Citation Nr: 18132296
Decision Date: 09/06/18	Archive Date: 09/06/18

DOCKET NO. 13-34 045A
DATE:	September 6, 2018
REMANDED
Service connection for cardiac events is remanded.
REASONS FOR REMAND
The Veteran served on active duty from February 1984 to May 2005.
In January 2018, the Veteran testified during a Travel Board hearing before the undersigned Veterans Law Judge.  A transcript of the hearing is of record.
The Veteran asserts his heart disorder is related to his military service.  Specifically, he asserts that his current heart problems are a result of his in-service complaints for chest pain and atrial fibrillation.  See December 2013 VA Form 9.  He testified that he was treated for atrial fibrillation, irregular heart beat and syncope in service and that, in November 2009, he was treated for bradycardia and given a pacemaker. 
Service treatment records reflect that the Veteran was treated for chest pain, lightheadedness, sinus bradycardia, rapid heart-beat, syncope, and atrial fibrillation.  A May 1991 treatment report reflects the Veteran was diagnosed with left ventricular hypertrophia.  
VA treatment records reflect that the Veteran was given a pacemaker in November 2009 and active problem lists include treatment for postsurgical status for cardiac pacemaker, syncope and collapse, and arrhythmia.  A February 2013 treatment report reflects treatment for coronary artery disease. 
In November 2009 the Veteran’s private treatment provider reported that he has had bradycardia for the last 20 years, has been symptomatic since 1995 and has had atrial fibrillation since 1995.  Treatment reports reflect the Veteran has had three syncopal episodes since 1995, that the Veteran was diagnosed with micturion syncope, and he has hypertension. 
The Veteran underwent VA examinations in January and June 2009, and December 2012.  The Board notes that the Veteran’s January and June 2009 examination reports have not been associated with the claims file.  The December 2012 examiner recorded that the Veteran has never been diagnosed with a heart conditions.  The examiner opined that the claimed condition was less likely than not incurred in or caused by military service.  He explained that the Veteran has no documented diagnostic evidence of atrial fibrillation while on active duty; all electrocardiograms reveal sinus rhythm.  
Based on the foregoing it is unclear how the December 2012 VA examiner arrived at the conclusion that the Veteran has never been diagnosed with a heart disorder and that there is no evidence that the Veteran had atrial fibrillation on active duty. Accordingly, the Board finds that a remand is necessary to obtain a supplemental medical opinion to clarify the nature and etiology of the Veteran’s heart disorder.  
The matter is REMANDED for the following actions:
1. The agency of original jurisdiction should associate with the Veteran’s claims file the January and June 2009 VA examination reports. 
2. The claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current heart disorder is related to an in-service injury, event, or disease.  In offering the opinion, the examiner is asked to consider service treatment records that reflect the Veteran was treated for atrial fibrillation, chest pain, lightheadedness, sinus bradycardia, rapid heart-beat, syncope, and left ventricular hypertrophia; and, the Veteran’s November 2009 pacemaker surgery.
3. The need for an examination is left to the discretion of the examiner.  A rationale for all opinions offered is requested as the Board is precluded from making any medical findings.
4. Then, the record should again be reviewed.  If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be given the opportunity to respond.
 
ANTHONY C. SCIRÉ, JR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Gonzalez, Associate Counsel

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