BVA9505382 DOCKET NO. 93-05 935 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for a heart disorder. 2. Entitlement to service connection for a back disorder. 3. Entitlement to service connection for a bilateral knee disorder. REPRESENTATION Appellant represented by: Vincent P. Yustas, Attorney WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Deborah W. Singleton, Counsel INTRODUCTION The veteran served on active duty from May 1973 to July 1982. This appeal arises from an October 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. During the course of the veteran’s November 1993 hearing the issue of entitlement to service connection for hypothyroidism was raised. The RO denied this issue in a June 1994 rating decision, however, while the veteran’s Congressman has been informed of the denial, it is unclear whether notice of the denial of entitlement to service connection for hypothyroidism was communicated to the veteran. Accordingly, appropriate action is warranted. REMAND The veteran asserts that he now has a heart disorder which had its onset in service. The record reflects that the veteran reported in his substantive appeal that he currently suffers from re-occurring pericarditis which has caused residual disability including chronic chest pain, sinus tachycardia, and a damaged heart. A review of the service medical records indicate that the veteran was evaluated and treated for acute pericarditis on at least two occasions in June 1980 and February 1981. The service medical records further note that tachycardia, possible pericarditis, atypical chest pain secondary to pericarditis, and acute pericarditis, resolved, were diagnosed during those treatment sessions. Moreover, between inpatient sessions in June 1980 and February 1981, the record reflects a history of persistent chest pain. In December 1989, the veteran was seen for an employment physical examination. This study disclosed sinus tachycardia, with premature ventricular contractions on electrocardiographic testing. X-ray of the chest revealed that it was within normal limits, but borderline. Study of the veteran’s heart revealed normal findings. In June 1991, the veteran filed his claim seeking, among other things, service connection for a heart disorder. He was accorded a Department of Veterans Affairs ("VA") compensation examination in August 1991, and the diagnoses included a history of pericarditis, and "right atrial enlargement with possible lateral ischemia." The veteran was prescribed nitroglycerin for chest pain in March 1992. In September 1992, when the veteran was evaluated at a VA Cardiology Clinic, the examiner noted that the results of a previous exercise stress test were not significant for ischemia. The examiner also noted that an August 1991 electrocardiogram showed "sinus tachycardia" with nonspecific ST-T wave changes. He stated that this documented finding "[might] be related to noncardiac causes," and suggested that a thyroid function test, as well as other laboratory work-up, be performed. The relevant reports of the recommended studies, however, are not of record. Moreover, the Board observes that the veteran's claims file was not made available to the examiner at the time of the most recent VA evaluations. In this regard, the examiner noted that there was no evidence that pericarditis had previously been found. As noted above, the service medical records reveal at least two diagnoses of pericarditis. Subsequently received was a statement from James R. Buckles, M.D., dated in July 1992, indicating that the veteran had been seen by him for various ailments. Dr. Buckles stated that the veteran had developed paroxysmal atrial tachycardia ("PAT"). He stated that the veteran provided a history of having acute pericarditis while in service, and felt that this condition could be a contributing factor of PAT. In Caffrey v. Brown, 6 Vet.App. 377, 381 (1994), the United States Court of Veterans Appeals held that where the VA orders a medical examination pursuant to its statutory duty to assist a veteran who submits a well-grounded claim, such "examination must consider records of prior medical examinations and treatment in order to assure a fully informed examination." In this case, the record reflects that the VA examinations of August 1991 and September 1992 were conducted without considering the veteran's claims files (including his service medical records), and in the case of the latter examination, without the benefit of appropriate diagnostic tests. Hence, the veteran was not provided "thorough and contemporaneous medical examination[s]." Green v. Derwinski, 1 Vet.App. 121, 123 (1991); Waddell v. Brown, 5 Vet.App. 454, 456 (1993). Under the circumstances of this case, the Board finds that additional development is necessary to ensure full compliance with the duty to assist requirements. The case is therefore REMANDED to the regional office (RO) for the following development: The veteran should be afforded a special VA cardiovascular examination to determine the nature and extent of any heart disorder diagnosed. This examination should be conducted in accordance with the VA Physician's Guide for Disability Evaluation Examinations, and all necessary tests and studies, including a thyroid function test, should be accomplished and clinical manifestations reported in detail. The claims folder, including the service medical records, must be made available to the examiner prior to evaluation for use in the study of this case. In reviewing the veteran's case, the examiner is further requested to offer an opinion as to whether the veteran's current heart disability is related to his inservice symptomatology. The examination report should be typed. Following completion of the requested development, the agency of original jurisdiction should again review the evidence and determine whether the veteran's claim for a heart disorder may now be granted. If not, he and his representative should be provided a supplemental statement of the case and the case should be returned to the Board for further appellate consideration. The veteran need take no action unless otherwise notified. The Board intimates no opinion as to the ultimate disposition of the issues on appeal. Appellate consideration of the veteran's claims for service connection for a back and bilateral knee disorders is deferred pending completion of the additional development. DEREK R. BROWN 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).