BVA9501843 DOCKET NO. 93-10 665 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey THE ISSUE Entitlement to service connection for postoperative residuals of coarctation of the aorta. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. F. Halsey, Counsel INTRODUCTION The veteran served on active duty from December 1954 to December 1956. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating actions taken in April and July 1991 that denied an application to reopen a claim of service connection for coarctation of the aorta. (A claim of service connection was initially denied in February 1957. The veteran was notified of the adverse action in correspondence dated February 26, 1957, but did not appeal.) Following receipt of an October 1992 letter from a physician employed by the veteran's representative, the RO determined, in a November 1992 rating action, that new and material evidence sufficient to reopen the claim had been presented. Nevertheless, the RO found that a grant of service connection was not warranted. REMAND The veteran contends that coarctation of the aorta was first discovered while he was on active military duty. He notes that it became such a problem that surgery during service was required. In support of his claim, he points to an October 1992 medical opinion suggesting that he may not have had this condition when he entered military service. This opinion also includes a statement to the effect that the veteran's condition deteriorated during service. The veteran claims that this medical opinion, considered alongside documented inservice complications of coarctation of the aorta, lead to a conclusion that coarctation of the aorta either began during service or was aggravated thereby. Although the October 1992 opinion regarding the veteran's condition at entrance is posited in somewhat speculative terms, it raises certain questions that require further development. For example, 38 C.F.R. § 3.306(b)(1) (1993) provides that the "usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment ... will not be considered service connected unless the disease or injury is otherwise aggravated by service." § 3.306(b)(1) (emphasis added). The effect of this regulation is to allow a grant of service connection for any condition incurred before enlistment--whether a congenital defect or not--in those cases where the evidence shows that surgical treatment during service had unusual effects. Records prepared following the inservice surgery suggest improvement in arterial pressure studies, but little else is available on the question of how the veteran's current status is influenced by any unusual effects of the surgery. In order to obtain evidence sufficient to answer the questions regarding the onset of coarctation of the aorta, its course during service, and the effects of the inservice surgery, the case is REMANDED for the following actions: 1. The RO should schedule the veteran for an examination by a cardiologist. The claims file must be made available to and reviewed by the examiner prior to the examination. The examination and review of the record should be performed with a view toward answering the following questions. (A discussion of the facts and medical principles involved in each answer should be set forth in detail.) a. Did the veteran's coarctation of the aorta exist prior to the date he entered active duty? Please base this determination not on medical judgment alone, but on careful examination of the record, with due regard to accepted medical principles pertaining to history, manifestations, clinical course, and character of the condition. b. If the coarctation of the aorta existed prior to the veteran's active duty, did it (the underlying pathology) increase in severity during service (based on all the evidence pertaining to its manifestations before, during, and after service)? c. If there was such an increase in severity, is it your opinion that the increase was clearly due to the natural progress of the condition, based on medical facts and principles? d. Finally, were there any unusual effects of the surgery in service that contribute to his current disability? 2. Following completion of the foregoing, the RO should review the record and ensure that all requested actions have been completed in full. Any required corrective action should be taken. Thereafter, the RO should adjudicate the issue on appeal. If the benefit sought by the veteran is not granted, a supplemental statement of the case should be issued. After the veteran and his representative have been given an opportunity to respond to the supplemental statement of the case, the claims folder should be returned to this Board for further appellate review. No action is required of the veteran until he receives further notice. The purposes of this remand are to procure clarifying data and to comply with governing adjudicative procedures. The Board intimates no opinion, either legal or factual, as to the ultimate disposition of this appeal. J. E. DAY 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).