Citation Nr: 1319331 Decision Date: 06/14/13 Archive Date: 06/21/13 DOCKET NO. 08-02 401 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for coronary artery disease with congestive heart failure. 2. Entitlement to service connection for peripheral neuropathy of the bilateral lower and upper extremities. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL The Veteran and his wife ATTORNEY FOR THE BOARD A.E.H. Gibson, Associate Counsel INTRODUCTION The Veteran had active duty service from January 1973 to January 1980 and from February 1981 to March 1994. These matters are before the Board of Veterans' Appeals (Board) on appeal from a June 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In March 2013, the Veteran and his wife testified before the undersigned Veterans Law Judge (VLJ) at a hearing conducted at the Waco RO. A transcript of the proceedings has been associated with the Veteran's claims file located on the Virtual VA paperless claims processing system. Further review of the Virtual VA reveals medical and service department records. 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 issues under consideration must be remanded for further development. While the Board sincerely regrets the delay, the additional development requested will ensure procedural due process and that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Veteran is seeking to service connect coronary artery disease with congestive heart failure and peripheral neuropathy of the bilateral lower and upper extremities. He has testified that he was in South America in 1990, and while there he contracted a skin infection. This skin infection was variously diagnosed, and was problematic for the Veteran up until separation from service. He further testified that peripheral neuropathy and coronary artery disease manifested after separation from service, and that testing of a nerve from his leg revealed an unknown viral infection. The Veteran indicated that his physician has opined that it is possible that a viral infection in the heart caused his coronary artery disease and peripheral neuropathy. The Board observes that service treatment records (STRs) show the Veteran was treated for a skin infection on his hands and fingers while in service. It was identified as a fungal infection, a possible bacterial infection, tinea versicolor, eczema, dermatitis, and pityriasis rosea, and noted to manifest as macular/papular lesions. See, e.g., STRs dated September 1990, November 1990, May 1991, December 1992, March 1993, and October 1993. Additionally, personnel records confirm that he was in Honduras, El Salvador, Guatemala, Belize, and Nicaragua. A March 2006 VA medical center (VAMC) discharge summary notes the possibility that the Veteran had a viral infection affecting his myocardium, which triggered inflammatory neuropathy of the CIDP type with predominance of axonal damage. See VA treatment dated March 21, 2006. Under the Veterans Claims Assistance Act (VCAA), VA has a duty to assist claimants in the development of their claims. This duty may include providing a medical examination or obtaining a medical opinion when such is necessary to decide the claim. See 38 U.S.C.A. § 5103A(d)(2) (West 2002); 38 C.F.R. §§ 3.159(c)(4), 3.326(a) (2012). The United States Court of Appeals for Veterans' Claims has held that an examination is required when there is (1) evidence of a current disability, or persistent or recurrent symptoms of a disability, (2) evidence establishing an "in-service event, injury, or disease," or a disease, manifested in accordance with presumptive service connection regulations, occurred that would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The evidentiary requirement for element (3) is low. Id. Here, the evidence shows the Veteran contracted a skin infection, and he alleged his doctor has surmised that it may have been the source of an infection that spread to his heart, causing his coronary artery disease and peripheral neuropathy. As such, the second and third elements of McLendon are fulfilled. Accordingly, the Veteran should be examined and a medical opinion should be obtained as to the likelihood that his current disabilities are related to service. The Board observes that the Veteran's Dallas VAMC records dated from 2005 to February 2006 have been found to be unavailable, which the Veteran was notified of by letter dated November 27, 2007. He has testified that he was hospitalized at the Dallas VAMC in 2005, that a portion of a nerve from his leg was sent to SW University Hospital for testing, and that the results should be among his records from the Dallas VAMC. Because the Dallas VAMC records are missing, a request should be sent to SW University Hospital to search for any relevant records. Accordingly, the case is REMANDED for the following action: 1. Request that the Veteran identify any additional treatment he has received for his coronary artery disease with congestive heart failure and peripheral neuropathy of the bilateral lower and upper extremities, since August 2012. Make arrangements to obtain the records identified, including updated treatment records. Make arrangements to obtain any medical records from the SW Univeristy Hospital. Also inform the Veteran that he should request that the doctor who allegedly opined that his coronary artery disease and peripheral neuropathy were caused by a viral infection in service provide a written statement stating such on his behalf. Notify the Veteran that such evidence would be supportive of his claims. 2. Upon completion of the foregoing, schedule the Veteran for appropriate VA examinations to assess the etiology of his coronary artery disease with congestive heart failure and peripheral neuropathy. The examiner must review the entire claims file and a copy of this remand. The examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) that coronary artery disease with congestive heart failure and peripheral neuropathy had their clinical onset during active service or are related to any in-service disease, event, or injury; specifically to include his skin infection in 1990. The examiner is asked to specifically comment on the March 2006 VAMC treatment record noting that peripheral neuropathy may have been triggered by a viral infection. The examiner is advised that some of the Veteran's treatment records are unavailable and that he/she should therefore consider and discuss the Veteran's lay statements regarding his in-service skin infection and the onset of his coronary artery disease with congestive heart failure and peripheral neuropathy. The examiner must provide a comprehensive report, including complete rationales for all conclusions reached. If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. 3. Upon completion of the above, review the claims file to ensure that the foregoing requested development has been completed. In particular, review the VA examination report to ensure that it is responsive to and in compliance with the directives of this remand, and if not, implement corrective procedures. See Stegall v. West, 11 Vet. App. 268 (1998). 4. Finally, readjudicate these claims on appeal. If the claims remain denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate time for response. The Veteran has the right to submit additional evidence and argument on the 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. 2012). _________________________________________________ JOHN Z. JONES 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).