Citation Nr: 21069342 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 10-13 280 DATE: November 18, 2021 REMANDED The issue of entitlement to service connection for a heart disorder for treatment purposes under 38 U.S.C. Chapter 17 is remanded. REASONS FOR REMAND The appellant served on active duty from October 1975 to September 1981, when he was discharged from service under other than honorable conditions. An October 1983 VA Administrative decision determined that the discharge for this period of service was under conditions that preclude VA benefits, except for medical care under 38 U.S.C. Chapter 17. In that regard, the healthcare and related benefits authorized by Chapter 17 of Title 38 of the United States Code shall be provided to certain former service persons with administrative discharges under other than honorable conditions for any disability incurred or aggravated during active military, naval, or air service in line of duty. 38 C.F.R. § 3.360(a). In November 1997, the Board for Correction of Naval Records denied the appellant's application for a discharge upgrade. In a January 2016 decision, the Board remanded the claim of entitlement to service connection for heart failure for treatment purposes under 38 U.S.C. Chapter 17. The purpose of that remand was to obtain outstanding private treatment records from Dr. C.G.P., as well as the appellant's Social Security disability records. The identified records were subsequently obtained. Thus, the Agency of Original Jurisdiction (AOJ) substantially complied with the Board's January 2016 Remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Dyment v. West, 13 Vet. App. 141, 146-7 (1999); D'Aries v. Peake, 22 Vet. App. 97 (2008). Additionally, the appellant testified before a Veterans Law Judge at a Board hearing in November 2015. A transcript of that hearing has been associated with the appellant's claims file. Subsequently, the Veterans Law Judge who presided over that hearing left the Board. In April 2020, the appellant was offered the opportunity to testify at a new hearing. He accepted the offer and testified at a Board hearing before the undersigned in July 2021. A transcript of that hearing has been associated with the appellant's claims file. Entitlement to service connection for a heart disorder for treatment purposes under 38 U.S.C. Chapter 17 is remanded. The appellant contends that his current heart disorder (claimed as "heart failure") began during his military service. Service connection, including service connection for treatment purposes only, will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. §§ 3.303(a), 3.360(c). Establishing service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F. 3d 1362 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may also be granted on a secondary basis for a disability that is proximately due to or the result of (caused) or permanently worsened beyond its natural progression (aggravated) by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc). At his July 2021 Board hearing, the appellant testified that he had no heart problems prior to entering military service; that he started having heart problems from bootcamp onward; that as a rifleman in the infantry, he had to carry a lot of heavy weight and endure lots of running; and that he passed out on several occasions because of his heart condition (he indicated that he had chest pains because his heart rate was really high and that he blacked out several times during his military service). The appellant also suggested that his current heart disorder was possibly caused or aggravated by his seizure disorder which was recently service connected for treatment purposes under 38 U.S.C. Chapter 17. A review of the record reveals that the appellant has been diagnosed as having a systolic murmur (grade 2/6); hypertension (i.e., high blood pressure); and "hypertensive heart disease, benign, without heart failure." See Private Treatment Records from Dr. C.G.P., received by VA on December 3, 2019; September 4, 2021; and September 7, 2021. Further review of the record shows that the appellant passed out after marching (possibly due to heat stroke) in June 1976; that he presented to the emergency room for observation in June 1976 with a history of blackout spells prior to admission (he was ultimately diagnosed as having syncope of unknown etiology, but no disease found); and that he was evaluated for a heart murmur in May 1979. See Service Treatment Records (STRs), received by VA on March 24, 2014. Given that the appellant has a currently diagnosed heart disorder; that his STRs corroborate his testimony regarding blackouts and some heart-related issues during service; that his hearing testimony suggests that heavy lifting and lots of running/marching contributed to his chest pains and passing out on several occasions; and that he has suggested an alternative theory of entitlement to service connection for treatment purposes (i.e., secondary service connection), the Board finds it necessary to remand this matter for a VA examination and to obtain a medical opinion addressing the nature and etiology of the appellant's claimed heart disorder. McLendon v. Nicholson, 20 Vet. App. 79 (2006). This matter is REMANDED for the following actions: 1. Obtain any of the appellant's outstanding medical records and associate them with the claims file. If possible, the appellant himself should submit any pertinent new evidence regarding the condition at issue in order to expedite the claim. 2. Schedule the appellant for an appropriate VA examination to ascertain the nature and etiology of the appellant's claimed heart disorder. Following a review of the claims file and an evaluation of the appellant, the examiner should render a medical opinion addressing the following: a. Identify all heart disorders diagnosed on evaluation. b. For each heart disorder diagnosed, the examiner should opine as to whether that heart disorder "at least as likely as not" (50 percent or greater probability) began during, was caused by, or is otherwise related to his military service, to include the general rigors of military service (e.g., carrying heavy equipment and lots of running and marching), the history of blackout spells for which he was he was ultimately diagnosed in June 1976 as having syncope of unknown etiology, or the evaluation for a heart murmur in May 1979. See STRs, received by VA on March 24, 2014, p 7. The examiner should also explain the difference between hypertension and hypertensive heart disease and address whether the Veteran's current systolic murmur is the same heart murmur that he was treated for during active duty military service. c. For each heart disorder diagnosed, the examiner should opine as to whether that heart disorder "at least as likely as not" (50 percent or greater probability) was proximately caused by or aggravated beyond its natural progression by his service-connected (for treatment purposes) seizure disorder. The examiner must provide adequate rational for all medical conclusions reached and the examiner's opinion must address the appellant's lay statements and testimony in support of his claim. 3. After undertaking any other appropriate development deemed necessary, readjudicate the issue on appeal based on the additional evidence of record. If the determination remains adverse to the appellant, he must be provided with a supplemental statement of the case (SSOC). An appropriate period of time must then be allowed for a response before the record is returned to the Board for further review. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael L. Marcum, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.