Citation Nr: 1237861 Decision Date: 11/05/12 Archive Date: 11/09/12 DOCKET NO. 10-02 122 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for hypertension, to include as secondary to a service-connected disability. REPRESENTATION Appellant represented by: Non Commissioned Officers Association WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD M. McPhaull, Counsel INTRODUCTION The Veteran served on active duty from October 1965 to March 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2008 rating decision issued by the Detroit, Michigan Department of Veterans Affairs (VA), which in pertinent part, declined to reopen the Veteran's claim of entitlement to service connection for hypertension. Jurisdiction of the claims file was subsequently transferred to the Pittsburgh, Pennsylvania RO. In March 2010, a Travel Board hearing was held before a Veterans Law Judge who is no longer affiliated with the Board. A transcript of that hearing is associated with the claims file. In August 2010, the Board reopened the claim and remanded the issue for additional development. As noted, the Veterans Law Judge who held the March 2010 hearing is no longer affiliated with the Board. The Veteran was informed of such, and in April 2012 he requested another Board hearing. See38 C.F.R. § 20.717 (2012). In September 2012, a videoconference hearing was held before the undersigned. A transcript of that hearing has also been associated with the claims file. In addition to the paper claims file, there is a Virtual VA paperless claims file associated with the Veteran's claim. A review of the documents in such file reveals that they are either duplicative of the evidence in the paper claims file or are irrelevant to the issue on appeal. The appeal is once again REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND In the August 2010 remand, the Board directed, in part, that the Veteran be afforded an examination to determine whether his current hypertension was caused or aggravated by the service connected diabetes. Indeed, after a review of the claims file, and an examination of the Veteran, the examiner was to opine whether it was at least as likely as not that the Veteran incurred hypertension as a result of active service or whether or not the service-connected diabetes mellitus caused or aggravated his hypertension. In December 2010, a VA examiner opined that the hypertension was not caused by diabetes, but did not provide an explicit opinion as to whether it was aggravated by diabetes. Cf. Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board is required to insure that its remand directives are complied with. Stegall v. West, 11 Vet. App. 268 (1998). Inasmuch as the RO has now granted service connection for coronary artery disease, a question arises as to whether hypertension is related to that disease. A medical opinion is needed in this regard. See Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000) (Upon the filing of a claim for benefits, VA generally must investigate the reasonably apparent and potential causes of the Veteran's condition and theories of service connection that are reasonably raised by the record or raised by a sympathetic reading of the claimant's filing, including those unknown to the Veteran). Finally, as this matter is being remanded for the reasons set forth above, any additional VA treatment records of the Veteran for his hypertension should also be obtained. See 38 U.S.C.A. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, the case is REMANDED for the following: 1. Forward the claims file and any relevant records in Virtual VA to the physician (if available) who conducted the December 2010 VA hypertension examination, to provide an opinion as to whether the service-connected diabetes mellitus, or coronary artery disease, either individually or in the aggregate, (a) caused or (b) aggravates (permanently worsened) any identifiable hypertension. As noted, the diabetes mellitus issue should only address aggravation. If further examination is deemed necessary, or if the December 2010 examiner is unavailable; the Veteran should be scheduled for a new examination to obtain the needed opinions. The entire claims file, to include a complete copy of this Remand, must be made available to the physician designated to examine the Veteran, and the examination report shall include discussion of the Veteran's documented medical history and assertions. All indicated tests and studies should be accomplished. 2. Review the Veteran's claims file and ensure that the foregoing development actions have been completed in full, and that no other notification or development action, in addition to those directed above, is required. 3. If the benefit sought on appeal remains denied, issue a supplemental statement of the case. Then return the case to the Board, if otherwise in order. The Veteran need take no action until he is so informed. He 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 for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2011). _________________________________________________ Mark D. Hindin 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) (2012).