Citation Nr: 1005366 Decision Date: 02/05/10 Archive Date: 02/25/10 DOCKET NO. 08-21 834 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to service connection for coronary artery disease, status post myocardial infarction. 2. Entitlement to service connection for a right knee disability. 3. Entitlement to service connection for tinnitus. 4. Entitlement to service connection for seasonal sinusitis. 5. Entitlement to service connection for a right wrist disability. 6. Entitlement to service connection for a right inguinal hernia repair. 7. Entitlement to service connection for residuals of broken teeth. REPRESENTATION Appellant represented by: North Carolina Division of Veterans Affairs ATTORNEY FOR THE BOARD David T. Cherry, Counsel INTRODUCTION The Veteran had active service from July 1969 to February 1972, from November 1990 to May 1991, from October 1999 to June 2000, and from February 2003 to January 2005. This case comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Winston-Salem, North Carolina, Department of Veterans Affairs (VA) Regional Office (RO). In a July 2009 statement, the Veteran raised the issue of entitlement to an increased disability rating for degenerative disc disease of the cervical spine. This issue, however, is not currently developed or certified for appellate review. Accordingly, this matter is referred to the RO for appropriate consideration. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The appellant is claiming entitlement to service connection for coronary artery disease, status post myocardial infarction. While adjudication of this claim may ultimately require consideration whether coronary artery disease was presumptively incurred due to the Veteran's in-service exposure to Agent Orange and other herbicides, see www.publichealth.va.gov/exposures/agentorange, and National Academy of Science, Veterans and Agent Orange: Update 2008 597 (2009) ("Coronary heart disease is a specific term related to atherosclerosis; ischemic heart disease is a broader term and typically includes coronary heart disease and its symptoms.") (emphasis added); VA has yet to issue any regulations giving the Board the legal authority to presumptively service connect coronary artery disease. Based on the October 2009 decision of the Secretary of Veterans Affairs referenced in the above cited VA web page such authority may exist in the near future, and any changes would have to be considered at that time. As of the date of this remand, however, there is no legal authority upon which to presumptively service connect coronary artery disease. 38 C.F.R. §§ 3.307, 3.309 (2009). Accordingly, in light of the appellant's history of a myocardial infarction in October 1994, the question which must be resolved is whether the Veteran aggravated his preexisting coronary artery disease during either of his final two tours of active duty. In this respect, and with regard to the question of entitlement to service connection for a right knee disorder, the March 2008 VA examination report is inadequate for rating purposes. Hence, an examination by respective specialists is in order. A January 2002 statement from Forsyth Cardiology Associates reflects that the Veteran underwent an angioplasty in 1992. An August 2003 medical examination report shows that the appellant underwent right knee surgery in 1969 and 1996, and a March 2008 VA examination report notes that the claimant had a total knee replacement in June 2007. Unfortunately, all pertinent records pertaining to this care are not available. Hence, further development is in order. Moreover, the RO obtained VA treatment records from the satellite outpatient clinic in Winston-Salem for the periods from April 2001 to June 2007 and from October 2008 to August 2009. Any additional records from that facility should be obtained. Finally, in a June 2002 rating decision, the RO denied entitlement to service connection for tinnitus, seasonal sinusitis, a right wrist disability, a right inguinal hernia repair, and residuals of broken teeth. In November 2002, the Veteran submitted a notice of disagreement as to all denials in the June 2002 rating decision. As such, a statement of the case must be issued concerning these issues. Manlincon v. West, 12 Vet. App. 242 (1999). The Board notes that the June 2002 rating decision also denied entitlement to service connection for hypertension and bilateral hearing loss. Since that decision service connection for hypertension has been granted, and since then the appellant has failed to timely perfect an appeal to the question of entitlement to service connection for a bilateral hearing loss. Hence, no further action on these two issues is appropriate. Accordingly, the case is REMANDED for the following action: 1. The RO should ask the appellant to identify any and all facilities where he received treatment for either coronary artery disease or a right knee disability, to include the facilities where he underwent right knee surgery in 1969 and 1996, and where he underwent a total knee replacement. The RO should attempt to obtain any identified medical records along with all records from the Providence Hospital and Forsyth Cardiology Associates. The RO should obtain all records from the VA satellite outpatient clinic in Winston-Salem, North Carolina for the periods from June 2007 to October 2008, and since August 2009. The RO should associate any obtained records with the Veteran's claim folder. If the RO cannot locate any identified record from the VA satellite outpatient clinic in Winston-Salem, North Carolina, the RO must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, the Veteran must be examined by a cardiologist to determine whether it is at least as likely as not that his coronary artery disease, status post myocardial infarction, was aggravated beyond its natural progression by either the claimant's third or fourth period of active service. The claims folder is to be made available to the examiner to review. A complete rationale must be provided for all opinions offered. 3. After completing instruction one, the Veteran must be examined by an orthopedist to determine whether it is at least as likely as not that his right knee disability was aggravated beyond its natural progression during either the Veteran's first, second, third or fourth periods of active service. The claims folder is to be made available to the examiner to review. A complete rationale must be provided for all opinions offered. 4. The Veteran is to be notified that it is his responsibility to report for the examinations and to cooperate in the development of the claims. The consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2009). In the event that the claimant does not report for the aforementioned examinations, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 5. After the development requested, the RO should review the examination reports to ensure that they are in complete compliance with the directives of this REMAND. If the reports are deficient in any manner, the RO must implement corrective procedures at once. 6. Thereafter, the RO should readjudicate the claims of entitlement to service connection for coronary artery disease, status post myocardial infarction, and a right knee disability. Consideration whether coronary artery disease should be presumptively service connected is in order if that is the law at the time the claim is readjudicated. If any benefit is not granted, the Veteran and his representative must be furnished with a supplemental statement of the case and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. 7. The RO should issue a statement of the case addressing the claims of entitlement to entitlement to service connection for tinnitus, seasonal sinusitis, a right wrist disability, a right inguinal hernia repair, and residuals of broken teeth. The Veteran is hereby informed that the Board may only exercise appellate jurisdiction over these matters if he perfects an appeal in a timely manner. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.200 (2009). The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). _________________________________________________ DEREK R. BROWN 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) (2009).