Citation Nr: 21076880 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-12 256 DATE: December 28, 2021 REMANDED Entitlement to service connection for a heart murmur is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1971 to December 1972. His decorations include the National Defense Service Medal. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Columbia, South Carolina. The issue on appeal was previously before the Board in September 2019, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. Entitlement to service connection for a heart murmur is remanded. Although the Board regrets the additional delay, further development is necessary to ensure substantial compliance with the prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the September 2019 remand, the Board requested that the AOJ arrange to have the Veteran re-examined. The examiner was to provide an opinion as to whether there was clear and unmistakable evidence that the Veteran's pre-existing heart murmur was not aggravated (permanently worsened beyond the natural progression) by his service. In January 2020, a VA examiner supplied an unclear opinion on that question. Specifically, although the examiner checked a box on the examination form indicating that the claimed condition was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness, the examiner stated in the narrative portion of the opinion, in part, "Therefore, pre[-]existing murmur is less likely than not aggravated beyond natural progression by active service." Because the examiner did not provide a clear and unambiguous opinion with respect to the question posed by the Board (i.e., employing the correct standard), further development for clarification of the opinion is required. In a July 2021 appellate brief, the Veteran's representative advanced argument to the effect that the Veteran was treated for his blood pressure in July 1973, within a year of service, and that it can therefore "be reasonably inferred that the pre[ ]existing heart condition noted at entry did, in fact, progress to a new disability sometime between the veteran's induction and July 1973." On remand, the examiner should address that theory. In this regard, the Board notes that the Veteran reported in August 1973 that he had been treated for "high blood" by a Dr. Turner in July 1973. Presently, the claims file does not appear to contain any records from Dr. Turner. Because such records, if obtained, could bear on the outcome of the Veteran's appeal, efforts must be made to procure them. See, e.g., 38 C.F.R. § 3.159(e)(2) (if VA becomes aware of the existence of relevant records before deciding a claim, VA will, among other things, request that the claimant provide a release for the records). This matter is REMANDED for the following action: 1. Ask the Veteran to provide a release for relevant records of treatment from Dr. Turner, who reportedly treated him for "high blood" in July 1973, and to identify, and provide appropriate releases for, any other non-VA care providers who may possess new or additional evidence pertinent to the issue on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and his representative should be notified. 2. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. After the foregoing development has been completed to the extent possible, make arrangements to have the VA examiner who previously evaluated the Veteran in January 2020 provide a supplemental report. After reviewing the record, the examiner should provide a clear opinion as to whether it is clear and unmistakable (i.e., manifest, obvious, or undebatable) that the Veteran's pre-existing heart murmur did NOT increase in severity during service beyond the natural progress of the condition. In so doing, the examiner should discuss the medical significance, if any, of the Veteran's complaints of chest pain and shortness of breath during service, as well as a January 1972 consultation sheet reflecting that the Veteran had been told that his murmur was becoming louder after basic training. The examiner should also address the argument advanced by the Veteran's representative to the effect that the Veteran was treated for his blood pressure in July 1973, within a year of service, and that it can therefore "be reasonably inferred that the pre[ ]existing heart condition noted at entry did, in fact, progress to a new disability sometime between the veteran's induction and July 1973." If the January 2020 examiner is no longer employed by VA or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinions. A complete rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lanton, F. Associate 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.