Citation Nr: 21031846 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 18-32 634 DATE: May 24, 2021 REMANDED Entitlement to service connection for a cardiovascular disability to include supraventricular arrhythmia with atrial fibrillation, claimed as the result of herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran had active service from July 1957 to September 1973. He served in the Republic of Vietnam and was awarded the Combat Infantryman Badge. Entitlement to service connection for a cardiovascular disability to include supraventricular arrhythmia with atrial fibrillation, claimed as the result of herbicide agent exposure, is remanded. In its February 2021 Remand instructions, the Board of Veterans' Appeals (Board) requested that further Department of Veterans Affairs (VA) cardiovascular evaluation be obtained. The examiner was directed to specifically address a March 2008 hypertension diagnosis; the National Academy of Sciences' study Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War (Nov. 15, 2018); the July 1958 service treatment records documenting a Grade II aortic systolic murmur; a June 1973 chest X ray study findings of an enlarged heart; and the Veteran's lay statements. A February 2021 VA cardiovascular evaluation was incorporated into the record. The Veteran was diagnosed with hypertension and atrial fibrillation. The VA physician concluded that "the conditions claimed were less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness." He commented that: "given that 2/3 of men over the age of 60 have hypertension, and given that the vast majority of them were never in Vietnam or exposed in other circumstances to toxic herbicides, it is not appropriate to ascribe the Veteran's hypertension to the special circumstance of possible Agent Orange exposure" and "given that the referenced murmur was an isolated finding, and is not reproduced in current cardiac auscultation, and given that the Veteran was able to complete 20 years of active duty in the US Army, it is highly unlikely that the alleged murmur represents valvular heart disease." The VA physician did not note or otherwise address the March 2008 hypertension diagnosis; the National Academy of Sciences' study Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War (Nov. 15, 2018); the July 1958 service treatment records documenting a Grade II aortic systolic murmur; a June 1973 chest X ray study findings of an enlarged heart; and the Veteran's lay statements. The Agency of Original Jurisdiction's compliance with the Board's remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Clinical documentation dated after February 2021 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider, who has treated him for any cardiovascular disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records dated after February 2021. 3. Schedule the Veteran for a VA examination, conducted by the appropriate physician, to assist in determining the nature and etiology of the claimed cardiovascular disorder and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (Continued on the next page) (a) Diagnose all cardiovascular disabilities found. The examiner should specifically state whether ischemic heart disease was been identified. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified cardiovascular disabilities had its onset during active service or is related to any incident of service, including the Veteran's presumed herbicide agent exposure while in the Republic of Vietnam. The examiner should specifically address the March 2008 hypertension diagnosis; the National Academy of Sciences' study Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War (Nov. 15, 2018); the July 1958 service treatment records documenting a Grade II aortic systolic murmur; a June 1973 chest X ray study findings of an enlarged heart; and the Veteran's lay statements. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Ferguson, 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.