BVA9501082 DOCKET NO. 93-07 268 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUE Entitlement to service connection for coronary artery disease. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Christine E. Puffer, Associate Counsel INTRODUCTION The veteran had active service from July 1955 to July 1958, September 1958 to September 1961, and a period of active duty for training from July 22, 1989, to July 29, 1989. REMAND The veteran contends that he did not have a heart condition prior to entering into active duty for training in July 1989. It has been argued on his behalf that, even if a heart condition had existed prior to service, it was aggravated therein. A RO request for service medical records sent to the National Personnel Records Center (NPRC) was returned in April 1991, with an appended request that the veteran complete a specified form. Although the completed form is in the claims folder, it is the unsigned original, and there is no indication that a copy of the same was forwarded to the NPRC for further action. None of the service medical records from either of the veteran's first two periods of active service are of record. A review of the medical documents of record from the veteran's last period of service indicates that he received treatment at the Eglin Air Force Base Hospital (Eglin) in July 1989 prior to being transferred to Wilford Hall United States Air Force (U.S.A.F.) Medical Center (Wilford). However, none of the records reflecting treatment of the veteran at Eglin from July 27, 1989, to August 2, 1989, are on file. In addition, few of the clinical records regarding the veteran's treatment at Wilford during August 1989 are of record. As the duty to assist includes the obtaining of all relevant medical records, a remand is warranted. Dyess v. Derwinski, 1 Vet.App. 90, 92 (1991). The veteran's representative has cited a July 1990 Air Force letter that found that, while the veteran's coronary artery disease had existed prior to service, it had possibly been aggravated therein. However, a review of the noted letter indicates that the reviewing medical officer was rather equivocal as to whether the veteran's cardiac condition had been truly aggravated in service. In support of his claim, the veteran has submitted a medical statement from Robert B. Blumer, M.D., dated in May 1992. Dr. Blumer indicated that the stated Air Force finding that the veteran's cardiac condition had pre-existed service was apparently in error. The physician referenced an April 1987 stress test and associated electrocardiogram in support of this conclusion. No other medical records were cited. The VA has recognized the need for a historical review of a veteran's medical condition in evaluating a medical condition. See 38 C.F.R. § 4.1. In this regard, the Board notes that the veteran's medical records contain an April 1987 chest X-ray report that noted left ventricular prominence and moderate uncoiling of the aorta; similar findings were also noted in February 1988. Electrocardiogram reports of February 1988 and June 1989 both were abnormal, and suggested, in part, that consideration of myocardial disease be given. In light of the noted medical records and conflicting opinions, the Board finds that further development is needed to clarify the medical issues associated with the veteran's claim. See Littke v. Derwinski, 1 Vet.App. 90 (1990). As additional development of the evidence is necessary, this case is REMANDED to the RO for the following action: 1. The RO should request copies of all records of treatment, including both outpatient and hospitalizations, accorded the veteran at Eglin Air Force Base during July and August 1989. If the medical records are unavailable, all necessary steps to secure copies of the same from the appropriate source should be taken. 2. The RO should request copies of all clinical records of treatment accorded the veteran at Wilford Hall U.S.A.F. Medical Center during August 1989. If the medical records are unavailable, all necessary steps to secure copies of the same from the appropriate source should be taken. 3. The RO should submit the completed NA Form 13075 contained in the claims folder to the NPRC, and obtain copies of the veteran's service medical records for his periods of active service from July 1955 to July 1958, and from September 1958 to September 1961. 4. Upon completion of the development requested above, the veteran's claims folder should be submitted for review by a VA cardiologist. A comparative analysis of the medical evidence of record should be conducted by the examiner for the purpose of formulating a medical opinion as to the date of any initial manifestations of the veteran's coronary artery disease. If the examiner should determine that the veteran's coronary artery disease existed prior to his period of active duty for training from July 22, 1989, to July 29, 1989, a further opinion should be offered as to whether that condition increased in severity beyond its natural progression during the veteran's July 1989 active duty for training. The rationale for all opinions expressed should be explained. When the development requested in the above paragraphs has been completed, the case should again be reviewed on the basis of the additional evidence. Unless the veteran is satisfied with any favorable action and withdraws his appeal, a supplemental statement of the case should be furnished the appellant and his representative. They should then be afforded the appropriate period of time to respond. Thereafter, the case should be returned to the Board for further consideration. The purpose of this REMAND is to assist the veteran in the development of his claim, and the Board does not intimate any opinion as to the merits of this case, either favorable or unfavorable, at this time. No action is required of the veteran until he is notified. WARREN W. RICE, JR. 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).