Citation Nr: 18160632
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 07-35 229
DATE:	December 27, 2018
REMANDED
Service connection for a heart disorder, claimed as Wolff-Parkinson-White Syndrome (WPW) and premature ventricular contractions (PVC) is remanded.
Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from October 1997 to February 2003.  
As an initial matter, a review of the evidence of record reveals that the Veteran has been diagnosed with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).  Accordingly, the Board has recharacterized the issue on appeal as service connection for an acquired psychiatric disorder to better reflect the scope of the claim.  Clemons v. Shinseki, 23 Vet. App. 1 (2009).
1. Service connection for a heart disorder, claimed as Wolff-Parkinson-White Syndrome (WPW) and premature ventricular contractions (PVC) is remanded.
The Veteran asserts, through her attorney, that she was diagnosed with WPW while in service, which required a surgical ablation that was performed in service, and that she should be service-connected for premature ventricular contractions, a residual of that procedure.
By way of background, the Veteran’s claim for service connection was denied in an October 2008 Board decision for lack of a current diagnosis.  In that same decision the Board found that the Veteran’s heart disorder was not a pre-existing condition as there was no showing of clear and unmistakable evidence of pre-existing heart condition and that the presumption of soundness was not rebutted, as the Board quoted a VA examiner’s opinion that her heart condition was exacerbated during military service.  As the Veteran’s heart condition worsened to the point of her requiring a surgical procedure, the Board continues to find that the presumption of soundness has not been rebutted.
The Veteran appealed the Board’s decision.  The Court of Appeals for Veterans Claims (Court) issued a Joint Motion Remand ( JMR ) in December 2008 which vacated and remanded the October 2008 Board decision.  The Court found that the VA examination relied upon by the Board was inadequate for adjudication purposes and that a new VA medical evaluation was necessary.
The case was returned to the Board and the Board remanded for a VA examination in July 2011, in August 2012, and again in June 2016.  
In September 2016, an ACE and Evidence Review was conducted.  The examiner concluded that the Veteran had a diagnosis of mild arrhythmia, and no longer had a diagnosis of WPW, as the ablation procedure in service resolved that condition.  The examiner stated that “WPW is by definition a congenital condition in which one is born with an extra, accessory nerve conduction pathway…Veteran had this accessory pathway removed/ablated, so no longer has a current diagnosis of WPW.”
The examiner did not address the Veteran’s assertion that her diagnosed PVC (VA examination February 2008 and noted in this examiner’s report) was a residual of her WPW, which was also a remand directive in the June 2016 Board remand.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  Also, the examiner stated that the Veteran did not have PVCs while on active duty.  As the service treatment records are not associated with the file, the evidence of record does not support this conclusion.  Moreover, the Court ordered a new VA examination, not a records review.
Based on the foregoing, the Board determines that a VA examination is necessary in accordance with both the Court’s and the Board’s remands.  
Finally, the Board notes that a formal finding of Unavailability of Service Records was placed in the Veteran’s file in September 2006.  However, the Veteran’s military personnel files were associated with the Veteran’s file in November 2014.  As the last time that a search was made for the Veteran’s service treatment records (STR) was in September 2006, a new search for the Veteran’s STR should be conducted.

2. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is remanded.
As an initial matter, the Board notes that the Veteran’s treatment records show diagnoses of PTSD and MDD.  The Veteran credibly asserts that her PTSD is a result of coming under small arms fire, rockets and mortars while serving in Afghanistan, as well as finding the body of her best friend with a bullet wound to the head in the barracks at Fort Benning.  To date, she has not been afforded an Initial PTSD examination by VA.
Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), a medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.  See also 38 U.S.C. § 5103A (d)(2) (2012); 38 C.F.R. § 3.159 (c)(4)(i).

The matters are REMANDED for the following action:
1. Make every effort to obtain the Veteran’s complete service treatment records.
2. After undertaking the above development to the extent possible, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any heart condition.  
The examiner must opine whether any heart condition is at least as likely as not related to an in-service injury, event, or disease, including the diagnosed Wolff-Parkinson-White Syndrome (WPW) condition in service, which required an ablation procedure while the Veteran was on active duty, and any residuals from WPW, or from the ablation procedure. 
The examiner must address the medical evidence submitted by the Veteran’s attorney.  He submitted evidence that WPW “involves premature ventricular contractions according to the American Heart Association’ web site.”  The examiner must discuss this article and the link between WPW and PVC, noting that the Veteran has been repeatedly diagnosed with PVC.
The Veteran is presumed sound upon entry and the presumption of soundness attaches to the Veteran’s heart condition.  
In providing the requested opinion, the examiner should comment on the Veteran’s competent lay reports.  
3.  After the Veteran’s reported stressors have been developed, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD).  If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor, to include coming under fire from small arms, rockets, and mortars while serving in Afghanistan.  
If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include the Veteran’s experiences under fire in Afghanistan, and finding her best friend dead of a bullet wound to the head in the barracks at Fort Benning.  
(Continued on the next page)
 
4. Then, the record should again be reviewed.  If any benefit sought on appeal remains denied, the Veteran and her representative should be furnished with a supplemental statement of the case and be given the opportunity to respond.
 
Jennifer White
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Nelson, Associate Counsel

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