BVA9505228 DOCKET NO. 93-12 860 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for a cardiovascular disability, including hypertension. 2. Entitlement to service connection for a psychiatric disability. 3. Entitlement to service connection for pes planus. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Mark J. Swiatek, Counsel REMAND The veteran had active duty from October 1960 to September 1963. This matter comes before the Board of Veterans' Appeals (Board) from a November 1992 decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. A review of the record discloses that the November 1992 rating decision regarding a heart disability and pes planus was based on the finding of a pre-existing congenital or developmental abnormality that was not aggravated "beyond natural progress" by service. It was determined that the psychiatric disability was related to the cardiovascular disorder, pre-existed service and was not aggravated by service. In essence, the decision accepted the determination of a military medical evaluation during 1961 with respect to the heart, and psychiatric disorders. The record, however, does not include a contemporaneous, comprehensive VA examination on any matter at issue. Nor does it include complete service medical records likely to be available. The Board observes that the service medical records on file include the report of physical examination for entry into service that shows no finding of any heart or psychiatric disorder. Noted was second degree pes planus of the left foot. The summaries of medical evaluations during May and June 1961 mention the findings of various diagnostic tests. The complete inpatient records, however, are not on file. The separation medical examination does not mention pes planus. In view of the decision of the United States Court of Veterans Appeals (Court) in Crowe v. Brown, No. 93-550 (U.S. Vet. App. Dec. 20, 1994), the Board finds that additional development is required in order to provide a record upon which an informed determination of the issue on appeal can be made. In Crowe, the Court set forth various medical questions that must be addressed in adjudicating issues of preexistence of a disability and aggravation by service, in particular the presumption of soundness. A copy of this decision is attached. Accordingly, the case is REMANDED to the RO for the following action: 1. The RO should make another attempt to secure the veteran's complete original service medical records through official channels. These should include all records from his May 1961 admissions to the United States Army Hospital, Augsburg, Germany and the United States Army Hospital, Frankfurt, Germany. 2. The veteran should be contacted and asked to provide the names and addresses of all VA and non-VA health care providers who have treated him for any cardiovascular disorder, including hypertension, any psychiatric disability or pes planus since his separation from active service. He should also be requested to identify those physicians who treated him at any time for such complaints prior to service. After obtaining the appropriate release for medical information, the RO should request all records likely to be available which have not been previously obtained and associate them with the claims folder. 3. Thereafter, the veteran should be scheduled for an examinations by a board- certified psychiatrist, cardiologist and orthopedist, if available, to determine the nature and extent of any, psychiatric or cardiovascular disability or pes planus found. The psychiatric examiner is requested to review the claims folder and provide an opinion regarding the following questions: (1) Did a history recorded in service, in the absence of medical records showing treatment for, or a diagnosis of, a psychiatric disability prior to service conclusively establish that the veteran had a psychiatric disability upon entering service; (2) If so, was there a worsening of the veteran's psychiatric disability during service; and (3) if so, is there clear and unmistakable evidence that the increase in severity was due to the "natural progress" of the disease; (4) or did the psychiatric symptoms in service render the veteran more susceptible to such symptoms later and; (5) could a worsening of the condition reasonably have been expected to have been found at the time of the separation examination. If the first question is answered in the negative, the examiner is requested to provide an opinion regarding etiologic significance, if any, of any psychiatric complaints prior to and during service, and the degree of probability, if any, that the psychiatric disability currently found is related to the psychiatric complaints in service. The orthopedic specialist should be requested to provide the same analysis with respect to pes planus. In each instance, the examiners should provide a rationale for all opinions and conclusions expressed. 4. With respect to a cardiovascular disability, including hypertension, the physician should, after review of the claims folder, provide opinions to the questions set forth above. Regarding hypertension, the examiner should provide a statement regarding the etiology of the disorder and the significance, if any, of the cardiovascular complaints during service in the development of hypertension. 5. Thereafter, the RO should readjudicate the issues on appeal to include consideration of Crowe v. Brown. If any benefit sought on appeal is not granted, a supplemental statement of the case should be issued and the veteran and his representative provided the applicable period in which to respond. Thereafter, the case should be returned to the Board for further consideration, if in order. By this REMAND, the Board intimates no opinion as to the final outcome warranted. No action is required of the veteran until he is notified by the RO. CHARLES E. HOGEBOOM 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 action has been taken in accordance with the Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 303, 108 Stat. 4645, ___ (1994), and 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).