BVA9507971 
DOCKET NO.  93-14 065     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Waco, Texas

THE ISSUE

Entitlement to an increased evaluation for rheumatic heart
disease, currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: The American Legion

ATTORNEY FOR THE BOARD

A. K. Mulroy, Associate Counsel

REMAND

The veteran had active duty from November 1968 to November 1971.

The veteran contends that his current heart symptomatology and
disability are due to his rheumatic heart disease, and warrants an
evaluation greater than 10 percent.  Specifically, he maintains
that his current diagnosis of coronary artery disease, myocardial
infarction, and hypertension may not  be dissociated from his
service-connected rheumatic heart disease, and should be
considered in the assignment of a disability evaluation for
rheumatic heart disease.

In reviewing the record the Board notes that although the veteran
was diagnosed with rheumatic heart disease soon after service, the
diagnosis has not been confirmed since that time.  However, he has
subsequently developed coronary artery disease and hypertension,
and has experienced a myocardial infarction.  The coronary artery
disease and myocardial infarction have been diagnosed since his
last VA examination dated in January 1992.

The Board notes that, as pointed out by the veteran's
representative, VA regulations state that subsequent progress of
rheumatic heart disease and the effect of superimposed
arteriosclerotic heart disease or hypertensive changes cannot
usually be satisfactorily disassociated or separated so as to
permit differential service connection.  38 C.F.R. § 4.101 (1994).
The Board notes that while such differentiation may be difficult,
it is not forbidden or impossible, particularly in this instance,
where the issue is not service connection but an increased
evaluation for rheumatic heart disease.  However, there is no
medical opinion in the file addressing whether the veteran's
recent heart symptomatology could be clinically dissociated from
his service-connected rheumatic heart disorder.  Such a medical
conclusion is beyond the scope of the Board.  Additionally, it is
noted that the veteran's recent heart symptomatology developed
subsequent to the latest VA examination.

Therefore, the Board concludes that an additional VA examination,
with an opinion by the examiner, would be helpful in evaluating
the veteran's current service-connected disability status.

To ensure that the VA has met its duty to assist the claimant in
developing the facts pertinent to the claim and to ensure full
compliance with due process requirements, the case is REMANDED to
the RO for the following development:

The veteran should be afforded a VA
cardiovascular examination in order to
determine the current degree and extent of
his rheumatic heart disease.  The claims
folder should be made available to the
examiner for review prior to the
examination.  Following the examination and
a thorough review of the claims folder, the
examiner is requested to offer an opinion
as to whether the veteran ever had
rheumatic heart disease; and whether the
veteran's hypertension, coronary artery
disease, and myocardial infarction may be
clinically dissociated from the
service-connected rheumatic heart disease.
If so, the examiner is requested to attempt
to differentiate between disability due to
residual symptomatology associated with
rheumatic heart disease, and disability due
to the symptomatology associated with the
other disorders.

When the above development has been completed, the case should
again be reviewed by the originating agency.  If the decision
remains adverse to the veteran, he and his representative should
be furnished a supplemental statement of the case and afforded a
reasonable period to respond.  Thereafter, subject to current
appellate procedures, the case should be returned to the Board for
further appellate consideration, if appropriate.

The veteran need take no action until he is further informed.  The
purpose of this REMAND is to obtain clarifying information and the
Board intimates no opinion as to the ultimate outcome of this
case.

          U. R. POWELL
          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).