Citation Nr: 18156296 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 17-16 758A DATE: December 7, 2018 REMANDED Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for a heart disorder (systolic heart murmur) is remanded. Entitlement to a compensable rating for anemia is remanded. Entitlement to a compensable rating for uterine fibroid tumor is remanded. REASONS FOR REMAND The Veteran had active duty from January 1971 to August 1976. 1. Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for a heart disorder. As to the petition to reopen the claim for a heart disorder, the Board finds that the April 2014 VA examination and March 2017 VA medical addendum opinion are inadequate. While the April 2014 VA examiner could not render an opinion because the Veteran’s service treatment records (STRs) were unavailable, the March 2017 VA examiner opined that the pre-existing heart murmur was not aggravated beyond its natural progression because there was no documentation of aggravation beyond the expected natural progression. In rendering this opinion, however, the examiner did not cite to any evidence or provide a more detailed rationale, including discussion of the February 2017 lay statement from the Veteran’s commander attesting to her outstanding performance, which resulted in the Veteran being made the drill sergeant but after two years, her health started to decline, resulting in her discharge due to hardship. It is noted that her statements and service treatment records document symptoms of fatigue and general malaise. Remand is necessary to obtain an adequate medical opinion in this matter. 2. Entitlement to a compensable rating for anemia. 3. Entitlement to a compensable rating for uterine fibroid tumor. Issues 2-3. The Board observes that the Veteran was issued a statement of the case in April 2017. The record, however, further reflects that the Veteran underwent VA examinations in September 2018. Likewise, additional relevant VA medical treatment records were obtained and associated with the claims file. Therefore, to ensure due process of law, the Veteran must be provided with a supplemental statement of the case, as additional, relevant has been received since the issuance of the April 2017 statement of the case. See 38 C.F.R. § 19.31. The matters are REMANDED for the following action: 1. Obtain an addendum regarding the etiology of the Veteran’s heart condition from an appropriate clinician, which addresses the following: a) Identify all heart conditions found to be present. b) Indicate whether any diagnosed heart condition, including a heart murmur, clearly and unmistakably pre-existed the Veteran’s active duty from January 1971 to August 1976. (i) If yes, is there also clear and unmistakable evidence indicating this pre-existing heart condition, including a heart murmur, was not aggravated during or by her service, meaning not chronically (permanently) worsened beyond its natural progression? (ii) If no, it is determined that a heart condition, including a heart murmur, is it at least as likely as not (a 50 percent probability or more) that any diagnosed heart condition, including a heart murmur, had its onset during her service from January 1971 to August 1976 or within one year of discharge from active service. The examiner should specifically address the Veteran’s documented treatment, her statements, and the February 2017 lay statement from her commander about her decline in health. A complete rationale for the medical opinion is required. The examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If an opinion cannot be expressed without resort to speculation, the examiner should so indicate and discuss why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. (Continued on the next page)   2. After accomplishing any additional development deemed appropriate, readjudicate the claims on appeal. If the benefits sought remain denied, the Veteran and her representative should be provided with an appropriate SSOC and given the opportunity to respond. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Sangster, Counsel