Citation Nr: 22046065 Decision Date: 08/15/22 Archive Date: 08/15/22 DOCKET NO. 16-29 925 DATE: August 15, 2022 REMANDED Entitlement to service connection for ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1960 to March 1968 and from July 1968 to December 1982. On appeal is a June 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) that, as relevant here, denied service connection for ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement. VA has found the Veteran to be incompetent, and the appellant is the Veteran's wife and fiduciary for VA benefits purposes. When the matter was initially before the Board of Veterans' Appeals (Board) in October 2018, the Board remanded for additional development, to include obtaining a VA medical opinion to determine the nature and etiology of the Veteran's ventricular tachycardia. The requested development has been completed and the matter returned to the Board for further adjudication. Entitlement to service connection for ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement, is remanded. The Veteran seeks service connection for ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement. The Veteran and his spouse have claimed that he has ventricular tachycardia as a result of exposure to Agent Orange in the Republic of Vietnam. He served in the Republic of Vietnam during the Vietnam era; therefore, he is presumed to have been exposed to herbicides. As part of the development of the claim, the RO obtained a VA medical opinion in January 2022. The examiner, an ophthalmologist, rendered a positive nexus opinion for direct service connection but provided only a single-sentence rationale: "The literature does describe herbicide exposure as a potential cause of cardiac disease including arrhythmias." The examiner cited a medical journal in support of this contention, but it is unclear from the citation whether the article in question examined tactical herbicide agents such as Agent Orange as opposed to "agrochemicals," as cited in the article's title. The Board finds this medical opinion to be inadequate as the examiner did not offer explanation for the opinion other than to list, without further discussion, the single citation. The RO obtained another VA medical opinion in February 2022. This examiner rendered a negative nexus opinion but, by way of rationale, stated only that the Veteran's ventricular tachycardia "is not a diagnosis linked to herbicide exposures and is not related to high IGM levels." No rationale for this statement was provided, nor was there any discussion of the medical journal article cited by the January 2022 examiner. Further, as relates to secondary service connection, the examiner again offered a negative opinion, but in so finding stated only that the Veteran's ventricular tachycardia "is unrelated to and not an aggravation of" his already service-connected disabilities. No rationale was offered for this opinion. As such, the Board finds that this opinion is also inadequate. The RO obtained a final addendum opinion in February 2022. The examiner rendered a negative opinion and as rationale stated that the causes of ventricular tachycardia are "unknown," noting only that the Veteran did not demonstrate any heart problems while on active duty and opining that there is "no indication" that his ventricular tachycardia "was secondary to his service-connected conditions or secondary to exposures while active duty." The Board finds this opinion also to be inadequate, as it was also presented without any supporting rationale. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A remand by the Board confers on the claimant a legal right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). A failure by the Board to ensure that its remand orders are complied with constitutes legal error. Id. Thus, on remand, a new VA medical opinion must be obtained. The matter is REMANDED for the following action: Obtain a medical opinion from a qualified clinician to determine the nature and etiology of the Veteran's ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement. The Veteran's claims file, including a copy of this remand, must be made available to and reviewed by the examiner. The examiner must provide a thorough, well-reasoned opinion as to whether it is at least as likely as not that the Veteran's ventricular tachycardia, status post dual-chamber implantable cardio-defibrillator placement: Began in service, within one year of service separation, or is otherwise related to the Veteran's service, to include his conceded exposure to herbicide agents; Was caused by his service-connected neuropathy or PTSD; or Was aggravated by his service-connected neuropathy or PTSD. The examiner must provide a comprehensive discussion including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. In providing these opinions, the examiner must specifically consider and address: The medical literature referenced by the January 2022 VA examiner that suggested a nexus between certain types of herbicide exposure and cardiac disease; The Veteran's contentions that he has high IGM levels in his blood due to his service-connected neuropathy or PTSD; and The Veteran's lay statements concerning the onset and continuity of his symptomatology. If the examiner rejects the Veteran's credible statements, the examiner must provide a rationale for doing so. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bess, T. 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.