Citation Nr: 0809654 Decision Date: 03/21/08 Archive Date: 04/03/08 DOCKET NO. 04-09 754 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to service connection for a heart disability. REPRESENTATION Appellant represented by: New York State Division of Veterans' Affairs ATTORNEY FOR THE BOARD T. L. Reynolds, Counsel INTRODUCTION The veteran served on active duty from June 1969 to August 1970. This case comes to the Board of Veterans' Appeals (Board) on appeal of a January 2003 rating decision rendered by the Buffalo, New York, Regional Office (RO) of the Department of Veterans Affairs (VA). When this case was before the Board in July 2005, it was remanded for additional development. While the case was in remand status, the veteran's appeal for service connection for hypertension was resolved by a September 2007 rating decision granting service connection for this disability. REMAND In the July 2005 remand, the Board directed that the claims folder be returned to a physician who examined the veteran in January and April 2003 for review. In pertinent part, the physician was to provide an opinion as to whether there was a 50 percent or better probability that the veteran's heart disease originated in service or is otherwise related to service. If that examiner was no longer available, the required opinion was to be obtained from another physician with appropriate expertise. In April 2007, a nurse practitioner. reviewed the claims folders and stated that she found no evidence of heart disease. In August 2007, the claims folders were reviewed by C.O., who stated there is no objective evidence of coronary artery disease and that the veteran's chest pain is atypical. C.O.'s credentials were not provided. The Board has not found either of the foregoing opinions to be adequate. In this regard, it appears that neither opinion was provided by a physician with expertise in cardiology. Moreover, neither author has adequately addressed the evidence of record indicating that the veteran does have heart disease. For instance, mild coronary artery disease was among the diagnoses following cardiac catheterization in September 2002. Arteriosclerotic heart disease was diagnosed on VA examinations in January and April 2003. Moreover, left ventricular systolic dysfunction, diastolic dysfunction and left atrial enlargement were found on an echocardiogram in September 2006. In light of these circumstances, the Board has concluded that further development of the record is still in order. Accordingly, this case is REMANDED to the RO or the Appeals Management Center (AMC), in Washington, D.C., for the following actions: 1. The RO or the AMC should obtain a copy of any VA medical records pertaining to treatment or evaluation of the veteran's heart since March 2007. If the veteran identifies any other pertinent medical records, the RO or the AMC should undertake appropriate development to obtain a copy of those records. If it is unsuccessful in obtaining any pertinent evidence identified by the appellant, it should so inform the appellant and his representative and request them to provide the outstanding evidence. 2. Then, the claims folders should be forwarded to a cardiologist for review. The cardiologist should identify all existing heart disorders. For each such disorder, the examiner should provide an opinion as to whether there is a 50 percent or better probability that the disorder is etiologically related to the veteran's active service or was caused or permanently worsened by his service- connected hypertension. The rationale for each opinion stated must also be provided. In particular, if the cardiologist determines that the veteran currently has no heart disorder, he or she should explain why the earlier diagnoses are wrong. Another examination of the veteran with any indicated studies should be performed only if deemed necessary by the cardiologist. 3. The RO or the AMC should also undertake any other development it determines to be warranted. 4. Then, the RO or the AMC should readjudicate the appellant's claim based on a de novo review of the record. If the benefit sought on appeal is not granted to the appellant's satisfaction, a Supplemental Statement of the Case should be issued, and the appellant and his representative should be afforded the requisite opportunity to respond before the claims folders are returned to the Board for further appellate action. By this remand the Board intimates no opinion as to any final outcome warranted. No action is required of the appellant unless he is otherwise notified but he has the right to submit additional evidence and argument on the matter the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ Shane A. Durkin Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), 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) (2007).