraventricular arrhythmia was not caused by his service-connected hypertension. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dean, Michael S. 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.