Citation Nr: 1016095 Decision Date: 04/30/10 Archive Date: 05/06/10 DOCKET NO. 06-21 998 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE 1. Entitlement to service connection for residuals of a myocardial infarction. 2. Entitlement to service connection for hypertension. WITNESSES AT HEARING ON APPEAL Appellant and Craig N. Bash, M.D. ATTORNEY FOR THE BOARD Brian J. Milmoe, Counsel INTRODUCTION The Veteran served on active duty from March 1984 to March 1986, with additional service in the Texas Army National Guard from July 2002 to July 2004. This matter was most recently before the Board of Veterans' Appeals (BVA or Board) in September 2009, when it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, through the VA's Appeals Management Center (AMC) in Washington, DC. The purpose of such remand was to permit the AMC to develop and adjudicate initially a claim for service connection for hypertension that was reasonably raised by the record and that was inextricably intertwined with the issue of the Veteran's entitlement to service connection for residuals of a myocardial infarction. On remand, a portion of the AMC's responsibilities were delegated to the Remand and Rating Development Team (RRDT) located within the RO in Huntington, West Virginia. Following attempts to complete the requested actions, the case has since been returned to the Board for further review. REMAND A preliminary review of the record upon return to the Board discloses a need for further development. In this regard, the originally certified issue on appeal before the Board was that of the Veteran's entitlement to service connection for residuals of a myocardial infarction, and during the course of the appeal relating to that matter, testimony and documentary evidence was received by VA from a private physician reasonably raising a claim for service connection for hypertension. Essentially, the thrust of that claim was that the Veteran's hypertension had its onset in service and subsequently led to his myocardial infarction. Remand was then initiated by the Board to permit the AMC to develop and adjudicate this inextricably intertwined claim of service connection for hypertension. On remand, the RRDT wrote to the Veteran in November 2009 and advised him, in part, that it needed evidence that his hypertension had existed from military service to the present time. The Veteran by return mail furnished no additional evidence, noting that he had no other information or evidence to submit. Then, the AMC by way of a Supplemental Statement of the Case of January 2010 adjudicated the inextricably intertwined claim of service connection for hypertension and readjudicate the certified issue of service connection for residuals of a myocardial infarction. In doing so the Supplemental Statement of the Case stated in the Reasons and Bases that: The evidence from Dr. Bash stated that your blood pressure was normal when you entered the National Guard and was found to be elevated to 142/98 in 2002, after you entered reserve service. He stated that your hypertension, which may have lead [sic] to the MI, occurred during service and should be service connected. However, your National Guard service included both active duty and non-active duty periods. In order to service connect hypertension due to your National Guard service, the date hypertension was first discovered must be while you were on a period of ACDUTRA [Active Duty for Training]. Since the evidence does not show that hypertension was first found while on active duty, service connection cannot be granted. (Emphasis added.). The Board notes that the terms "active duty" and "active duty for training" have specific definitions that describe distinct period of service. In this case, the Veteran had a period of active duty from March 1984 to March 1986, with additional service in the Texas Army National Guard from July 2002 to July 2004, which would typically have included periods of both active duty for training and inactive duty training. While the Supplemental Statement of the Case was correct in indicating that "[i]n order to service connect hypertension due to your National Guard service, the date hypertension was first discovered must be while you were on a period of ACDUTRA[,]" it then concluded that "[s]ince the evidence does not show that hypertension was first found while on active duty, service connection cannot be granted." Consequently, the adjudication of the Veteran's claim for service connection for hypertension is incomplete in that it has not considered whether the Veteran's hypertension was manifested during a period of active duty for training, as opposed to active duty, as contended by the Veteran. As such, further adjudication of the Veteran's inextricably intertwined claim of service connection for hypertension is necessary. Therefore, in order to give the Veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is necessary. This case is being returned to the RO via the Appeals Management Center (AMC) in Washington, D.C., and the Veteran will be notified when further action on his part is required. Accordingly, this case is REMANDED for the following action: The RO/AMC should readjudicate the Veteran's claim for service connection for hypertension to include addressing the question of whether hypertension was first manifested during a period of active duty for training with the Texas Army National Guard from July 2002 to July 2004, as contended by the Veteran. If necessary, the RO/AMC should verify all period of active duty training performed by the Veteran with the Texas Army National Guard from July 2002 to July 2004. The RO/AMC should also review the medical evidence of record and determine whether there is sufficient medical evidence to decide the claim regarding the question the date of onset of the Veteran's hypertension, and if there is not sufficient medical evidence to address that question, the RO/AMC should afford the Veteran an examination or obtain a medical opinion to determine the date of onset of the Veteran's hypertension. When the development requested has been completed, the case should again be reviewed by the RO on the basis of the additional evidence. If the benefit sought is not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case, and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. The purpose of this REMAND is to obtain additional development, and the Board does not intimate any opinion as to the merits of the case, either favorable or unfavorable, at this time. The Veteran is free to submit any additional evidence and/or argument he desires to have considered in connection with his current appeal. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the Veteran until he is notified. _________________________________________________ RAYMOND F. FERNER Acting 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).