Citation Nr: 0030027 Decision Date: 11/16/00 Archive Date: 11/22/00 DOCKET NO. 99-08 659 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for mitral valve prolapse with heart murmur and arrhythmia to include as secondary to the service connected status post subtotal thyroidectomy for multinodular goiter with hypothyroidism. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. Trueba-Sessing, Associate Counsel INTRODUCTION This case comes before the Board of Veterans' Appeals (Board) from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which denied the benefits sought on appeal. The veteran served on active duty from December 1973 to May 1974 and from July 1979 to July 1980. The veteran also served with the U.S. Air Force Reserves from October 1973 to December 1973, the Air National Guard of Wyoming from February 1975 to September 1976, and the Army National Guard of Arkansas from September 1976 to October 1982. Additionally, the Board notes that in a December 1998 VA form 21-4138 (Statement in Support of Claim) the veteran requested consideration of a claim of service connection for left and right atrial enlargement as secondary to her service connected thyroid condition. Furthermore, in an April 2000 VA form 21-4138, the veteran requested consideration of a claim of service connection for neck scars secondary to her service connected thyroid condition. However, as the only issue currently before the Board is that set forth on the title page of this decision, these matters are referred to the RO for appropriate action. REMAND The veteran claims that she currently suffers from mitral valve prolapse with heart murmur and arrhythmia to include as secondary to the service connected status post subtotal thyroidectomy for multinodular goiter with hypothyroidism. However, a review of the record discloses that additional development is needed prior to adjudication by the Board. While the Board regrets the delay associated with this remand, this action is necessary to ensure that this claim is fairly adjudicated. Recent changes in the law pertaining to the VA's duty to assist, previously codified under 38 U.S.C.A. § 5107 (West 1991), state that the Secretary shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claimant's claim for a benefit under a law administered by the Secretary, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. The Secretary's duty to assist includes affording the veteran a VA examination or obtaining a VA medical opinion when such examination or opinion is necessary to make a decision on the claim. See H.R. 4864, The Veterans Claims Assistance Act of 2000, Pub. L. No. 106- ___ (signed by the President on Nov. 9, 2000). The new amendment therefore eliminates the requirement that a claim be well grounded before VA's duty to assist is triggered. The evidence in this case indicates that a medical examination may possibly aid in the establishment of entitlement to service connection for the claimed heart disorder, thereby triggering the duty to assist. In this respect, the record contains a September 2000 statement from Craig N. Bash, M.D., indicating that the veteran's current cardiac problems (hypertension, heart arrhythmias and murmurs, and mitral valve prolapse) were first documented in 1974/1975 and are all directly caused by the veteran's service connected toxic nodular goiter and/or its treatment. The law is clear that if the medical evidence of record is insufficient, or, in the opinion of the Board, of doubtful weight or credibility, the Board is always free to supplement the record by seeking an advisory opinion, ordering a medical examination or citing recognized medical treatises in its decisions that clearly support its ultimate conclusions. However, it is not free to substitute its own judgment for that of such an expert. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Based on these findings, the Board finds that a VA examination may aid in the establishment of entitlement to service connection for mitral valve prolapse with heart murmur and arrhythmia to include as secondary to the service connected status post subtotal thyroidectomy for multinodular goiter with hypothyroidism. Therefore, in light of the recent amendment, the Board finds that the veteran should be afforded a VA medical examination to determine whether her current heart disorder is related to her service connected disability or is otherwise related to her service. Accordingly, the case is REMANDED to the RO for the following action: 1. The RO should arrange for the veteran to undergo a VA examination to ascertain the etiology and date of onset of her current mitral valve prolapse with heart murmur and arrhythmia. The claims folder should be provided to the examiner for his or her review in connection with the examination. All necessary tests and evaluations should be performed, and the examiner should not render a final opinion until after receipt of all test results. Following a review of the veteran's claims file including her service medical records, completion of the examination, and receipt of all test results, the examiner should specifically address whether it is at least as likely as not that the veteran's current mitral valve prolapse with heart murmur and arrhythmia began in service or was incurred in service. To the extent possible, the examiner should provide an approximate date of onset for the veteran's heart disorder. In addition, the examiner should address whether it is at least as likely as not that the veteran's current mitral valve prolapse with heart murmur and arrhythmia is secondary to the service connected status post subtotal thyroidectomy for multinodular goiter with hypothyroidism. All pertinent clinical findings and the complete rationale for all opinions expressed should be set forth in a typewritten report. 2. The RO should review the examination report to determine if it is in compliance with this REMAND. If deficient in any manner, it should be returned, along with the claims file, for immediate corrective action. 3. After undertaking any additional development deemed appropriate, and giving the veteran full opportunity to supplement the record, the RO should then adjudicate the veteran's claim of entitlement to service connection for mitral valve prolapse with heart murmur and arrhythmia to include as secondary to the service connected status post subtotal thyroidectomy for multinodular goiter with hypothyroidism. If the benefit sought on appeal is not granted, the veteran and her representative should be furnished with a supplemental statement of the case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional evidence. The Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. No action is required of the veteran until she is notified. The veteran has the right to submit additional evidence and argument on the matter the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). WARREN W. RICE, JR. Veterans Law Judge Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 2000), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2000).