BVA9503021 DOCKET NO. 93-03 762 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to secondary service connection for a cardiovascular disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel REMAND The veteran had active service from June 1967 to January 1969. This matter comes before the Board of Veterans' Appeals (Board) from a March 1991 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The VA is required to adjudicate any issues which are reasonably raised by a liberal reading of the documents and testimony submitted by the claimant prior to a final Board decision. Reviewing the record, it is clear that a claim for service connection of alcoholism and substance abuse secondary to the veteran's service-connected psychiatric disability, organic brain syndrome with post-traumatic stress disorder, has been raised. The record includes recently submitted data in support of the claim. Geralyn M. Campi, M.D., reported in February 1992 that stressful employment could serve as a precipitant in causing an acute myocardial infarction. The Board observes that in October 1989, the RO denied service connection for alcohol dependence and substance abuse. The veteran did not appeal the decision after receiving a notice in November 1989. The Board finds that the issue of secondary service connection for cardiovascular disability should not be limited to coronary artery disease, but should address any cardiovascular disability leading to myocardial infarction, including hypertension. In March 1992, a VA examiner, addressing the relationship of coronary artery disease to the veteran's psychiatric disability, reported that the main precipitating factors were atherosclerosis and clotting. The role of psychiatric disability, if any, in the development of arteriosclerosis and hypertension was not specifically addressed and no opinion was expressed regarding the likelihood of a causal relationship, if any, between the veteran's psychiatric disability and either of these disorders or alcohol or substance abuse. In the Board's judgment, these other matters are sufficiently intertwined with the issue currently on appeal as to warrant further action by the RO before a decision by the Board. Accordingly, this appeal is REMANDED to the RO for the following actions: 1. The RO should contact the veteran and request that he provide the names, addresses and approximate dates of treatment for all VA and non-VA health providers who have treated him for any cardiovascular disability and alcoholism or substance abuse at any time since his separation from service. With any necessary authorization, the RO should attempt to obtain copies of those treatment records identified by the veteran which have not been previously secured. 2. The RO should then schedule the veteran for a special psychiatric examination to determine whether the veteran has alcohol and/or drug dependence and an opinion concerning the etiology of any such dependence. Specifically, the examiner should state the degree of probability, if any, that such dependence, if present, is causally or etiologically related to the veteran's post-traumatic stress disorder. The claims folder must be made available to the examiner for review. 3. Thereafter the claims folder should be submitted to a board-certified cardiologist, if available, for review. The examiner is requested to identify any cardiovascular disabilities present and provide an opinion regarding the etiology therefor, to include whether it is at least as likely as not that cardiovascular disability is causally related to the veteran's service-connected psychiatric disability or alcoholism and/or substance abuse. The examiner should provide complete rationales for all opinions and conclusions expressed. 4. Thereafter, in light of the evidence obtained pursuant to the requested development, the RO should readjudicate the claim of secondary service connection for a cardiovascular disability and the claim to reopen the issue for service connection for alcoholism and/or substance abuse. If any benefits sought on appeal is not granted to the satisfaction of the veteran, a supplemental statement of the case should be issued for all issues in appellate status and the veteran and his representative provided the applicable time to respond. Thereafter, the case should be returned to the Board for further consideration, if otherwise in order. By this REMAND the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. CHARLES E. HOGEBOOM Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1993).