Citation Nr: 18149666 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-02 556 DATE: November 13, 2018 REMANDED Entitlement to service connection for a heart condition is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1976 to December 1976 and from February 1977 to September 1992. The Veteran is Peacetime and Persian Gulf War Veteran. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2013 rating decisions of the Department of Veterans Affairs (VA) in Winston-Salem, North Carolina Regional Office (RO) denying service connection for a heart condition. 1. Entitlement to service connection for heart condition is remanded. The Veteran contends that his current heart condition is the result of contracting Chagas disease while stationed in Panama or that it had its onset during his service. In the alternative, he alleges that it is based on his service in the Persian Gulf. In August 2015, the Veteran was afforded a VA examination to determine the etiology of his diagnosed heart condition and an addendum opinion was requested in November 2015. Unfortunately, the opinion provided is incomplete. The VA examiner opined that it was less likely than not (less than 50/50 probability) that the Veteran’s condition of nonischemic cardiomyopathy was caused by or related to service in the Persian Gulf and that it was more likely than not (more than 50/50) probability that it was due to an infection etiology that most closely fits a history of Chagas disease. The examiner explained that Chagas disease was caused by a parasite that was found only in the Americas, that it was not possible the Veteran had been infected with Chagas while stationed in the Persian Gulf and that Chagas disease remains the most likely etiology for the Veteran’s heart condition. However, the examiner did not address whether the Veteran had been infected with Chagas while serving in Panama or whether his heart condition had its onset during service. On remand, such an opinion is required. The Veteran has stated that he was deployed to Panama during service. However, his complete service personnel records confirming such deployment are not of record. On remand, his complete service personnel records should be obtained. On remand, the Veteran should be asked to furnish, or to furnish an authorization to enable VA to obtain, any additional private treatment records from providers who treated him for his heart condition. Finally, given the time that will elapse on remand, updated VA treatment records should be obtained. The matter is REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Request from all appropriate source(s) copies of the Veteran’s complete service personnel records following the procedures set forth in 38 C.F.R. § 3.159. Efforts to procure the evidence should be fully documented, and should be discontinued only if it is concluded that the evidence sought does not exist or that further efforts to obtain the evidence would be futile. 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the claims file. If any of the records sought are not available, the claims file should be annotated to reflect that fact, and the Veteran and his representative should be notified of their right to submit alternative evidence. 3. After completing the above listed development, then return the claims file, to include a copy of this remand, to the August 2015 VA examiner for an addendum opinion. If the examiner who drafted the August 2015 opinion is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (a 50 percent or higher probability) that the Veteran’s diagnosed heart condition was manifested in service OR is due to an event in service? The examiner should specifically address the Veteran’s contention that his heart condition is the result of contracting Chagas disease from his tour in Latin America and his reports of having chest pains in January 1991 and March 1992. The examiner should consider all of the evidence of record, including the Veteran’s lay statements and medical records. Any opinion offered should be accompanied by a clear rationale consistent with the evidence of record. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Iglesias, Law Clerk