Citation Nr: 1101503 Decision Date: 01/12/11 Archive Date: 01/20/11 DOCKET NO. 07-28 036 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a heart condition claimed as a heart murmur. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Shamil Patel, Associate Counsel INTRODUCTION Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2010). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran served on active duty from September 1951 to August 1953. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which denied service connection for a heart murmur. A Board hearing was held in June 2010 with the Veteran in Washington, D.C., before the undersigned Veterans Law Judge, who was designated by the Chairman to conduct the hearing pursuant to 38 U.S.C.A. § 7107(c), (e)(2) and who is rendering the determination in this case. A transcript of the hearing testimony is in the claims file. The claim was remanded by the Board in July 2010 for additional development. That development has been completed, and the case is once again before the Board for appellate review. 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 Unfortunately, the Board finds that additional development is necessary in order to fully and fairly adjudicate the Veteran's claim. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the Veteran was afforded a VA examination in September 2010. After reviewing the claims file, obtaining a history from the Veteran, and conducting a physical examination, the examiner concluded that the Veteran had a history of heart palpitations which were at least as likely as not incurred in service. However, it is unclear whether the diagnosed condition is a disability in and of itself, whether it is a symptom of an underlying heart condition, or whether it is a symptom of another condition. The Board notes that the Rating Schedule does not contemplate heart palpitations as a specific disability. See 38 C.F.R. § 4.104 (2010). Therefore, further clarification is warranted. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2010). Expedited handling is requested.) 1. The claims file, including a copy of this remand, should be forwarded to the VA examiner who conducted the September 2010 VA examination. Upon review, he should provide a supplemental opinion clarifying the Veteran's diagnosis. The examiner should specify whether the heart palpitations condition previously diagnosed is the primary disability; or whether it is the result of an underlying heart condition; or whether it is the result of another condition; or whether it is the result of another cause. If the heart palpitations condition is not the primary disability, then the examiner should specify the underlying cause, and offer an opinion as to whether it is at least as likely as not that the underlying condition was incurred in or aggravated by service. The examiner should review the entire record and provide a complete rationale for all opinions offered. If an opinion cannot be expressed without resort to speculation, discuss why such is the case. In this regard, indicate whether the inability to provide a definitive opinion is due to a need for further information or because the limits of medical knowledge have been exhausted regarding the etiology of the disability at issue or because of some other reason. If the VA examiner is not available, the Veteran should be scheduled for another examination to determine whether the exact nature and etiology of the Veteran's heart palpitations. All indicated tests and studies should be accomplished, and the examiner should comply with the instructions above, to include specifying whether the heart palpitations condition previously diagnosed is the primary disability; or whether it is the result of an underlying heart condition; or whether it is the result of another condition; or whether it is the result of another cause. If the heart palpitations condition is not the primary disability, then the examiner should specify the underlying cause, and offer an opinion as to whether it is at least as likely as not that the underlying condition was incurred in or aggravated by service. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. 2. Following completion of the foregoing, the AMC/RO must review the claims folder and ensure that all of the foregoing development has been conducted and completed in full. In particular, the AMC/RO should determine whether the examiner has responded to all questions posed. If not, the report must be returned for corrective action. 38 C.F.R. § 4.2 (2010). 3. After the requested development has been completed, the AMC/RO should readjudicate the merits of the Veteran's claims based on all the evidence of record, including any additional information obtained as a result of this remand. If the benefits sought on appeal remain denied, the appellant and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Thereafter, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if in order. The Board intimates no opinion as to the ultimate outcome of this case. The appellant need take no action unless otherwise notified. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. 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. 2010). _________________________________________________ S. L. Kennedy 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) (2010).