Citation Nr: 22017769 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 14-29 920 DATE: March 26, 2022 REMANDED Entitlement to service connection for residuals of in-service gonorrhea is remanded. Entitlement to service connection for hypertension (HTN) is remanded. Entitlement to service connection for a heart murmur is remanded. REASONS FOR REMAND The Veteran had active-duty service from June 1978 to September 1979. This matter comes to the Board of Veterans' Appeals (Board) from a November 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In July 2017, the Veteran testified at a Central Office hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. The Board remanded these claims in February 2018 for further development. The Board denied the issues of entitlement to service connection for gonorrhea, a heart murmur and hypertension in a February 2020 decision. The Veteran appealed and the United States Court of Appeals for Veterans Claims (CAVC) granted the parties Joint Motion for Remand (Joint Motion) and vacated and remanded the matters in a December 2020 order. These claims were subsequently remanded again in June 2021 to further ensure compliance with the Joint Motion. 1. Entitlement to service connection for residuals of in-service gonorrhea is remanded. 2. Entitlement to service connection for hypertension (HTN) is remanded. 3. Entitlement to service connection for a heart murmur is remanded. The Veteran claims that he is entitled to service connection for residuals of in-service gonorrhea, HTN, and a heart murmur. While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claims may be adjudicated on the merits. In June 2021, the Board remanded these claims to afford the Veteran with new VA examinations and nexus opinions. The Board notes that while the July 2021 VA examiner provided negative nexus opinions, the examiner also noted that an echocardiogram was necessary in order to complete the examination report. Unfortunately, it the appears that the Veteran cancelled an appointment for some form of ultrasound in August 2021 without explanation, and it is otherwise not clear from the record why he was not afforded the echocardiogram that was requested by the July 2021 VA examiner. Additionally, although some opinions were provided with reference to an echocardiogram, it is not clear from the record whether this was a current study or one from the past. The Board therefore finds that the claims need to be remanded to obtain an echocardiogram and addendum nexus opinions for these claims. The matters are REMANDED for the following action: 1. Schedule the Veteran for an echocardiogram and add the results of the echocardiogram to the claims file. 2. After the above development has been completed and all records have been associated with the claims file, the Veteran must be afforded either an addendum opinion, or if additional examination is deemed warranted, a new VA examination by an examiner with appropriate expertise to determine the nature, etiology, and severity of the Veteran's claimed residuals of gonorrhea. Any and all studies, tests, and evaluations that are deemed necessary should be conducted. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and treatment records. (a) Does the Veteran have a current residual of his gonorrhea in service, to include his heart murmur and hypertension? (b) The examiner should then provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's gonorrhea and/or residuals, to include heart murmur and hypertension, had its onset in or is etiologically related to his period of active service, to include his diagnosed in-service gonorrhea? A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. 3. After the above development has been completed and all records have been associated with the claims file, the Veteran must be afforded either an addendum opinion, or if additional examination is deemed warranted, a new VA examination by an examiner with appropriate expertise to determine the nature, etiology, and severity of the Veteran's claimed HTN and heart murmur. Any and all studies, tests, and evaluations that are deemed necessary should be performed. The claims folder, including a copy of this remand, should be reviewed by the examiner. The examination report should note review of these records, and the VA and treatment records. The examiner should then: (a) Provide an opinion as to whether it is at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's claimed HTN and/or heart murmur originated during, or is etiologically related to his period of active service, to include his diagnosed in-service gonorrhea. In this regard, the examiner is to specifically consider the Veteran's statement that a medical professional had advised him that there was a relationship between his heart murmur and his in-service gonorrhea infection. (b) Is it at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed heart murmur was caused or aggravated by his in-service gonorrhea or its residuals, to include hypertension? (c) Is it at least as likely as not (i.e. a probability of 50 percent or greater) that the Veteran's diagnosed hypertension was caused or aggravated by his in-service gonorrhea or its residuals, to include heart murmur? A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that his reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, Associate 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.