Citation Nr: A24029740 Decision Date: 06/06/24 Archive Date: 06/06/24 DOCKET NO. 231024-387550 DATE: June 6, 2024 REMANDED Entitlement to service connection for atrial fibrillation, to include as due to exposure to herbicide agents or service-connected hypertension, is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1969. By way of history, VA received the Veteran's claim for compensation in June 2023. A September 2023 rating decision denied the claims and the Veteran was notified of the decision in October 2023. On an October 24, 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 23, 2024. Therefore, the Board may only consider the evidence of record at the time of the September 2023 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the Board hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. However, because the Board is remanding the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). Pre-Decisional Duty to Assist Errors A remand is necessary to obtain adequate addendum medical opinions for the claimed atrial fibrillation, left hip, and left knee disabilities as the current June 2023 medical opinions are inadequate. Atrial Fibrillation The Veteran asserts that his currently diagnosed atrial fibrillation is due to exposure to herbicide agents. In a June 2023 medical opinion, a VA examiner opined that the claimed atrial fibrillation was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran left service in 1969 without any complaints of atrial fibrillation at the time and a formal diagnosis was not rendered until many years after service. The examiner did not address or even acknowledge the Veteran's exposure to herbicide agents or the fact that the Veteran is service connected for hypertension and received treatment for both atrial fibrillation and hypertension concurrently. The Board acknowledges that atrial fibrillation is not of the enumerated conditions presumptively linked to herbicide agent exposure either before or after enactment of the PACT Act. However, the Veteran's claim should have been considered, nonetheless, on a direct basis due to his established in-service exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). Lastly, private treatment records dated in 2022 (so prior to the rating decision on appeal) reflect that his atrial fibrillation diagnosis was regularly discussed in the context for treatment of his service-connected hypertension. The Board therefore finds that secondary service connection was reasonably raised by the record and should have been addressed. Left Hip and Left Knee A June 2023 VA examiner opined that the left hip and left knee disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Regarding the left hip, the examiner reasoned that the Veteran was examined, and records reviewed and there was no evidence to support his claim that hip pain or knee strain "[were] service connected." The Board finds the left hip and left knee opinions inadequate. The examiner did not address the Veteran's reports that his left hip and knee resulted from jumping on and off two and half ton trucks and loading and unloading of materials from these trucks during service. The examiner also did not address the Veteran's reports of "trick or locked knee" at the time of separation from service. Notably, the opinions are conclusory and offer no meaningful supporting rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion). The matters are REMANDED for the following action: 1. Obtain another medical opinion from an appropriate VA examination to help determine the likely etiology of the claimed atrial fibrillation. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the opinion. After review of the evidence, the examiner is asked to respond to the following: (a) Opine whether the Veteran's atrial fibrillation had its onset during service or is otherwise directly related to it, to include established exposure to herbicide agents. (b) Was the diagnosed atrial fibrillation as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) caused by the service-connected hypertension? (c) Is the diagnosed atrial fibrillation as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) aggravated (any incremental increase in disability regardless of permanence) by the service-connected hypertension? For secondary service connection, the examiner must consider any causal link between the diagnosed atrial fibrillation and the service-connected hypertension. The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher). A full and thorough rationale must be provided for all opinions, referencing relevant medical and lay evidence where appropriate. 2. Obtain another medical opinion from an appropriate VA examination to help determine the likely etiology of the claimed left hip and left knee disabilities. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the opinion. After review of the evidence, the examiner is asked to respond to the following: (a) Opine whether the Veteran's left hip arthritis and/or trochanteric pain syndrome had its onset during service or is otherwise related to it, to include jumping on and off two and half ton trucks and loading and unloading of materials from these trucks during service. Explain why or why not. (b) Opine whether the Veteran's left knee arthritis had its onset during service or is otherwise related to it, to include jumping on and off two and half ton trucks and loading and unloading of materials from these trucks during service. In answering this question, address the reports of "trick" or locked knee at the time of the separation examination in September 1969. Explain why or why not. The standard of review to be applied is "as likely as not" (meaning that the likelihood is at least approximately balanced or nearly equal, if not higher). (Continued on the next page) ? A full and thorough rationale must be provided for all opinions, referencing relevant medical and lay evidence where appropriate. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.