Citation Nr: 22012231 Decision Date: 03/03/22 Archive Date: 03/02/22 DOCKET NO. 18-50 280 DATE: March 3, 2022 REMANDED Entitlement to service connection for a heart disability is remanded. Entitlement to service connection for a pulmonary disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to March 1971. He served in Vietnam from September 1969 to August 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran service connection for ischemic heart disease, asthma, and bronchitis. In September 2021, the Board broadened the Veteran's claim to one for any heart or pulmonary disability. Also, in September 2021, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board's remand directives. Specifically, the Board remanded to afford the Veteran a VA examination to ascertain his disabilities and obtain medical opinions regarding the same. The claim is back before the Board for further appellate proceedings. Regrettably, the Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, the Board requested a VA examiner to elicit a full history from the Veteran related to his heart and pulmonary disabilities. Then, the examiner was asked to opine as to whether the Veteran's exposure to herbicide agents is related to any disability, to include consideration of the National Academies of Sciences, Engineering, and Medicine's Agent Orange Update 11 (2018). The examiner was to also opine as to whether any disability was related to the Veteran's service-connected posttraumatic stress disorder (PTSD). The Board notes that the Veteran has still not been afforded a VA examination as to his pulmonary disability. Indeed, during service, the Veteran was treated for seasonal rhinitis. See STRs. The AOJ obtained opinions related to the Veteran's disabilities but there was no physical examination or an attempt to elicit a full history. See December 2021 VA examination reports. Moreover, the examiner did not consider the Agent Orange Update and, instead, opted to discredit the source as non-medical in nature. As such, remand for VA examinations is necessary to substantially comply with the Board's prior remand directives. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his heart and pulmonary disabilities that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, schedule the Veteran for an examination to determine the nature and etiology of any cardiovascular disability, to include hypertension. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all cardiovascular disabilities present. For each identified disability, the examiner is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran's cardiovascular disability was incurred in, or is otherwise related to, his time on active service, to include exposure to herbicide agents therein? The examiner must consider the National Academies of Sciences, Engineering, and Medicine's Agent Orange Update 11 finding sufficient evidence of an association between hypertension and herbicides. B. Is it at least as likely as not that the Veteran's cardiovascular disability (a.) caused or (b.) aggravated by his service-connected PTSD? In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the development in #1 above is completed, schedule the Veteran for an examination to determine the nature and etiology of any pulmonary disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all pulmonary disabilities present. For each identified disability, the examiner is asked to respond to the following inquiries: A. Is it at least as likely as not that the Veteran's pulmonary disability was incurred in, or is otherwise related to, his time on active service, to include exposure to herbicide agents therein? The examiner should discuss the association, if any, of the Veteran's seasonal rhinitis in service and any disability. B. Is it at least as likely as not that the Veteran's pulmonary disability (a.) caused or (b.) aggravated by his service-connected PTSD? In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Strickland 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.