Citation Nr: 22012236 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 16-26 224 DATE: March 3, 2022 REMANDED Entitlement to service connection for a cardiac disability, to include paroxysmal supraventricular tachycardia (PSVT), is remanded. Entitlement to an increased rating for degenerative joint disease of the sacroiliac joint and lumbar spine, which is currently rated 10 percent prior to December 9, 2019, 20 percent from December 9, 2019 to December 7, 2020, and 40 percent thereafter, is remanded. A total disability rating based upon individual unemployability (TDIU) prior to December 2, 2019 is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from April 1995 to May 1998. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018 and November 2020, the Board remanded the claims. In a December 2021 rating decision, the RO reinstated the Veteran's 40 percent rating for his service-connected lumbar spine disability effective December 8, 2020 and granted entitlement to a TDIU on a schedular basis effective December 2, 2019. However, as the increases do not represent a total grant of the benefits sought on appeal, the claims of entitlement to an increased rating and entitlement to a TDIU prior to December 2, 2019 remain on appeal before the Board. AB v. Brown, 6 Vet. App. 35 (1993). 1. Cardiac disability, to include PSVT The Veteran was afforded a VA heart conditions examination in December 2019. The Veteran reported that she began having symptoms while stationed in Germany during service but was misdiagnosed and was not properly diagnosed until 2006. She endorsed symptoms of episodic palpitations and a racing heart rate associated with chest discomfort. She also said that it affects her ability to drive and she must be careful so as to avoid losing consciousness while driving. The December 2019 VA examiner determined that the Veteran's PVST was resolved and rendered a negative nexus opinion. However, in November 2020, the Board determined that the December 2019 VA medical opinion was inadequate as it did not account for the Veteran's diagnosis of PSVT in 2006, and the claim was remanded to obtain an addendum opinion. A VA addendum opinion was obtained in February 2021 from a gynecologist. In rendering a negative nexus opinion, the VA clinician reasoned that the Veteran's reported in-service symptoms were attributed to other diagnoses. The VA examiner failed to address the Veteran's contentions that she began having symptoms while stationed in Germany during service but was misdiagnosed and was not properly diagnosed until 2006. As such, the Board finds that this opinion is inadequate, and an addendum VA medical opinion is required. In ordering remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the clinician consider the Veteran's own description of the history of this condition. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). 2. Lumbar spine disability. In November 2020, the Board determined that the Veteran's prior VA lumbar spine examinations did not comply with Correia v. McDonald, 28 Vet. App. 158 (2016) as they did not include testing for both active and passive motion, in weight-bearing and non weight-bearing. The Veteran was subsequently provided VA examinations of his lumbar spine in December 2020, January 2021, June 2021, and September 2021. These examinations evaluated the current severity of the Veteran's condition since December 8, 2020. However, the VA examiners did not comment on the Veteran's range of motion testing for both active and passive motion, in weight-bearing and non weight-bearing prior to December 8, 2020. Accordingly, the Board finds that a retrospective medical opinion is warranted to adequately evaluate the severity of the Veteran's lumbar spine condition prior to December 8, 2020. 3. TDIU prior to December 2, 2019 The Board finds that the Veteran's TDIU claim is inextricably intertwined with his claims for entitlement to service connection for a cardiac disability, to include PSVT, and entitlement to an increased rating for degenerative joint disease of the sacroiliac joint and lumbar spine, which is currently rated 10 percent prior to December 9, 2019, 20 percent from December 9, 2019 to December 7, 2020, and 40 percent thereafter. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). As such, the issue of entitlement to a TDIU prior to December 2, 2019 is also remanded. The matters are REMANDED for the following actions: 1. Forward the Veteran's claims file to an appropriate VA clinician to provide a medical opinion regarding the nature and etiology of the Veteran's cardiac condition(s). The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. If the clinician believes that a physical examination should be conducted in order to provide the requested opinion, one should be provided. a.) Diagnose all cardiac conditions since April 2, 2012, to include PSVT. b.) State whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the any cardiac condition diagnosed since April 2, 2012 had its onset in, was caused by, or is otherwise related to service. The examiner must acknowledge the service treatment records showing that the Veteran reported chest pain and dizzy spells in October 1995, dizzy spells and lower right sided chest wall pain in November 1995, difficulty breathing and chest pain and dizziness in December 1995, complications breathing associated with chest pain in June 1996, pain or pressure in the chest while denying heart trouble or palpation or pounding heart in February 1998, and heart trouble/chest pain in a February 1998 dental note; and denied chest pain, palpitation, and heart trouble or murmur in May 1999. Please also acknowledge and consider the April 2013 VA treatment showing that the Veteran's heart palpations were associated with shortness of breath and chest pain. For the purpose of providing the opinions requested, please accept as valid the Veteran's statement that she began with having problems while in Germany during service, but was misdiagnosed and was not properly diagnosed until 2006; and state whether a nexus between any of the Veteran's cardiac conditions and her service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 2. Forward a copy of this remand to a qualified examiner for the purpose of obtaining an opinion (based on file review only) regarding the adequacy of the lumbar spine range of motion (ROM) testing conducted on the November 2012 and December 2019 VA physical examinations. On the November 2012 and December 2019 VA examinations, ROM was not tested on passive ROM or in weight-bearing conditions. Please state whether range of motion testing on passive ROM and/or in weight-bearing conditions was required to adequately assess the Veteran's pain on motion at that time. Please explain why or why not. Please state whether there is any structural abnormality of the involved joint (that is to say, whether normal excursion of the joint is impaired/not possible). If there is a structural abnormality of the joint, does that abnormality impact the joint such that passive range of motion in this case would be more limited than active? Please explain whether testing in weight-bearing conditions is more demonstrative of the degree of pathology in the Veteran's case, or whether testing in non weight-bearing conditions would better demonstrate the severity of the disability. If, and only if, the examiner determines that all required testing was not conducted on the November 2012 and December 2019 VA examinations, please provide retrospective assessments of what the likely ranges of motion would have measured on both the November 2012 and December 2019 examinations, had ROM been tested in (1) passive motion, (2) in weight-bearing, and (3) in non-weight-bearing. If this assessment is not feasible, please clearly explain why that is so. A rationale for all opinions expressed should be set forth. If the examiner cannot provide an opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 3. After completing the requested action, please readjudicate the claims on appeal, including entitlement to a TDIU prior to December 2, 2019. C. Samuelson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Bilstein, 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.