BVA9501139 DOCKET NO. 93-14 079 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a heart disability. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Theresa M. Catino, Associate Counsel INTRODUCTION The veteran served on active duty from April 1941 to January 1944. In a letter received by the regional office (RO) in April 1993, the veteran claimed that he is unable to work. He also questioned his eligibility for dental treatment. These matters, which are not inextricable intertwined with the issue on appeal, are referred to the RO for appropriate action. REMAND In a May 1983 statement, the veteran initially appeared to indicate that he was withdrawing his claim of entitlement to service connection for a heart disability. However, the veteran then specifically stated, "I understand that I will be examined and my case will be reconsidered following [the] exam, and I will retain my appeal rights." The Board of Veterans' Appeals (Board) construes the totality of the May 1983 statement as expressing the veteran's desire not to withdraw his pending appeal. Consequently, the veteran's appeal will be adjudicated based on all the evidence of record and without consideration of the laws, regulations, and case law regarding the issue of finality. Throughout the appeal, the veteran has contended that he incurred, and was treated for, a heart disability during service. In statements dated in April and August 1993, the veteran specifically asserted that he was treated in service for a malfunctioned valve and that the Army wrote a letter verifying this treatment. Although a review of the claims folder indicates that the RO has made some attempts to obtain all of the service medical records, the RO should make a special search to obtain this particular service medical record, in light of the veteran's statements. In addition, the veteran has asserted that his heart disability was caused by his service-connected psychoneurosis and anxiety hysteria. In a December 1992 statement, he maintained that someone at the Department of Veteran's Affairs (VA) Outpatient Clinic in Greenville, South Carolina told him that his heart condition was caused by his service-connected nervous disorder. The only outpatient treatment record included in the claims folder which discusses the relationship between the veteran's heart condition and his nervous disorder includes a physician's opinion that the medication that the veteran is taking for regulation of his heart rate is related to his service-connected nervous disorder. The Board is uncertain whether any other statement is available. It is noted that the February 1944 rating decision that granted service connection for psychoneurosis, anxiety state, recognized that the service- connected disorder was manifested by precordial pains, dyspnea, and weakness of pulse, without organic bases. A rating decision dated in October 1982 reiterated the recognition that the veteran had functional tachycardia associated with the service-connected psychiatric disorder. The United States Court of Veterans Appeals (Court) has held that there is a continuing obligation on the VA to assist the veteran in developing the facts of his claim throughout the entire administrative adjudication process. This obligation includes the duty to obtain records regarding the veteran's medical history. Murincsak v. Derwinski, 2 Vet.App. 363, 373 (1992). Any post-service medical records of treatment that the veteran has received for his heart complaints may demonstrate the etiology of an organic disorder. The most recent VA examination was conducted in June 1983. Significantly, this examination was only a general medication examination. Although the examiner noted the veteran's continued problems of nervousness and found on examination that the veteran had a heart rhythm irregularity with frequent premature auricular contractions and a Grade II systolic murmur over the mitral valve, the examiner did not express an opinion as to whether this present heart disability was caused by, or is in any way related to service or to his service-connected psychoneurosis and anxiety hysteria. VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1991). This duty to assist includes the duty to develop facts when the record before the Board is clearly inadequate. EF v. Derwinski, 1 Vet.App. 324 (1991); Littke v. Derwinski, 1 Vet.App. 90 (1990). The development of facts includes a "thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the evaluation of the claimed disability will be a fully informed one." Green v. Derwinski, 1 Vet.App. 121, 124 (1991). The Board concludes that further assistance to the veteran is required. Accordingly, the case is REMANDED to the RO for the following: 1. The RO should contact the National Personnel Records Center to conduct a special search in an attempt to locate any additional service medical records. Any available records should be associated with the claims folder. 2. The veteran should be contacted and requested to furnish a complete list of all medical personnel and facilities from which he has received treatment for his heart disability since his separation from service. In a statement received directly by the Board in August 1993, the veteran mentioned several sources, records of which have not yet been sought. The Board is also interested in records of any treatment that the veteran may have received from the VA, including the Outpatient Clinic in Greenville, South Carolina. After obtaining the appropriate releases from the veteran where necessary, the health care providers should be contacted and requested to provide all treatment records in their possession pertaining to the veteran. If these records are unavailable, or are duplicates of those already on file, those facts should be annotated in the claims folder. Any available records should be associated with the claims folder. 3. The veteran should be accorded a special VA cardiovascular examination to determine the nature, extent, and etiology of any heart disease he may presently have. The report of examination should include a detailed account of all manifestations of the disorder 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 cardiologist must express an opinion as to whether any heart disease found on examination was caused by, or is etiologically related to, the symptoms shown during service or to the veteran's service-connected psychoneurosis and anxiety hysteria. The claims folder and a copy of this remand must be made available to and reviewed by the examiner prior to the examination. The cardiologist should provide complete rationale for all conclusions reached. 4. Thereafter, the RO should formally adjudicate the issue of entitlement to service connection for a heart disability (on both a direct and a secondary basis). Following completion of these actions, and, if the decision remains unfavorable, the veteran should be furnished with a supplemental statement of the case which includes all pertinent laws and regulations not previously provided, including 38 C.F.R. § 3.310 (1993). He should then 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. The purpose of this REMAND is to obtain clarifying evidence. No action is required of the veteran until further notice is issued. M. SABULSKY 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).