Citation Nr: 18159851 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 16-55 654 DATE: December 20, 2018 REMANDED Entitlement to service connection for a heart condition, to include supraventricular arrhythmia, valvular heart disease, and atrial septal defect, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1978 to June 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin. The Veteran testified at an informal DRO hearing in August 2015. 1. Entitlement to service connection for a heart condition, to include supraventricular arrhythmia, valvular heart disease, and atrial septal defect, is remanded. There appear to be outstanding private treatment reports. During her August 2015 DRO hearing, the Veteran mentioned receiving treatment for her cardiac condition at Froedtert Hospital and at Sinai Hospital with Dr. Batiara. See August 2015 DRO Formal Hearing. The Veteran also notes that she was seen at Sinai Hospital for palpitations over the years, however all of her tests were negative. See September 2013 Cardiothoracic surgery. The Veteran’s medical treatment records also indicate she underwent a mitral valve repair at the University of Michigan. See June 2016 Cardiology Attending Outpatient Note. On remand, efforts should be undertaken to obtain these records. Moreover, as the claim is being remanded, any recent VA treatment records should be obtained. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (c)(2). Finally, the Veteran should be scheduled for a VA examination, as described below. The matter is REMANDED for the following action: 1. Ensure that the Veteran’s complete service treatment records have been obtained, to include a copy of any separation examination. 2. Ask the Veteran to complete a VA Form 21-4142 for any further private healthcare records they would like the VA to obtain. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. Special attention is directed toward records at Froedtert Hospital, Mount Sinai prior to 2013, treatment records by Dr. Batiara, and treatment records by Dr. Steven Bolling at University of Michigan. 3. Make arrangements to obtain any outstanding VA medical treatment records dated from November 2017 forward. 4. Schedule the Veteran for an appropriate VA examination to obtain a medical opinion regarding her cardiac condition. The entire claims file and a copy of this REMAND must be made available to the examiner in conjunction with the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The examination should include any diagnostic testing or evaluation deemed necessary by the examiner. The examiner must identify all heart disorders found to be present. After reviewing the file and examining the Veteran, the examiner must render an opinion as to the following: (a) Prior to active service, the Veteran underwent surgery in March 1976 for repair of an atrioseptal defect. See Discharge Summary from Mount Sinai Medical Center, dated June 23, 1976. Is/was the Veteran's atrioseptal defect (i) a congenital or developmental defect, (ii) a congenital or developmental disease, or (iii) acquired in nature? Please provide complete rationale for your opinion. (b) If the atrioseptal defect is/was a congenital or developmental disease or acquired in nature, is it at least as likely as not (50 percent probability or greater) that it underwent an increase in severity during the Veteran's active service (i.e., a permanent worsening of the underlying disease as distinguished from a temporary or intermittent flare-up)? If so, was the increase in severity of the atrioseptal defect clearly and unmistakably (i.e., highest degree of medical certainty) due to the natural progress of the disease? (c) If the atrioseptal defect is/was a congenital or developmental defect, is it at least as likely as not (50 percent probability or greater) that it was subject to a superimposed disease or injury during the Veteran's active service? If so, describe the resultant disability. (d) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed heart disorder (i.e., supraventricular arrhythmia, valvular heart disease, etc.) had its clinical onset during the Veteran's active service or is related to any in-service disease, event, or injury? In providing the requested opinions, the examiner's attention is directed to the Veteran’s service treatment records as follows: • Undated emergency room record showing treatment for chest pain and fatigue with a notation of “occ PVC”; • Dated June 6, 1978, showing complaints of chest pain and difficulty breathing; • Dated August 21, 1979, showing complaints of radiating chest pain associated with shortness of breath; • Electrocardiographic record dated August 21, 1979 showing 1st degree A.V. block and IYCD-Y2; and • August 28, 1979, cardiology consultation. (Continued on the next page)   A complete rationale should be provided for any opinion expressed. If any opinion cannot be provided without resort to speculation, the examiner should so state and provide a rationale for why the opinion would require resort to speculation. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Sinckler, Associate Counsel