Citation Nr: 1018348 Decision Date: 05/18/10 Archive Date: 06/04/10 DOCKET NO. 08-13 450 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder variously claimed as a bipolar disorder. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for coronary artery disease. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and his father ATTORNEY FOR THE BOARD D. J. Drucker, Counsel INTRODUCTION Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). The Veteran had active military service from June 30 to December 18, 1978. This matter comes to the Board of Veterans' Appeals (Board) on appeal from November 2005 and April 2006 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In January 2008, the Veteran testified during a personal hearing at the RO. A transcript of the hearing is of record. The Veteran was scheduled to testify at a hearing at the RO before Veterans Law Judge in March 2009, but cancelled the hearing and did not request that it be rescheduled. As such, the Board is of the opinion that all due process requirements were met regarding the Veteran's hearing request. 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 a psychiatric disorder, variously claimed as bipolar disorder, and for hypertension and coronary artery disease. In written statements and during his 2008 personal hearing at the RO, the Veteran indicated that, prior to entering active service, while a teenager, he was hospitalized for a psychiatric disorder and subsequently took prescribed medication for that and for hypertension (see hearing transcript at page 8). He indicated that a recruiter advised that he not discuss his prior medical history when examined for enlistment. The Veteran's father testified that he tried to discourage his son's entry into service because of his physical condition but the recruiter said there was no problem (Id. at 5). The Veteran said he was depressed in service and cried (Id. at 14). He said he took medication for hypertension when he enlisted and had nosebleeds in service (Id. at 8 and 14). The Veteran further stated that shortly after discharge he saw a counselor and, in 1979, sought psychiatric treatment (Id. at 9). He said he was diagnosed with a bipolar disorder in 1996 (Id. at 12). Private medical records indicate that the Veteran was hospitalized from January to March 1975, when he was approximately 15 years old, for a disorder diagnosed as nonpsychotic organic brain syndrome, other, and a behavioral disorder of adolescence. His blood pressure reading at that time was 102/80. On a report of medical history completed on June 12, 1978, when he was examined for enlistment, the Veteran reported his pre-service psychiatric hospitalization. When examined that day, his blood pressure reading was 140/80. According to a June 14, 1978 neuropsychiatric consultation report, the Veteran described hospitalization for a typical adolescent adjustment reaction. The examiner found the Veteran qualified for active service. The service examination report includes a note dated June 14, 1978 to the effect that the Veteran had mild hypothyroidism. The Veteran was evidently found qualified for active service. Service treatment records show that on July 7, 1978, the Veteran's blood pressure was 170/120 and a questionable history of heart trouble that existed prior to service was noted. An electrocardiogram (EKG) was recommended. Another record indicates that he was seen in the clinic for complaints of breathing problems and chest pain on the left side. He reported having the problem for several weeks and being treated for it with no relief. His blood pressure reading at that time was 134/102. The assessment was obesity, high blood pressure and poor conditioning. On July 21, 1978, results of the EKG were noted as within normal limits. When subsequently seen in the clinic, the Veteran reported having a high blood pressure reading prior to service; it was currently 120/74. He also complained of left chest pains with exercise or strenuous activity. He denied a history of heart murmur or congenital defect and was advised to lose weight. Post service, private medical records, starting in 1983, reflect the Veteran's in and outpatient medical treatment for psychiatric disorders, variously diagnosed as major depression and, more recently, as a bipolar disorder. Federal prison medical records, dated in June 1994, indicate that the Veteran was treated for depression at age 13 with two prior suicide attempts including one in 1983. An adjustment disorder with depression was diagnosed. In August 1994, these records indicate that the Veteran had a life long history of bipolar disorder. The Veteran was privately hospitalized for treatment of major depression in October 1994 and hospitalized by VA for treatment of a bipolar disorder in May 2005. Private hospital records dated in 1984 indicate that the Veteran had hypertension Coronary artery disease was noted in approximately 1997 and bypass surgery was performed in 2000. A veteran is presumed to be in sound condition when examined and accepted into service except for defects or disorders noted at that time. 38 U.S.C.A. § 1111 (West 2002). A pre- existing injury or disease is considered to have been aggravated by active service if there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C.A. § 1153 (West 2002); 38 C.F.R. § 3.306(a) (2009). Here, a medical opinion is required as to whether the Veteran's psychiatric disorder and hypertension were aggravated by service. Any additional VA and non-VA medical records should also be obtained, dated after October 2006. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited handling is requested.) 1. Obtain all medical records regarding the Veteran's treatment at the Mountain Home VA medical center, and any private medical records identified by him, for the period from October 2006 to the present. 2. Schedule the Veteran for a VA psychiatric examination to determine the etiology of any psychiatric disorder including bipolar disorder found to be present. The claims folders, to include a copy of this Remand, must be made available to and reviewed by the examiner in conjunction with the examination report. Any indicated studies should be performed. The examiner should identify all psychiatric disorders found to be present. Taking into consideration the evidence incorporated in the January to March 1975 private medical records and service medical records (including the June 12, 1978 entrance examination report and June 14, 1978 neuropsychiatric consultation report) when was the onset of the psychiatric disability (or disabilities)? If any disability was incurred before June 30, 1978, was there a permanent increase in disability, beyond the natural progress of the disorder, during the Veteran's period of military duty, namely from June 30 to December 18, 1978? If any diagnosed disability was incurred after June 30, 1978, the examiner is requested to provide an opinion concerning the etiology of any chronic psychiatric found to be present, to include whether it is at least as likely as not (i.e., to at least a 50-50 degree of probability) that any currently diagnosed chronic psychiatric disorder was incurred in or otherwise caused by military service. A rationale should be provided for all opinions rendered 4. Schedule the Veteran for a VA cardiovascular examination to determine the etiology of any hypertension and coronary artery disease found to be present. The claims folders, to include a copy of this Remand, must be made available to and reviewed by the examiner in conjunction with the examination report. Any indicated studies should be performed. The examiner should identify all cardiovascular disorders found to be present, including any hypertension, coronary artery disease, or another disorder. Taking into consideration the evidence incorporated in the service medical records (including the June 12, 1978 entrance examination report) when was the onset of any cardiovascular disability (or disabilities)? If any disability was incurred before June 30, 1978, was there a permanent increase in disability, beyond the natural progress of the disorder, during the Veteran's period of military duty, namely from June 30 to December 18, 1978? If any diagnosed disability was incurred after June 30, 1978, the examiner is requested to provide an opinion concerning the etiology of any chronic hypertension found to be present, to include whether it is at least as likely as not (i.e., to at least a 50-50 degree of probability) that any currently diagnosed chronic hypertension was incurred in or aggravated by military service. The examiner is asked to provide an opinion as to whether it is at least as likely as not (i.e., probability of 50 percent or greater) that any currently diagnosed coronary artery disease was either (a) caused by or (b) aggravated by the Veteran's hypertension. A rationale should be provided for all opinions rendered. 5. The AMC should review the medical opinions obtained to ensure that the Board's remand directives were accomplished. Return the case to the examiner if all questions posed were not answered. 6. Finally, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and his representative should be provided 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 or matters that 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). _________________________________________________ MICHAEL MARTIN 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).