Citation Nr: 21013528 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-40 230 DATE: March 9, 2021 REMANDED Entitlement to service connection for a cardiovascular disorder claimed as heart attack is remanded. Entitlement to service connection for a psychiatric disorder claimed as anxiety disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1975 to June 1980 and from May 1982 to May 1986. This matter comes before the Board from a June 2016 rating that denied service connection for a cardiovascular disorder claimed as “heart attack” and for a psychiatric disorder claimed as “anxiety disorder.” The Veteran filed a NOD in June 2017, a statement of the case was issued in July 2017 and he submitted a VA form I-9 in July 2017. In January 2021 the Veteran testified before the undersigned at a hearing held before the undersigned. A transcript of this hearing is associated with the claims folder. 1. Service connection for a cardiovascular disorder claimed as heart attack is remanded. The Veteran contends that service connection is warranted for a cardiovascular disorder. At his hearing he alleged that the high stress duties of being an air traffic controller in the military, including under combat conditions led to a cardiovascular disease which resulted in a near fatal heart attack at the age of 40. He indicated that the emergency room doctor who treated him for his heart attack appeared to associate the stress from working as an air traffic controller to conditions leading to his heart attack. His representative pointed out that the Veteran had not been examined to determine whether any cardiovascular disorder is related to his in-service exposures to stress while serving in his military occupational specialty (MOS) as air traffic controller. . Also, in his May 2017 NOD he cited to articles and studies linking stress, including specifically from his MOS as air traffic controller to heart disease. In his NOD, also suggested that during one assignment in the “yards” and “rehab group” while in the service, he was exposed to hazardous dusts, chemicals and gases. It is noted that the STRs included a February 1983 Asbestos surveillance program which he answered whether he was exposed to asbestos. Service treatment records are negative for any diagnosed heart disorder, including in multiple examinations and reports of medical history throughout his periods of service. An October 1982 ECG noted findings of sinus bradycardia but was otherwise interpreted as normal. . Service personnel records including letters of commendations showed that he served as an air traffic controller and helicopter direction center supervisor, with duties confirmed to have been under high pressure situations and combat conditions including under serious terrorist threat while participating in Operation Urgent Fury Operations in Grenada and a support of Marines in Lebanon including flight operations into the Beirut area. Post-service records confirm that the Veteran had a history of a heart attack, also known as myocardial infarction (MI), 1997 with angiogram and percutaneous transluminal coronary angioplasty PTCA of left anterior descending artery (LAD). Records dated in November 2002 show such a history and reflect a current diagnosis of coronary artery disease (CAD) status post PCTA. A December 2006 cardiology consult for tachycardia during exertion with history of CAD noted the history of the 1997 MI, but with normal cardiac function shown on stress test and transthoracic echocardiogram and his complaints of possible syncope deemed to be most likely vasovagal related, but recommended secondary CAD risk factor prevention. The normal cardiac evaluation findings in December 2006 were noted in annual checkup in September 2008. The Board cannot make a fully-informed decision on the issue of whether the Veteran has a current cardiovascular disability that was incurred in or aggravated by service, including from stress caused by his duties as an air traffic controller in service including under combat conditions because no VA examination has been scheduled to address such questions. In light of the facts of this case, including the confirmed military duties as air traffic controller under combat conditions, and his medical history of MI and CAD post service, a remand is necessary to afford the Veteran such an examination. Additionally the Veteran should be provided another opportunity to submit evidence in support of his claim to include the records of the 1997 MI treatment that are presently not of record. 2. Service connection for a psychiatric disorder claimed as anxiety disorder is remanded. The Veteran contends that service connection is warranted for a cardiovascular disorder. At his hearing, he alleged that he has anxiety related to his heart disorder, specifically pointing to his near death experience when he had his MI as triggering such anxiety. The Veteran has described it as a byproduct of his heart attack, which itself he has attributed to the stress of his MOS as an air traffic controller. His representative has requested he undergo a VA examination to address this claim. The Board notes that the Veteran has not been diagnosed with or treated for a psychiatric disorder in the STRS or post service records. Nevertheless, given his allegations of anxiety that he has alleged is linked to his heart disorder in his hearing, a remand is necessary to afford him such an examination. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any private records addressing treatment for his 1997 myocardial infarction. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for a VA examination for his claimed cardiovascular disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is any cardiovascular disability, including one resulting in a 1997 MI, and any residual disability therein at least as likely as not related to service, including his service in a very high stress environment with confirmed duties as an air traffic controller serving under combat conditions including Operation Urgent Fury Operations in Grenada and in support of Marines in Lebanon including flight operations into the Beirut area and/or exposure to any toxic chemicals reported by the Veteran during his service? All opinions should be accompanied with a complete rationale. The examiner should address the findings in the STRs including an ECG showing sinus bradycardia in October 1982, the personnel records confirming his service as an air traffic controller under combat conditions, and the articles cited by the Veteran in his NOD regarding stress and cardiovascular disorders. 3. Schedule the Veteran for a VA examination for his claimed psychiatric disorder of anxiety disorder. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Does the Veteran have any current psychiatric disability that is at least as likely as not related to service, including his service in a very high stress environment with confirmed duties as an air traffic controller serving under combat conditions including Operation Urgent Fury Operations in Grenada and in support of Marines in Lebanon including flight operations into the Beirut area? If not, is it as likely as not that any current psychiatric disability is at least as likely as not proximately due to his claimed cardiovascular disability including one resulting in a 1997 MI and any residual disability therein? If not, is it as likely as not that any current psychiatric disability is at least as likely as not aggravated, i.e., worsened beyond its natural progression, by his claimed cardiovascular disability including one resulting in a 1997 MI and any residual disability therein? If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation. All opinions should be accompanied with a complete rationale. The examiner should address the personnel records confirming his service as an air traffic controller under combat conditions, and the articles cited by the Veteran in his NOD regarding stress and cardiovascular disorders. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Eckart 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.