Citation Nr: 1329658 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 00-12 232A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUE Entitlement to service connection for heart disease. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. H. Nilon, Counsel INTRODUCTION The Veteran served on active duty from June 1977 to June 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a February 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas that in relevant part denied service connection for heart disease. The Board issued a decision in December 2010 that in relevant part denied service connection for heart disease. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In September 2011 the Court issued an Order granting a Joint Motion of the Parties to vacate the Board's decision and to return the case to the Board for further development. The case is once again REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required on his part. REMAND The Veteran had a VA examination in April 2013 in which the examiner issued an opinion stating the Veteran does not have a heart condition that is etiologically related to chest pains in service. The Veteran's representative submitted an Informal Hearing Presentation to the Board in June 2013 (associated with Virtual VA) asserting that the Veteran's arrhythmias and cardiomegaly may be due to or aggravated by medications the Veteran takes for his service-connected orthopedic disabilities and his service-connected obstructive sleep disorder. This theory of secondary service connection was not addressed by the VA examiner and was not considered by the RO in the first instance. The Veteran's representative also asserts that the Veteran's service treatment records (STRs) appear to be incomplete, in that several periodic physical examinations that should have been routinely performed (in 1981, 1989 and 1993-94) are not among the examination reports of record. While the appeal is in remand status the RO should request any STRs that are not already of record and associated such records with the claims file or with Virtual VA/VBMS. Accordingly, the case is REMANDED for the following action: 1. Submit a request to the appropriate agencies for any service treatment records that are not already associated with the claims file. If no additional service treatment records are discovered, a negative response should be entered into the record. 2. After obtaining any additional records of treatment, return the file to the VA physician who performed the examination in April 2013 for an addendum opinion specifically addressing whether the Veteran's service-connected medical and psychiatric disabilities have aggravated a diagnosed heart disorder (i.e., the examiner should state whether it is at least as likely as not that medications taken for one or more service-connected disabilities, or that the symptoms of one or more of the service connected disabilities have caused a permanent increase in severity of arrhythmia, cardiomegaly or any other heart disorder). If the examiner determines that a heart disorder was aggravated by one or more service-connected disabilities, the examiner is further asked to provide an assessment of the additional degree of disability so caused, above and beyond the normal course of the heart disease. The rationale for all opinions expressed should be provided, and if it is not possible to provide an opinion without resort to speculation, the reasons that is so should be explained. If the identified examiner is unavailable, the file should be referred to another qualified person for the requested opinion. 3. Then, the Originating Agency should readjudicate the appeal. If any benefit sought on appeal is not granted to the Veteran's satisfaction, issue the Veteran and his representative a supplemental statement of the case and afford them the requisite opportunity to respond. Thereafter, if indicated, the case should be returned to the Board for further appellate action. By this remand, the Board intimates no opinion as to any final outcome warranted. The Veteran need take no action until he is otherwise notified, but he may furnish additional evidence and/or argument during the appropriate time frame. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This REMAND must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or the Court 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). _________________________________________________ MICHAEL E. KILCOYNE 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).