Citation Nr: 21040925 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 20-02 192A DATE: July 7, 2021 REMANDED Entitlement to service connection for a heart disability is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1970 to April 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in August 2020 for further development. For the reasons discussed below, remand is again warranted. 1. Entitlement to service connection for abnormal electrocardiogram (now claimed as atrial fibrillation) is remanded. The August 2020 Board remand instructed that the Veteran was to be scheduled for a new VA examination. The Veteran was afforded a VA examination for her atrial fibrillation in September 2020. While the examiner noted the Veteran's lay statements of palpitations, the examiner noted that there weas no medical findings of any cardiovascular conditions to include atrial fibrillation on examination. The examiner opined that the Veteran's atrial fibrillation was less likely than not related to military service based on silent service treatment medical records for the claimed condition and separation from service in 1991 with initial evidence of diagnosis of the claimed condition in 2006 more than 12 months post service. The Board finds this opinion inadequate. Specifically, the examiner did not comment as to whether the Veteran's disabilities were related to her heart problems which required various testing during active service and immediately after active service. The examiner specifically indicated "silent service treatment medical records." This comment ignores the multiple instances of complaints of palpitations during active service. Remand for an addendum opinion is warranted. The matters are REMANDED for the following action: 1. Obtain all outstanding treatment records. 2. After all outstanding treatment records have been obtained, obtain an addendum opinion regarding the etiology of the Veteran's heart disabilities. Make sure it is from a physician but a different examiner than the September 2020 examiner. The examiner must review the entire claims file and must note that review in the examination report. The examiner should clearly set forth the rationale for all opinions expressed. The VA examiner should opine whether it is at least as likely as not (a 50 percent probability or greater) that any diagnosed heart disability is caused by, incurred during, or is otherwise related to her active service or manifested within a year of active service. The Board notes that the Veteran was indicated as having paroxysmal atrial fibrillation, nonobstructive coronary artery disease, and is status post permanent pacemaker implant for symptomatic bradycardia. The examiner must discuss the 1991 VA examination report noting a history symptoms of heart palpitations as well as other in-service complaints regarding heart palpitations with testing, and whether these symptoms are related to the current diagnoses. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Wimbish, 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.