BVA9505590 
DOCKET NO.  92-22 776     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in Des
Moines, Iowa

THE ISSUES

1.  Entitlement to service connection for coronary artery
disease.

2.  Entitlement to service connection for a left hand disorder on
a secondary basis.

3.  Entitlement to an increased (compensable) rating for cardiac
neurosis.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

Sabrina M. Tilley, Counsel

REMAND

The veteran served on active duty from September 1943 to April
1946

This matter originally came to the Board of Veterans' Appeals
(Board) on appeal from a November 1991 rating decision, which
confirmed a noncompensable rating for cardiac neurosis and denied
the claims for service connection for coronary artery disease and
a left hand disorder.  In June 1994, the case was remanded by the
Board to the RO for additional development.  The RO was
instructed to provide the veteran with a psychiatric examination
in order to determine the nature and severity of the psychiatric
aspect of the veteran's psychophysiological cardiovascular
disorder.  This examination was accomplished in July 1994.  No
psychiatric disorder was diagnosis at that time.  The examiner
noted that there was no clinical history to support a diagnosis
of panic attack or other anxiety disorder with cardiac symptoms.
Consequently, the examiner stated that one "[m]ust question, if
indeed, the veteran was having episodes of supraventricular
tachycardia or atrial flutter."  Because the veteran denied
having an evaluation by a cardiologist concerning his cardiac
neurosis complaints, the examiner stated that "[i]f this, indeed,
has not been accomplished, [ the examiner] would suggest that it
be done such that we can exclude a clear organic basis for his
symptomatology...occurred back in the 40's and early 50's."

The veteran's representative, citing Dalton v. Derwinski, 2
Vet.App. 643 (1992), argued that the Board is required to afford
the veteran a cardiovascular examination, according to the
recommendation of the physician in the July 1994 examination.
The Board agrees that further development is necessary prior to
the completion of its appellate review.

In the veteran's case, the nature, etiology, and severity of
cardiac symptoms are relevant factors in both determining the
veteran's entitlement to service connection for coronary artery
disease and in order to assess whether or not he is entitled to a
higher evaluation for cardiac neurosis, rated as
psychophysiologic cardiovascular disorder, under 38 C.F.R.
§ 4.132 Code 9501 (1994).  In view of the forgoing, the case is
REMANDED to the RO for the following actions:

1.  The RO should afford the veteran a
cardiovascular examination in order to
determine the current nature, severity, and
etiology of his existing cardiovascular
disease.  The medical examiner is requested
to review the entire claims folder and to
offer an opinion as the date of onset of
the organic basis for the veteran's
cardiovascular complaints, as well as the
nature and severity of the veteran's
present cardiovascular disorder.  The
examiner is requested to discuss the
medical probability that the veteran has a
cardiovascular disorder related his active
service.  If it is determined that the
existing cardiovascular disability is
unrelated to the veteran's service, the
examiner is requested to delineate which
symptoms, if any, are attributable to the
psychophysiologic cardiovascular disorder.
The clinical basis for the medical opinions
should be set forth in detail.

2.  The RO then should review the veteran's
claims for service connection for coronary
artery disease and for an increased rating
for cardiac neurosis in light of the
additional development.  If the benefits
sought on appeal are not granted, then the
veteran and his representative should be
provided with a supplemental statement of
the case.

After he and his representative have been given an opportunity to
respond, the case file should be returned to the Board for
further appellate review, if necessary.  The purpose of this
REMAND is to procure clarifying data and to comply with governing
adjudicative procedures.  The Board intimates no opinion, either
legal or factual, as to the ultimate disposition of this appeal.
The issue of entitlement to service connection for a left hand
disorder is held in abeyance pending the completion of the
additional development.

          LAWRENCE M. SULLIVAN
          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 remand 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) (1994).