Citation Nr: 22017410 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 11-13 900 DATE: March 25, 2022 REMANDED Entitlement to service connection for status post type I aortic dissection with medical sternotomy with repair, claimed as heart surgery, to include as secondary to hypertension and hepatitis C is remanded. Entitlement to service connection for a chest pain disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1973 to July 1976. This matter came before the Board of Veterans Appeals (Board) on appeal from a July 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during an August 2019 hearing. The transcript of the hearing is of record. The issues on appeal were most recently remanded in a November 2021 Board decision that granted service connection for Hepatitis C, denied service connection for hypertension, erectile dysfunction, and a right ankle disability, and remanded the remaining issues on appeal for further development. A January 2022 Board decision granted service connection for plantar fasciitis with metatarsalgia, hallux valgus and arthritis. As this constituted a complete grant of the benefit sought on appeal for that issue, it is not before the Board. 1. Entitlement to service connection for status post type I aortic dissection with medical sternotomy with repair, claimed as heart surgery, to include as secondary to hypertension and hepatitis C is remanded. The November 2021 Board decision requested a new VA opinion regarding whether the Veteran's heart disability was caused or aggravated by his service connected hepatitis C. The remand directives specifically asked that a complete rationale be provided for all opinions. A VA opinion was provided in January 2022. The provider found that the heart disability was not likely due to or the result of the Veteran's hepatitis C but did not provide any explanation for this opinion. In the portion of the questionnaire that asked him to a provide a medical rationale, the provider responded only "N/A." As the provider declined to provide a rationale, the opinion is inadequate. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The opinion is also inadequate as the provider did not provide any opinion regarding whether the Veteran's heart disability was aggravated (worsened beyond its natural progression), by his hepatitis C. See El-Amin v. Shinseki, 26 Vet. App. 136, 14041 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). Remand for a new opinion is therefore required. 2. Entitlement to service connection for a chest pain disability is remanded. A May 2021 VA opinion found that the Veteran's current chest pain diagnosis of stable angina was a direct result of his underlying heart surgery. As the evidence indicates that the Veteran's chest pain may be secondary to his aortic dissection, the issue of service connection for chest pain must also be remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain a VA opinion from an appropriate provider, other than the one who provided the January 2022 opinion, to address whether the Veteran's status post type I aortic dissection was as least as likely as not (50 percent or greater probability) caused or aggravated by his service-connected hepatitis C. The examiner should review the file and provide a complete rationale for all opinions expressed. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Arnold 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.