Citation Nr: 1306223 Decision Date: 02/22/13 Archive Date: 02/27/13 DOCKET NO. 12-19 975 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for cardiac disability, to include as a result of exposure to herbicides. REPRESENTATION Veteran represented by: Kentucky Department of Veterans Affairs ATTORNEY FOR THE BOARD R. Anderson, Associate Counsel INTRODUCTION The Veteran had active service from July 1968 to July 1971, including service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which reviewed the Veteran's claim pursuant to Nehmer v. United States Veterans' Administration, 712 F. Supp. 1404 (N.D. Cal. 1989). A notice of disagreement was received in March 2012, a statement of the case was issued in June 2012, and a substantive appeal was received in July 2012. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND The Veteran has advanced his service connection claim based on cardiomyopathy, but the question of whether he suffers from ischemic heart disease has also been considered since the Veteran had service in Vietnam. See 38 C.F.R. § 3.309(e). The report of VA examination in November 2010 is to the effect that a medical diagnosis of ischemic heart disease cannot be rendered. However, VA's consideration of the claim does not end with such a medical finding since a Veteran may still potentially show a link to service even though a disability is not on the presumptive list for herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). The VA examination of November 2010 did not include an opinion on a possible link between the Veteran's cardiomyopathy and herbicide exposure. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994 In addition, there are several references in the VA treatment records in which the VA providers suggest that they had reviewed, or that the Veteran would provide, medical records from the Kings Daughter's Hospital or his private cardiologist. However, these records are not associated with the Veteran's claims file. Accordingly, the case is REMANDED for the following actions: 1. The RO/AMC should take appropriate action to request pertinent medical records from King's Daughter's Hospital and any private cardiologist who has treated the Veteran. 2. After the above action is completed to the extent possible, the Veteran should be scheduled for a VA examination by a cardiologist to determine the nature and etiology of any current cardiac/coronary disabilities. All indicated tests and studies are to be performed. The claims folder and a copy of this remand must be made available to the examiner for review of the case. After examining the Veteran and reviewing the claims file, the examiner should then respond to the following: a) The examiner should specifically indicate whether a diagnosis of ischemic heart disease is warranted. b) Is it at least as likely as not (a 50% or higher degree of probability) that the Veteran's cardiomyopathy is causally related to the Veteran's exposure to herbicides during his active duty service? Detailed reasons should be provided for the opinion(s) offered. If any requested opinion cannot be offered without resorting to mere speculation, the examiner should indicate such in the examination report and explain why a non-speculative opinion cannot be offered. 3. In the interest of avoiding further remand, the RO/AMC should review the opinion obtained and ensure that an adequate rationale has been offered. 4. After completion of the above and any other development, which the RO/AMC may deem necessary, the RO/AMC should review the claims file and adjudicate the Veteran's claim as appropriate. If any claim on appeal remains denied, the Veteran should be furnished an appropriate supplemental statement of the case and be afforded an opportunity to respond thereto. Thereafter, the case should be returned to the Board for appellate review. The Veteran has the right to submit additional evidence and argument on the matter 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 for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ ALAN S. PEEVY 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) (2012).