92 Decision Citation: BVA 92-27675 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 90-49 474 ) DATE ) ) ) THE ISSUE Entitlement to an increased evaluation for rheumatic heart disease, currently evaluated as 60 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD William H. Hickman, Associate Counsel INTRODUCTION This matter comes before the Board on appeal from rating decisions of the Boston, Massachusetts, Regional Office (hereinafter RO). The veteran had military service from September 1952 to September 1956. A rating decision dated in February 1990 increased the veteran's evaluation from 10 percent to 30 percent. This rating decision labeled the veteran's service-connected heart disorder as "coronary artery disease" as well as the previous service-connected rheumatic heart disease. A notice of disagreement was received in May 1990. A statement of the case was issued in June 1990. A substantive appeal was received in June 1990. The veteran appeared and testified at a personal hearing in September 1990, and the hearing officer issued a decision in that same month. The case was received and docketed at the Board in November 1990. The veteran's representative submitted written arguments to the Board in January 1991. In April 1991 the Board remanded the case for further development. A rating decision dated in April 1992 increased the veteran's evaluation from 30 percent to 60 percent. A supplemental statement of the case was issued in April 1992. The case was received back at the Board in July 1992. In August 1992 the veteran's representative submitted additional written arguments. The case is now ready for appellate review. REMAND The RO in a rating decision dated in February 1990 increased the veteran's evaluation for rheumatic heart disease from 10 percent to 30 percent, and, apparently, expanded the grant of service connection to be inclusive of coronary artery disease. It is not clear from the rating decision on what basis this expansion was made or on what basis the increase in the rating was made. In this regard it is noted that there was no evidence of coronary artery disease in service or for many years thereafter. In fact as late as 1967, there was reported to be no evidence of heart disease. No evidence supporting a finding that a causal relationship exists between rheumatic heart disease and coronary heart disease is of record. Accordingly, when the case was received at the Board initially the Board remanded the case and requested an "examination by a cardiologist to determine the symptoms, signs, and manifestations, extent of impairment resulting from rheumatic heart disease and coronary artery disease". This was done so that the case could be properly evaluated under the provisions of Chapter 50, Subchapter V, § 50.20, subparagraph (f) of the VA publication Department of Veterans Benefits Manual M21-1. While the RO has associated with the claims folder many progress notes denoting the extent of the veteran's heart disorder, it does not appear that any examination by a cardiologist was carried out specifically for the purposes of determining the symptomatology attributable to rheumatic heart disease, and the symptomatology attributed to coronary artery disease. An examination was conducted. The RO, by rating action in April 1992 increased the evaluation from 30 percent to 60 percent but did not explain its basis for the increase pursuant to M21-1, Chapter 50, Subchapter V, § 50.20 e, f, (1)(2). It is noteworthy that the VA physician specifically stated that the "current symptoms or limitations directly attributable to RHD (rheumatic heart disease) are nil". Accordingly, under the facts of this case, the Board is of the opinion that additional development is required. Therefore, the case is REMANDED for the following actions: 1. The veteran should be requested to provide the names and addresses of all physicians and/or facilities which have provided treatment of cardiovascular disease since service. These records should be secured and incorporated into the claims folder. 2. The veteran should be scheduled for an examination by a cardiologist to determine the symptoms, signs, and manifestations, and the extent of impairment, if possible, resulting from rheumatic heart disease, if any, and from coronary artery disease. The examining physician should, if possible, distinguish between the respective symptoms in a written opinion. The claims folder should be made available to the examiner for review prior to the examination. 3. In light of the evidence developed in connection with the remand action, as well as the other evidence of record, the RO should review prior adjudicative actions and readjudicate the veteran's claim in accordance with Department of Veterans Benefits Manual, M21-1, Chapter 50, Subchapter V, § 50.20 e, f, (1)(2). 4. After completion of the above actions, the veteran should be informed of the results and asked if he wishes to continue his appeal. If so, the veteran and his representative should be issued an appropriate supplemental statement of the case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board for further appellate review. No action is required on the part of the veteran until he receives further notice. By this REMAND the Board intimates no opinion, either factual or legal, as to the ultimate disposition of the issue on appeal. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 NANCY R. ROBIN B. KANNEE ALBERT D. TUTERA Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 57 Fed. Reg. 4126 (1992) (to be codified as 38 C.F.R. § 20.1100(b)).