Citation Nr: 18148882 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 13-21 395 DATE: November 8, 2018 REMANDED Entitlement to service connection for a heart disability (claimed as large aortic valve) is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to February 1971, and from April 1976 to September 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision. The Veteran requested a Board hearing. See July 2013 substantive appeal. Nevertheless, he withdrew his request for a Board hearing via an August 2018 statement. 1. Entitlement to service connection for large aortic valve is remanded. 2. Entitlement to service connection for hypertension is remanded. The Veteran seeks service connection for hypertension and a heart disability, claimed as large aortic valve. See February 2010 informal claim; March 2010 formal claim. He has submitted post-service treatment records showing diagnoses of essential hypertension and chronic aortic root aneurysm associated with aortic valve regurgitation. See, e.g., treatment records, received September 24, 2009, The Veteran asserts that his claimed disabilities first manifested in service. See July 2013 substantive appeal. In this regard, service treatment records show that the Veteran complained of chest pain during his separation examination. See June 1997 report of medical history, in STRs, received March 2, 2010, at 61. Further, a concurrent ECG shows a finding of marked sinus bradycardia. Id. at 63. The Veteran argues that his heart disability was misdiagnosed at separation and that it was discovered later in life during a routine physical. See July 2013 substantive appeal. As the Board interprets the Veteran’s arguments, he appears to be asserting the following: (1) that his current heart disability first manifested in service and (2) that the examiner who conducted June 1997 separation examination either failed to identify or mischaracterized his heart condition. In support of his claims, the Veteran has referenced the fact that he served in the Southwest Asia theater of operations during the Persian Gulf War and that he was stationed in Haiti, adding that he was exposed to environmental hazards at both locations. See July 2013 substantive appeal. He has also put forward the theory that the claimed heart disability is secondary to his claimed hypertension. The Veteran has not undergone a VA examination for his claimed disabilities. The Board, however, finds that such an examination is warranted in the present case, as the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: Schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any current heart disability and hypertension. The examiner is to provide an opinion whether any current heart disability is at least as likely as not related to an in-service injury, event, or disease. If hypertension is diagnosed, the examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The examiner must address the Veteran’s assertion that his claimed disabilities first manifested in service. In this regard, service treatment records show that he Veteran reported a history of chest pains at his separation examination, and an accompanying ECG shows a finding of marked sinus bradycardia. See 03/02/2010 STR-Medical, at 60-63. The examiner should also consider the Veteran’s assertion that his heart disability was misdiagnosed (or went undiagnosed) during service. While the Veteran is not competent to establish that a misdiagnosis in fact occurred, his argument in this regard must nonetheless be considered. The examiner must also consider the Veteran’s suggestion that his claimed disabilities are related to hazardous environmental exposure during service in Southwest Asia and in Haiti. The examiner should elicit from the Veteran as much information as possible about such exposure. Should the examiner determine that the Veteran’s hypertension is related to service, he or she should opine whether any current heart disability is at least as likely as not (1) proximately due to hypertension, or (2) aggravated beyond its natural progression by hypertension. Similarly, should the examiner determine that a heart disability is related to service, he or she should opine whether the Veteran’s hypertension is at least as likely as not (1) proximately due to the service-connected heart disability, or (2) aggravated beyond its natural progression by service-connected heart disability. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. López, Associate Counsel