Citation Nr: 18136102
Decision Date: 09/19/18	Archive Date: 09/18/18

DOCKET NO. 17-34 799
DATE:	September 19, 2018
REMANDED
Entitlement to service connection for a heart disability, to include as due to Agent Orange or as secondary to service connected diabetes mellitus, is remanded.
Entitlement to service connection for hypertension, to include as due to Agent Orange or as secondary to service connected diabetes mellitus, is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Navy from November 1968 to November 1972.
1. Entitlement to service connection for a heart condition, to include as due to Agent Orange or as secondary to service connected diabetes mellitus, is remanded.
The Veteran has been diagnosed with supraventricular arrhythmia and atrial fibrillation, which he contends have been caused or aggravated by exposure to Agent Orange or by his service connected diabetes mellitus type II.  
In an April 2018 letter, L.B., a nurse practitioner treating the Veteran, reported that diabetes mellitus is considered a risk factor for atrial fibrillation and that the incidence of atrial fibrillation is much higher in patients with diabetes mellitus compared to control groups.  Unfortunately, L.B.’s statement was general in nature and she did not specifically address whether the Veteran's atrial fibrillation was at least as likely as not caused or permanently aggravated by his service connected diabetes mellitus.  However, since the evidence L.B. provided supports a finding that such a relationship is clinically possible and because no VA medical opinion has been obtained to address the issue, a remand is required.
2. Entitlement to service connection for hypertension, to include as due to Agent Orange or as secondary to service connected diabetes mellitus, is remanded.
The Veteran is also seeking entitlement to service connection for hypertension.  At his March 2018 videoconference hearing, he testified that he was prescribed asprin, and later, blood pressure medication to treat high blood pressure while in service.  Unfortunately, service treatment records are only available for the period from June 1968 to December 1968, and missing are the remaining four years of the Veteran's service, including a separation physical.  Since the Veteran has credibly testified to receiving medical treatment during his active service and because it does not appear the RO has made any formal finding concerning the unavailability any additional service treatment records, a remand is required to attempt to obtain the Veteran's complete service treatment records.  
The matters are REMANDED for the following action:
1. Obtain the Veteran’s complete service treatment records.  Document all requests for information as well as all responses in the claims file.  If additional service treatment records are lost, destroyed, or otherwise unavailable, a formal finding of such should be associated with the claims folder.
2. Schedule the Veteran for an examination by an appropriate clinician to obtain an opinion as to the nature and etiology of any heart condition, to include supraventricular arrhythmia and atrial fibrillation.  The examiner must opine whether it is at least as likely as not (1) proximately due to, or (2) aggravated beyond its natural progression by the Veteran’s service-connected diabetes mellitus, type II.
 
M. TENNER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. D. Anderson, Counsel