Citation Nr: 23014166 Decision Date: 03/08/23 Archive Date: 03/08/23 DOCKET NO. 17-51 992 DATE: March 8, 2023 REMANDED Entitlement to service connection for mitral valve prolapse (MVP) and first degree atrioventricular (AV) block is remanded. REASONS FOR REMAND The Veteran had a period of active duty from June 1979 to August 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge; a transcript of the hearing is of record. In February 2022 and September 2022, the Board remanded the issue on appeal for further development. There has been not substantial compliance with remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for MVP and first degree AV block is remanded. The Veteran contends she has MVP, and that such was initially diagnosed during her ACDUTRA period of service. She also contends an EKG during that time revealed a first-degree AV block. She associates symptoms such as shortness of breath, pain or pressure/tightness in chest, palpitation of pounding heart with her heart condition. In a May 2022 VA examination report, an examiner noted the Veteran's diagnoses as first-degree AV block and trace mitral insufficiency/history of MVP. The examiner remarked that the Veteran does not have a diagnosis of MVP because "there are no findings, signs, and or symptoms to support a diagnosis." In providing an unfavorable nexus opinion, the examiner states in part that "the Veteran's symptoms do not align with how the currently diagnosed disability is known to develop or [is]." The examiner concludes that the Veteran's reports are generally inconsistent with medical knowledge. Notably however, the examiner does not opine as to the etiology of the diagnosed first-degree AV block. In a September 2022, the Board remanded the appeal to obtain a clarifying addendum opinion regarding whether the Veteran has a current diagnosis of MVP, and if so, whether it is at least as likely as not related to service. In November 2022, another VA examiner provided an unfavorable nexus opinion, without first clarifying whether the Veteran has a current diagnosis of MVP. In the November 2022 examination report, the examiner's rationale states, "[a]fter reviewing the medical C-file records, there is no documentation of any symptoms, complaints or conditions such as mitral valve prolapse during active military service. It is my medical opinion to conclude that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness." The examiner does not state whether the Veteran currently has MVP. Although the prior remand did not request such clarification, it is not clear from either the May 2022 or November 2022 VA examination report whether the Veteran's first-degree AV block onset in service or is otherwise related to service. In light of the ambiguities surrounding the Veteran's heart condition, a new clarifying addendum opinion is needed. Lastly, the Board observes that at her hearing before the Board, the Veteran reported medical treatment at Eagle Landing Medical Group in 2019. Although she provided authorization for other providers to release her medical information, Eagle Landing Medical Group was not included on the form. As the claim is being remanded, the Board is affording the Veteran another opportunity to submit an authorization form for this and any other relevant medical provider who has treated her for a heart condition. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Eagle Landing Medical Group and any other relevant medical provider who has treated her heart condition. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain a clarifying addendum opinion from an appropriate clinician regarding the Veteran's heart condition claimed as MVP and first-degree AV block. The need for an examination is at the examiner's discretion. Upon review of the claims file, the examiner is asked to provide a response to the following: (a) Does the Veteran have a current diagnosis of MVP? Why or why not? If present, the examiner must opine whether it is at least as likely as not that MVP onset in service or is otherwise related to service. If MVP is not present, an explanation regarding the conflicting medical evidence must be provided. (b) Is it at least as likely as not that the Veteran's diagnosed first-degree AV block onset in service or is otherwise related to service? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran's description of her in-service injury and symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Telamour, 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.