Citation Nr: 22016804 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 18-01 585 DATE: March 23, 2022 REMANDED Entitlement to service connection for valvular heart disease and cardiomyopathy is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from January 1967 to October 1970. The Veteran's claim was previously characterized as a claim for service connection for ischemic heart disease. However, following a December 2021 Heart Conditions disability benefits questionnaire, it has been determined that the Veteran does not have a diagnosis of ischemic heart disease. Instead, the Veteran has been diagnosed with valvular heart disease and cardiomyopathy. Accordingly, the Veteran's claim has been recharacterized as a claim for service connection for valvular heart disease and cardiomyopathy. This matter was previously before the Board in October 2021 but was remanded to the Agency of Original Jurisdiction (AOJ) for further development. Specifically, the AOJ was required to obtain a VA medical examination and opinion regarding the Veteran's claimed heart disability. The required examination was competed in December 2021. Following the December 2021 examination, a medical opinion was obtained and associated with the claims file. As discussed in detail below, the Board finds that the December 2021 medical opinion is inadequate. Accordingly, the Board finds there has not been substantial compliance with the remand. instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for valvular heart disease and cardiomyopathy A veteran who had active service in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, will be presumed to have been exposed to an herbicide agent during such service unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. See 38 U.S.C. § 1116(f); 38 C.F.R. §3.307(a)(6)(iii). Valvular heart disease and cardiomyopathy are not among the diseases listed that are eligible for presumptive service connection. 38 C.F.R. § 3.309(e). Notwithstanding the presumption, service connection for a disability claimed as due to exposure to herbicide agents may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). The Veteran claims entitlement to service connection for valvular heart disease. A December 2021 Heart Conditions DBQ confirmed a current diagnosis of valvular heart disease. At issue in the present case is whether the Veteran's valvular heart disease and cardiomyopathy were incurred during or caused by his period of active service, to include exposure to herbicides including Agent Orange. In a December 201 medical opinion, the examiner found that "[t]he condition of [valvular heart disease], is more likely than not due to a congenital defect (as noted per the [V]eteran that he had a bicuspid aortic valve finding during his initial surgery)." The Board finds that the examiner's single-sentence medical opinion is conclusory and does not provide an adequate rationale for the determination. The Board notes that medical opinions that are speculative, general, or inconclusive in nature do not provide a sufficient rationale. Jones v. Shinseki, 23, Vet. App. 382, 389-90 (2010); 38 C.F.R. § 3.10. A medical opinion without rationale is not probative. Miller v. West, 11 Vet. App. 345 (1998). When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Additionally, the examiner's opinion raised the issue of whether the Veteran's valvular heart disease is congenital condition. For VA, a congenital abnormality that is subject to improvement or deterioration is considered a "disease," while a congenital abnormality that is more or less stationary in nature and not considered capable of improving or deteriorating is considered a "defect." VAOPGCPREC 82-90 (July 18, 1990). Service connection may be granted for diseases (though not defects) of congenital, developmental, or familial origin if the evidence as a whole shows that the manifestations of the disease in service constituted "aggravation" of the disease within the meaning of applicable VA regulations. VAOPGCPREC 82-90 (July 18, 1990); 38 C.F.R. §§ 3.303(c), 3.306. Service connection cannot be granted for a congenital or developmental defect, but such a defect can be subject to superimposed disease or injury. If the superimposed disease or injury occurred during military service, service connection may be warranted for the resultant disability. VAOPGCPREC 82-90 (July 18, 1990). An on opinion on the congenital nature of the Veteran's heart condition is needed. The Board acknowledges that the Veteran submitted a December 2021 private medical opinion noting that the Veteran's valvular heart disease is highly likely the result of exposure to herbicide agents during his active service. However, the Board finds that the December 2021 private medical opinion does not contain a rationale for the determination that the Veteran's valvular heart disease was a result of herbicide agent exposure. Thus, the opinion is not afforded any probative value. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (much of a medical opinion's probative value is found in its rationale supporting the conclusion); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Accordingly, the matters are REMANDED for the following action: 1. Return the Veteran's claims file to a qualified VA clinician so a supplemental opinion may be provided. The examiner should provide opinions as to the following: a. Determine whether the Veteran's valvular heart disease and cardiomyopathy are congenital. b. If they are not congenital, determine whether they began during service or are related to an incident of service, to include exposure to herbicide agents. c. If the Veteran's disability is a congenital defect (for VA purposes this means a condition that can neither improve nor worsen), determine whether there was a superimposed disease or injury in active service that resulted in additional disability of the heart. d. If the Veteran's disability is a congenital disease, determine whether it was permanently aggravated beyond its natural progression by service. The examiner's opinion should consider the Veteran's October 2021 testimony regarding his valvular heart disease and December 2021 private medical opinion concluding that his heart disease was related to exposure to herbicide agents. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. After all completed development, the AOJ should then readjudicate the claim. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Riordan, 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.