Citation Nr: 22016699 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 15-19 443 DATE: March 23, 2022 REMANDED The issue of entitlement to service connection for a heart condition, other than ischemic heart disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to January 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. Jurisdiction is currently with the RO in St. Petersburg, Florida. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in October 2018 and a transcript of the hearing has been associated with the claims file. This matter was previously before the Board, most recently in September 2021, at which time it was remanded for further development. Entitlement to service connection for a heart condition, other than ischemic heart disease, is remanded. The Veteran contends that he has a heart condition related to herbicide exposure during service while aboard the USS Rowan (DD782) in and off the coast of the Republic of Vietnam (Vietnam). In this regard, the Board notes that the Veteran's private treatment records indicate that he was diagnosed with additional heart conditions which were not previously discussed by VA examiners. See March 2021, September 2021, and October 2021 Heart & Rhythm Associates, PLLC Records. Therefore, the Board will remand the Veteran's claim so that an addendum opinion discussing these diagnoses may be obtained. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Additionally, in light of the remand herein for an addendum opinion addressing the additional heart diagnoses, the Board will also take the opportunity to obtain a more comprehensive opinion addressing aortic stenosis/valve replacement. The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the file to the January 2022 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. The claims file, and a copy of the remand, must be reviewed by the examiner. Following review of the file, and the remand, the examiner is to address the following: (a.) Is it at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran has a heart condition, other than ischemic heart disease, that had its onset in service, or within one year of his separation from service, or is otherwise related to service, to include as due to herbicide exposure? The examiner is asked to specifically address the Veteran's contention that he has a heart condition related to herbicide exposure during service while aboard the USS Rowan (DD782) in and off the coast of the Republic of Vietnam (Vietnam). Please note that the Veteran's herbicide exposure is presumed. The examiner is also asked to specifically address the Veteran's current diagnoses including aortic stenosis/valve replacement, bradycardia, atherosclerosis, concentric hypertrophy, and any other current heart diagnoses (other than ischemic heart disease) not discussed in previous VA examinations. The examiner is advised that even if the heart condition resolved during the appeal period, service connection may still be awarded if the diagnosis was made when the claim was filed or at any time while the appeal is pending. (b.) The examiner is also advised that although a heart condition is not among those enumerated diseases which are presumed to be associated with a history of exposure to herbicide agents, service connection may still be warranted on a direct basis. The examiner further is advised the lack of a diagnosis of in service is not, by itself, a sufficient reason to find there is no nexus to service. The salient question is whether any incident of service, including presumed exposure to herbicides, caused the current heart condition, other than ischemic heart disease, even though it may have been initially diagnosed years after the Veteran's discharge from service. (c.) If the heart condition(s), other than ischemic heart disease, is not directly related to service, is it at least as likely as not that the heart condition was caused or aggravated by the Veteran's recently diagnosed ischemic heart disease? Please address both causation and aggravation separately and explain why or why not. (d.) If the examiner finds the Veteran's heart condition, other than ischemic heart disease, was aggravated by his ischemic heart disease, he/she should attempt to quantify the degree of aggravation beyond the baseline level. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.