BVA9508242 DOCKET NO. 93-04 825 ) DATE ) ) Received from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to service connection for residuals of rheumatic fever. REPRESENTATION Appellant represented by: Arizona Veterans Service Commission WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD James L. March, Associate Counsel INTRODUCTION The veteran had active service from September 1948 to August 1952. This appeal comes to the Board of Veterans' Appeals (Board) from a July 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office in Chicago, Illinois. The veteran's claims file was subsequently transferred to the Regional Office (RO) in Phoenix, Arizona. REMAND The veteran contends that service connection is warranted for residuals of rheumatic fever. He alleges, in essence, that, although he had rheumatic fever prior to service, the exacerbation in service caused his heart disability. The veteran's enlistment examination, conducted in September 1948, was negative for any evidence of rheumatic fever. In March 1949, he was hospitalized complaining of having no pep. It was noted that he had had rheumatic fever in 1942 and that he had been bedridden for five months. Concerning the heart, it was noted that it was enlarged to the left, with a rapid rate and a rough systolic murmur. The impression was acute rheumatic fever. In August 1951, an examination revealed no murmur. Prior rheumatic fever was noted. In March 1952, the veteran was seen again complaining of chronic fatigue and leg cramps. Examination of the heart revealed a normal rate and rhythm, with no definite murmurs. X-rays showed that the heart was not enlarged. His separation examination report of July 1952 notes that he first had had rheumatic fever at the age of 14 years. The separation examination was negative for any residuals of rheumatic fever. Specifically, there were no cardiac problems; the examiner reported that the heart sounds were regular and that there were no murmurs. A chest X-ray was negative. The first evidence of medical treatment of the veteran after service is from January to February 1991 from John M. Wadleigh, D.O. In January 1991, Dr. Wadleigh first treated the veteran who complained of shortness of breath and a fast heart beat. The diagnosis was atrial fibrillation and status post rheumatic fever, with mild to moderate aortic and mitral stenosis. A VA examination was conducted in June 1991. The veteran reported having developed rheumatic fever during military service. A cardiac examination revealed an irregular rate and rhythm with a systolic ejection murmur. The diagnosis was history of rheumatic fever while in the military with subsequent atrial fibrillation which has continued and persisted despite current medical regime. An October 1991 note from Dr. Wadleigh indicates that the veteran had mitral and aortic valve disorder secondary to rheumatic heart disease. It was further noted that the veteran had cardiac dysrhythmia due to the valvular disorder, and that he had a systolic murmur. Similarly, a statement from Douglas C. Schaber, D.O., who had treated the veteran in January 1991, indicates that the veteran's cardiac problems were probably a direct result of his having had rheumatic fever several years prior. The medical evidence is fairly clear that the veteran's cardiac disability is due to rheumatic fever; however, it is not clear whether the episode in service was the specific cause. In light of the foregoing, the Board is REMANDING this case for the following actions: 1. The RO should contact the veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him since service for rheumatic fever or cardiac disability. In addition, the RO should inquire of the name, address, and approximate dates of treatment for the health care provider who treated his rheumatic fever prior to service. With any necessary authorization from the veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the veteran in response to this request, which have not been previously secured. 2. The RO should arrange for a VA cardiology examination by a board certified cardiologist, if available, to determine the current nature and extent of the veteran's cardiac disability. It is imperative that the claims folder and a copy of this REMAND be provided to the examining physicians for review prior to their examinations. The examiner should be requested to comment on whether it is at least as likely as not that the in-service episode of rheumatic fever was the specific cause of his current cardiac disability. All indicated studies should be done. 3. Then, the RO should undertake any other indicated development and readjudicate the issue on appeal. If the benefits sought on appeal are not granted to the veteran's satisfaction, the veteran and his representative should be issued a supplemental statement of the case and be afforded a reasonable opportunity to reply. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. In taking this action, the Board implies no conclusion as to any ultimate outcome warranted. No action is required of the veteran until he is otherwise notified by the RO. F. JUDGE FLOWERS 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. (CONTINUED ON NEXT PAGE) 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) (1994).