Citation Nr: 1322014 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 11-22 899 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Baltimore, Maryland THE ISSUE Entitlement to service connection for coronary artery disease, to include as secondary to a service-connected disability. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL The Veteran and F.M. ATTORNEY FOR THE BOARD L. Barstow, Counsel INTRODUCTION The Veteran had active military service from February 1950 to April 1956. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Baltimore, Maryland. In May 2013, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). 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 Regrettably, a remand is necessary for further evidentiary development. The Veteran contends that he has coronary artery disease that is related to his military service, to include as secondary to a service-connected disability. Regarding service connection on a direct basis, the Veteran's service treatment records (STRs) show that he had heart pains in February 1953. His heart was of normal size with no murmurs; he was prescribed medication. The Veteran again complained of "pain in heart" in February 1954. He was advised to stop drinking and decrease smoking. Records in January 1955 show that he continued to complain of heart pain and precardial pain. No heart disorder was diagnosed in service. The earliest post-service medical evidence of heart problems is a record dated in January 1980 indicating that the Veteran might suffer a constant recurrence of a gastrointestinal attack that creates spasms around his heart muscles. A record dated in June 1980 showed that the Veteran was seen in March 1980 for chest pains. Records dated after June 1980 show intermittent cardiac complaints. The Veteran was diagnosed with coronary artery disease in February 2009 and had coronary artery bypass surgery at that time. In light of the Veteran having heart pain in service, medical records confirming heart complaints dating as far back as January 1980, and a current diagnosis of coronary artery disease, the Board finds that a remand is necessary to afford the Veteran a VA examination. As for entitlement on a secondary basis, the Veteran is currently service connected for anxiety, evaluated as 100 percent disabling; loss of use of both feet associated with psoriasis, evaluated as 100 percent disabling; and psoriasis, evaluated as 30 percent disabling. A VA psychiatric examination in October 1981 shows that the Veteran reported palpitations. Considering the severity of the Veteran's service-connected disabilities, and as at least one examination for a service-connected disability shows a report of cardiac symptoms, the Board finds that an opinion as to whether the Veteran's coronary artery disease is secondary to a service-connected disability is necessary. Also, the most recent treatment records from the VA Medical Center (VAMC) in Washington, DC are dated in May 2009. Accordingly, on remand, records of any ongoing VA treatment that the Veteran may be receiving should be obtained. Additionally, the Veteran testified that he received treatment from the Washington VAMC since 1965. May 2013 Hearing Transcript (T.) at 8. He also testified receiving treatment at the Richmond, Virginia VAMC. The earliest VA treatment records that have been obtained are dated from May 1960 to August 1960. There are no further records until June 1980. On remand, any additional records identified by the Veteran should be obtained. 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) (2012). Expedited handling is requested.) 1. After obtaining the appropriate release of information forms where necessary, procure records of post-service cardiac treatment that the Veteran has identified. The Board is particularly interested in records of private treatment that the Veteran may have received, as well as from the Washington and Richmond VAMCs between August 1960 and June 1980; from June 1981 to February 1988; and since May 2009. If any such records identified by the Veteran are not available, he should be so informed, and notations as to the unavailability of such records and as to the attempts made to obtain the documents should be made in the claims file. All such available reports should be associated with the claims folder. 2. Then, accord the Veteran an appropriate VA examination to determine the nature, extent, and etiology of his coronary artery disease. The Veteran's claims file, including a copy of this remand, must be made available to the examiner for review in connection with the examination. All indicated should be conducted, and the reports of any such studies should be incorporated into the examination report to be associated with the claims file. The examiner is requested to obtain a detailed history of the Veteran's symptoms as observed by him and others since service, review the record, and offer an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of approximately 50 percent), or less likely than not (i.e., probability less than 50 percent) that coronary artery disease had its clinical onset in service or is otherwise related to service, to include being caused or aggravated (permanently worsened beyond normal progression) by a service-connected disability (anxiety, loss of use of both feet associated with psoriasis and psoriasis). [If the Veteran's coronary artery disease is found to have been aggravated by a service-connected disability, the examiner should quantify the approximate degree of aggravation.] A complete rationale should be given for all opinions and conclusions expressed. If the examiner must resort to speculation to render the requested opinion, he/she must state what reasons, with specificity, that this question is outside the scope of a medical professional conversant in VA practices. 3. Ensure that the examination report complies with (answer the questions posed in) this Remand. If the report is insufficient, it should be returned to the examiner for corrective action, as appropriate. 4. Then, readjudicate the issue on appeal. If the benefit remains denied, the Veteran and his representative should be provided a supplemental statement of the case and given an appropriate opportunity to respond. The case should then be returned to the Board for further consideration. 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 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). _________________________________________________ MILO H. HAWLEY 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).