Citation Nr: 21030001 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 18-09 293 DATE: May 17, 2021 REMANDED Entitlement to service connection for atrial fibrillation with rapid ventricular rate is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1984 to November 1988, from December 1995 to August 1996, and from February 2003 to March 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a videoconference hearing. A transcript of the hearing has been associated with the file. Entitlement to service connection for atrial fibrillation with rapid ventricular rate is remanded. The Veteran contends that her atrial fibrillation with rapid ventricular rate (atrial fibrillation) was caused by exposure to burn pits and environmental hazards while serving in Iraq. See Form 9 received 2/14/2018; see also Hearing Transcript at page 2. The Veteran was first provided a VA examination in June 2017. At the examination, the Veteran was diagnosed with atrial fibrillation with a date of diagnosis of 2017. As to onset of the atrial fibrillation, the Veteran stated that she had several recent episodes of palpitations that lasted 60 seconds and caused her to feel lightheaded and short of breath. See C&P Exam received 6/23/2017. The episodes would happen intermittently and began approximately five years ago. Id. She also stated that about 20-25 years ago she had episodes of heart racing, but her examinations were unremarkable. Id. The June 2017 VA examiner provided a negative nexus opinion stating that the Veteran's atrial fibrillation was less likely than not caused or incurred during service because it was acute and less than 6 months old. Id. at page 20. The Veteran was provided another VA examination in October 2017, wherein the VA examiner only reviewed the Veteran's file without the benefit of an in person or video telehealth examination. The VA examiner opined that it was less likely than not that the Veteran's atrial fibrillation was caused by burn pits and particulate matter in Iraq based on a report by the Medicine Division of National Academy of Sciences, Engineering, and Medicine. See C&P Exam receive 10/26/2017 at page 6. The Board finds that both the June 2017 and October 2017 VA medical opinions are incomplete. First, the June 2017 VA examiner did not address the Veteran's contention that her atrial fibrillation was caused by burn pits and/or environmental factors in Iraq, instead the examiner based the negative opinion on the onset of the condition being after active service. Relatedly, the October 2017 VA examiner did not directly address the Veteran's contention that her atrial fibrillation was caused by burn pits/environmental factors but instead cited to a report that did not discuss the relationship of the development of heart conditions and burn pit exposure. On remand, the Board will direct that the RO provide the Veteran with a new VA examination and medical opinion that directly addresses her contention and supports its conclusion with an adequate rationale. This matter is REMANDED for the following action: Schedule the Veteran for a VA examination for her atrial fibrillation with rapid ventricular rate. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: Is the Veteran's atrial fibrillation with rapid ventricular rate at least as likely as not related to service, including exposure to burn pits and/or environmental factors while serving in Iraq? The VA examiner is asked to review the Veteran's testimony of exposure to burning human waste, chemicals, and clothing. See Hearing Transcript received 8/31/2020 at page 5. Additionally, the examiner is asked to review several articles on the health and environmental effects of particle matter and burn pit diseases. See Correspondence received 9/02/2020. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.