Citation Nr: 18143137
Decision Date: 10/18/18	Archive Date: 10/17/18

DOCKET NO. 15-12 469
DATE:	October 18, 2018
REMANDED
Service connection for left ventricular outflow tract obstruction (claimed as heart disease) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1980 to December 1982, December 1990 to July 1991 and March 2003 to August 2003.  Service from July 2009 to December 2009 was active duty for training.
These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, that denied service connection for left ventricular outflow obstruction.
In May 2018, the Veteran testified before the undersigned Veterans Law Judge at a videoconference Board hearing at the RO in Buffalo, NY.  A transcript of the proceeding has been associated with the claims file. See 38 C.F.R. §3.103(c)(2).  The record was held open for 90 days to allow the Veteran to submit new evidence.

1. Service connection for left ventricular outflow tract obstruction (claimed as heart disease) is remanded.
The Veteran was diagnosed with left ventricular outflow tract obstruction (LVOTO) in May 2013.  The record refers to this at various times as both a defect and a disease.  Classification of this condition as a congenital disease or defect is important to the subsequent analysis of this claim. In classifying a condition as either a disease or a defect, the Board must rely on medical evidence for its determination, which may require guidance from medical authorities. Monroe v. Brown, 4 Vet. App. 513, 515 (1993). 
To assist an examiner, defects are defined as “structural or inherent abnormalities or conditions which are more or less stationary in nature,” while a disease is “capable of improving or deteriorating.” See VAOPGCPREC 82-90 at para. 2. The Board will again remand this matter to address this critical question of disease or defect, in compliance with the Court’s Order.
The Veteran references being put on a profile for shortness of breath as well as receiving a misdiagnosis of asthma.  Neither can be found in the current record.
The matter is REMANDED for the following action:
1. Contact the Veteran and obtain any additional records which contain evidence of the Veteran having symptoms of LVOTO, such as shortness of breath or a diagnosis of asthma, while on a period of qualifying service. 
2. After obtaining the above records (if such exists), have the record reviewed by a cardiologist:
a)	Explain the nature and course of LVOTO.
b)	Is the Veteran’s LVOTO a congenital disease (a hereditary illness that can get better or worse) or a congenital defect?
c)	Is there any evidence that he had any manifestations of the process during service:
-	January 1980 to December 1982
-	December 1990 to July 1991
-	March 2003 to August 2003
-	July 2009 to December 2009
d)	If the LVOTO is a congenital defect, does the Veteran have any superimposed pathology on the defect?
A thorough explanation must be provided for the opinions rendered. 
 
H. N. SCHWARTZ
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S.W. Strike, Associate Counsel