Citation Nr: 22068898 Decision Date: 12/14/22 Archive Date: 12/14/22 DOCKET NO. 16-41 696 DATE: December 14, 2022 REMANDED Entitlement to service connection for a heart condition is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from July 1978 to August 1998. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the Board at a hearing held by the undersigned in August 2019. A transcript of the hearing is of record. Subsequently, the Board reopened the Veteran's claim for service connection for a heart condition and remanded it in December 2019 for further development. The Board also remanded this claim in December 2021 for further development. The prior remands also included the matter of service connection for bronchitis. A May 2022 rating decision awarded service connection for bronchitis, evaluated as noncompensable, effective July 14, 2014. As the award of service connection represents a full grant of the appeal that had been before the Board, the appeal has been resolved and the Board will not further address this issue. Entitlement to service connection for a heart condition is remanded. Following the December 2021 remand, a VA examiner opined in May 2022 that it is less likely than not that the Veteran's heart condition was incurred in or caused by the Veteran's service. However, in the rationale section, the examiner stated that it is at least as likely as not that the Veteran's heart condition is related or attributable to his military service. Given the conflict, the Agency of Original Jurisdiction (AOJ) obtained an addendum opinion in July 2022. In July 2022, a different VA clinician opined that it is less likely than not that the Veteran's heart condition was incurred in or caused by the Veteran's service. In support of the opinion, the VA clinician noted that the Veteran's service treatment records reflect diagnoses of chest pain and reports of chest pain and pressure, heart trouble, and pounding heart. The VA clinician also noted that the Veteran was not diagnosed with coronary artery disease until 2008. Furthermore, the VA clinician provided evidence that she considered the August 2008 private treatment record that contains a notation that the Veteran "is known to us for coronary artery disease for approximately 10 years now," as directed in the December 2021 Board remand. However, the July 2022 VA opinion contains no discussion of whether the Veteran's coronary artery disease is related to exposure to poison sumac in Panama, as directed in the December 2021 Board remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that where the remand orders of the Board are not substantially complied with, the Board errs as a matter of law when it fails to ensure substantial compliance). Thus, an additional VA opinion is necessary to adjudicate the claim. The matter is REMANDED for the following action: Obtain a medical opinion from a qualified clinician for the Veteran's heart condition claim. The electronic claims file must be made available to the clinician for review in connection with the request for an opinion. If the reviewing clinician determines that an in-person examination (including via telehealth interview) is needed in order to answer the questions posed, then such should be scheduled. After reviewing the claims file, the reviewing clinician should address the following: Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's heart condition, diagnosed as coronary artery disease, is related or attributable to his military service, to include exposure to poison sumac in Panama and/or reports and treatment for chest discomfort and pain or pressure in the chest in service? In addressing this question, the reviewing clinician is requested to address the August 2008 private treatment record that contains the notation that the Veteran "is known to us for coronary artery disease for approximately 10 years now." (Continued on the next page) The reviewing clinician is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. The reviewing clinician must fully explain the rationale for any opinion, with citation to supporting clinical data/lay statements, as deemed appropriate. If the reviewing clinician cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide supporting rationale as to why an opinion cannot be made without resorting to speculation. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Breitbach, 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.