Citation Nr: 21031658 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-47 107 DATE: May 24, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 percent for the Veteran's service-connected beta thalassemia with secondary anemia is remanded. Entitlement to an initial compensable disability rating for the Veteran's service-connected vasovagal syncope with atypical chest pain is remanded. Entitlement to service connection for heat stroke is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 2010 to February 2014. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). Beta Thalassemia and Vasovagal Syncope Initially, the Board notes that the record for review may be incomplete. During his May 2021 Board hearing the Veteran indicated that he was in the Lexington, Kentucky VAMC ER within the week prior to his Board hearing due to feelings of dizziness and lightheadedness. Additionally, the Veteran was wearing a Holter Monitor during the hearing. Further, the Veteran reported that he had seen a doctor regarding his thalassemia on the same day he was in the ER. However, these records are not in the record, and as such the RO must attempt to obtain them. Finally, the Board notes that the last VA examination in connection with the Veteran's service-connected thalassemia was in June 2017. Additionally, while the Veteran was provided with a February 2021 Narcolepsy examination, it did not address his syncope and would not have addressed the records which the Board is instructing the RO to obtain. As such, given the potential worsening of the Veteran's claimed disabilities since his last VA examinations, a remand is warranted to provide the Veteran with a contemporaneous examination. Heat Stroke The Board is of the opinion that additional development is required before this issue on appeal is decided. The Veteran is seeking service connection for a heat stroke disability, or the residuals thereof. The Board notes that the Veteran's service treatment records (STRs) indicate that he was treated in service for heat stroke. Further the Board notes that the Veteran claims his heat stroke disability is etiologically related to his service-connected vasovagal syncope and/or his thalassemia disabilities. Additionally, the Board notes that to date, the Veteran has not been afforded a VA examination to address the etiology of his claimed disability. As such, the Board finds an examination and medical opinion is necessary to determine whether the Veteran has any currently diagnosed heat stroke disabilities or residuals which were caused by, aggravated by, or otherwise etiologically related to his active military service. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's issues on appeal. Specifically, the RO should attempt to obtain/locate the Veteran's current treatment records from the Lexington VAMC. Additionally, the RO must contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of the issues on appeal. Based on his response, the RO must attempt to procure copies of all records which have not previously been obtained from identified treatment sources. 2. After obtaining the Veteran's outstanding treatment records, schedule the Veteran for an appropriate VA examination, with an examiner(s) with sufficient expertise to determine the current nature and severity of the Veteran's beta thalassemia and vasovagal syncope with atypical chest pain disabilities. The claims file should be made available to and reviewed by the examiner(s) and all necessary tests should be performed. The examiner must provide a complete rationale for all proffered opinions. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete answer as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed 3. Then, afford the Veteran a VA examination by an examiner with sufficient expertise to address the etiology of the Veteran's claimed heat stroke residuals disability. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state whether the Veteran at least as likely as not (a 50 percent probability or greater) has a heat stroke, or residuals of heat stroke, that originated during his period of active service or are otherwise etiologically related to his active service. Further, the examiner must opine whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's claimed heat stroke condition is etiologically related to, or aggravated beyond the course of its natural progression by, either of his service-connected beta thalassemia and vasovagal syncope with atypical chest pain disabilities. For purposes of these opinions, the examiner should assume that the Veteran is a reliable historian and must not ignore the Veteran's competent reports of in-service injuries, or of symptoms experienced during active service and since. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. Specifically, the Board draws the examiner's attention to the Veteran's June 2017 lay statement describing his heat strokes and the symptoms he experienced since service. (Continued on the next page) The examiner must provide a complete rationale for all proffered opinions. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Gresham 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.