Citation Nr: 1000183 Decision Date: 01/04/10 Archive Date: 01/14/10 DOCKET NO. 08-17 161 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California THE ISSUE Entitlement to service connection for hypertension. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD C. L. Wasser, Counsel INTRODUCTION The Veteran served on active duty from May 1969 to July 1991. This case comes to the Board of Veterans' Appeals (Board) on appeal from a June 2006 decision by the RO in Oakland, California that denied service connection for hypertension. The Veteran initially requested a Board hearing, and such a hearing was scheduled, but the Veteran withdrew his hearing request in July 2009. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Although further delay is regrettable, the Board finds that further development is required prior to adjudication of the Veteran's claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Moreover, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and hypertension becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. In this regard, the Board notes that under Diagnostic Code 7101, a 10 percent rating is assigned for hypertension when diastolic pressure is 100 or more; or when systolic pressure is predominantly 160 or more; or when there is a history of diastolic pressure predominantly 100 or more and continuous medication for control is required. Note (1) indicates that hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of the section, hypertension is defined as diastolic pressure of 90mm or greater and isolated hypertension is defined as systolic blood pressure of predominantly 160mm or greater with a diastolic pressure of less than 90mm. 38 C.F.R. § 4.104, Code 7101. Service treatment records reflect that in August 1975, the Veteran's blood pressure was 155/95. Hypertension was not diagnosed. Subsequent service treatment records reflect fluctuating blood pressure readings, with no diagnosis of hypertension. In August 1983, his blood pressure was 138/96, while in December 1983 his blood pressure was 120/80. In March 1985 it was 112/78. On retirement examination in October 1990, his blood pressure was 132/84. The Veteran retired from military service in July 1991. Post-service medical records from David Grant Medical Center (DGMC) reflect that in April 1992, the Veteran's blood pressure was 140/87; hypertension was not diagnosed. In September 1992, his blood pressure was 128/76. At a September 1993 VA examination, the Veteran's blood pressure was 145/98 (lying), 134/91 (sitting), and 126/92 (standing). The examiner diagnosed hypertension; there was no opinion as to etiology. Outpatient treatment records from DGMC show that in September 2000, the Veteran's blood pressure was 151/90, and the diagnosis was rule out hypertension. An August 2001 treatment note reflects that the Veteran had a 5-day blood pressure check, and all readings were 150s-160s/90s. The diagnosis was hypertension. Subsequent medical records reflect treatment for hypertension. By a statement dated in May 2006, A.P., apparently a physician, from the internal medicine staff of Travis Air Force Base, indicated that the Veteran had been treated at David Grant Medical Center since 1988, and that the available records revealed hypertension dating back to 1992. She noted that records prior to that date had been retired. In November 2007, Dr. P. indicated that the Veteran had carried a diagnosis of hypertension since at least 1992. As there is evidence of a current disability, medical evidence of intermittently elevated blood pressure readings during service and within the first post-service year, and an indication that the disability may possibly be associated with the Veteran's service or manifested within the first post-service year, the Board finds that it is necessary to afford the Veteran a VA medical examination to obtain a medical opinion to determine whether the Veteran's current hypertension is related to service, or was manifested within the first year after separation from service. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C.A. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). Accordingly, the case is REMANDED for the following action: 1. The RO/AMC should arrange for a VA examination of the Veteran to determine the etiology and date of onset of the current hypertension. All indicated studies should be performed, and the claims folder must be made available to the examiner for review prior to the examination. Based on the examination of the Veteran and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or higher) that the current hypertension had its onset in service or within the first post-service year, or is causally related to service. The rationale for any opinion expressed should be provided in the examination report. 2. Thereafter, readjudicate the claim for service connection. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case, and given an opportunity to respond before the case is returned to the Board. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2009).