BVA9501693 DOCKET NO. 93-09 422 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUE Entitlement to service connection for heart murmur with congenital aortic regurgitation. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. S. Nemeth, Associate Counsel INTRODUCTION The appellant's active service in the Army National Guard extended from November 1984 to October 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 1991 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in No. Little Rock, Arkansas, which denied service connection for heart murmur with congenital aortic regurgitation. REMAND The appellant, who underwent surgery for the closure of a patent ductus arteriosus at age 5 and has had a heart murmur all his life, asserts that his pre-existing heart condition increased in severity due to service in the Army National Guard. He contends that he successfully completed basic and advanced individual training, but subsequent to that, the appellant began experiencing shortness of breath and chest pain during the two mile run. The appellant contends that he continues to be affected by short-windiness, which was not present before his service in the National Guard. In a service medical examination report dated December 1989, the appellant was reported to have "chest pain and dyspnea on exertion - unable to run or to exercise." A cardiology examination was recommended. A cardiology examination was performed in January 1990 by a private physician, who had apparently seen the appellant previously. The physician told the appellant that although he did not see any evidence of the progression of his valve disease, he should accept a medical discharge as he would not be able to complete the required two mile run. The doctor recommended another appointment in six months from that time. As this recommended examination may have probative value, the RO should obtain the report from that examination as well as the appellant's subsequent private medical records. The VA has a duty to assist the appellant in the development of his claim. 38 U.S.C.A. § 5107(a) (West 1991). This duty includes having the appellant examined. See Littke v. Derwinski, 1 Vet.App. 90 (1990). The appellant was never examined by a VA cardiologist during the development of this claim, therefore, the RO should make arrangements for the appellant to be so examined. Accordingly, this case should be remanded to the RO for the following development: 1. The RO should obtain from the appellant a list of all doctors and hospitals that have treated him for his heart condition before and since separation from service, including the dates and locations of the treatments. The RO should obtain all necessary signed releases and obtain all records that are not currently associated with the claims file. Specifically, the RO should obtain the records from Dr. D.A. Henry of the Little Rock Cardiology Clinic, P.A. These records should then be attached to the claims file. 2. The RO should verify whether all service medical records covering the appellant's military service have been obtained. If any service medical records are missing, the RO should make arrangements to obtain them from the appropriate service department. 3. The appellant should then be afforded a VA cardiology examination. The claims folder and a copy of this Remand must be made available to and be reviewed by the examiner prior to the examination. The report of the examination should include a detailed account of all manifestations of heart pathology found to be present. All necessary tests should be conducted and the examiner should review the results of any testing prior to completion of the report. The examiner should provide a comprehensive report including a diagnosis of any heart pathology found to be present. Specifically, the physician should provide an opinion as to the following: A. Based on the records on file, can we say that the medical record clearly establishes that the appellant had a heart disorder prior to his military service? If so, was there any increase in the basic pathology during service? B. What are the probabilities that the heart murmur and/or aortic regurgitation noted in service were acquired as a result of physical exercise or stress during the appellant's military training? The physician must provide complete rationale for all conclusions reached. 4. The RO should review the examination report and determine if it is adequate for rating purposes and in full compliance with this Remand. If not, the report should be returned for corrective action. Following the completion of these actions, the RO should review the appellant's claim and if the decision remains unfavorable, the appellant and his representative should be provided with a supplemental statement of the case and be afforded a reasonable period of time in which to respond. Thereafter, the case, in accordance with the current appellate procedures, should be returned to the Board for completion of appellate review. No further action on the part of the appellant is required until further notice. JOAQUIN AGUAYO-PERELES 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) (1993).