Citation Nr: 22012897 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 20-02 192A DATE: March 7, 2022 REMANDED Entitlement to service connection for abnormal electrocardiogram, now claimed as atrial fibrillation, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1970 to April 1991. In August 2020 and July 2021, the Board of Veterans' Appeals (Board) remanded this matter for additional development. Entitlement to service connection for atrial fibrillation is remanded. In July 2021, the Board remanded this claim to obtain a VA medical opinion to determine the etiology of the Veteran's atrial fibrillation. The remand directive specifically instructed the examiner to discuss the 1991 VA examination, which showed a history of symptoms of heart palpitations, as well as other in-service heart palpitations with testing. See July 2021 Board Decision. Pursuant to the Board's remand an October 2021 VA examination and medical opinion were obtained. Following an examination of the Veteran, the examiner rendered a negative nexus opinion. As part of his rationale, the examiner stated there was no indication of atrial fibrillation in the work-up in service. Moreover, the examiner opined that benign palpitations were very common and most likely ectopic beats, and if the Veteran's in-service palpitations were atrial fibrillation they would be very unlikely to abate for more than 25 years then re-declare themselves. The Board notes, however, that the October 2021 VA examiner's opinion is based on an inaccurate factual premise. Specifically, it appears that the examiner's opinion is based on the premise that the Veteran's atrial fibrillation manifested in 2018, which is 27 years after separation from service; however, the record shows the condition had its onset as early as 2005. For this reason, the Board finds the October 2021 VA medical opinion to be based on an inaccurate factual premise and is therefore insufficient for rating purposes. Accordingly, while the Board regrets the additional delay involved with remanding this claim again, it nevertheless finds that VA's duty to assist necessitates that the matter be remanded in order to obtain a new VA medical opinion. The matter is REMANDED for the following action: Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's atrial fibrillation. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner in rendering the opinion. (a.) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed heart condition had its onset in, within one year of separation, or is otherwise related to the Veteran's active duty service. In rendering the above opinion, the examiner should specifically consider and discuss the 1991 VA examination and the Veteran's service treatment records, which show a history of heart palpitations during and shortly after service. A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Talton, John H. 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.