Citation Nr: 1012002 Decision Date: 03/31/10 Archive Date: 04/07/10 DOCKET NO. 08-22 610 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to service connection for hypertension, secondary to service-connected diabetes mellitus type II. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD S. Richmond, Counsel INTRODUCTION The Veteran had active military service from January 1966 to January 1969. This matter comes to the Board of Veterans' Appeals (Board) from a December 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona, which denied service connection for hypertension. In August 2009, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing at the RO. The Veteran was granted 60 days from the date of the hearing to submit additional evidence but did not submit anything. The issues of entitlement to service connection for elevated cholesterol, psychiatric disorders including anxiety, depression, and nightmares, lowered thyroid function, and weight loss, all secondary to diabetes mellitus type II, service connection for posttraumatic stress disorder, and entitlement to an increased rating for erectile dysfunction have been raised by the record, but have not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over them, and they are referred to the AOJ for appropriate action. 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 The Veteran seeks service connection for hypertension secondary to diabetes mellitus type II. Service connection on a secondary basis can be granted based on a direct connection, i.e., the claimed disability is proximately due to or the result of the service-connected disability. See 38 C.F.R. § 3.310(a). Secondary service connection also can be granted based on aggravation. See 38 C.F.R. § 3.310(b) (effective October 10, 2006). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. Id. The Veteran underwent a VA examination in October 2007 to determine the etiology of his hypertension. The examiner noted the history of blood pressure readings since 2003 and also noted that the Veteran had no known complications of hypertension including history of stroke, coronary artery disease, or peripheral vascular disease. The examiner also found that in the absence of significant nephropathy/ renal insufficiency, the diabetes was less likely as not to be the cause of the hypertension. The examination report, however, did not address the issue of whether the Veteran's service- connected diabetes mellitus aggravated the hypertension beyond the natural progress of the disease. As the issue of aggravation was not addressed, the October 2007 examination is insufficient and another examination should be provided before this claim can be decided. Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine whether it is at least as likely as not (i.e., 50 percent chance or greater) that the Veteran's service connected diabetes mellitus type II aggravated the Veteran's hypertension. In determining whether or not there was aggravation, the relevant matter to discuss is whether there was any increase in severity of hypertension that is proximately due to or the result of the diabetes mellitus type II, and not due to the natural progress of the hypertension. The examiner should look at the baseline level of severity of the hypertension established by medical evidence created before the onset of aggravation, or the earliest medical evidence created at any time between the onset of aggravation and the medical evidence establishing the current level of severity of the hypertension. The examiner should review the October 2007 VA examination report and the rest of the claims file in conjunction with the examination. A rationale for all opinions must be provided. 2. Thereafter, any additional development deemed necessary should be accomplished. If the benefit sought on appeal remains denied, issue the Veteran and his representative a supplemental statement of the case and allow for a reasonable period to respond. 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). _________________________________________________ RONALD W. SCHOLZ 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).