Citation Nr: 1304633 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 10-27 940 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE Entitlement to service connection for hypertension, to include as secondary to diabetes mellitus and posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD C. R. dela Rosa, Associate Counsel INTRODUCTION The Veteran had active service from March 1968 to March 1970, including combat service in the Republic of Vietnam and his decorations include the Combat Infantryman Badge. This matter came before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision by the Regional Office (RO) in Montgomery, Alabama. In November 2012, a videoconference hearing was held before the undersigned Veterans Law Judge. The transcript of that hearing is of record. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). 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 entitlement to service connection for hypertension, which he avers is a result of his service-connected diabetes mellitus. During the November 2012 Board hearing, the Veteran's representative further indicated that his hypertension may also be a result of his service-connected posttraumatic stress disorder (PTSD). Private medical records include an August 2003 diagnosis of hypertension. A September 2003 consultation note that shows that the Veteran had a past medical history of hypertension. His first diagnosis of diabetes mellitus was shown in October 2003. A May 2004 note shows that the Veteran was a new diabetic. In January 2009, the Veteran was accorded a compensation and pension (C&P) diabetes mellitus examination. During the examination, the Veteran reported that his diabetes mellitus onset was in 2004. The examiner diagnosed the Veteran with hypertension but opined that it was not a complication of the diabetes mellitus as it was diagnosed at the same time the diabetes mellitus was diagnosed. Further, the examiner opined that there was no renal disease that would have caused the hypertension. Since that time, service connection has been established for PTSD, and In addition, in June 2012, the Veteran's representative asserted entitlement to presumptive service connection for heart disease in light of the Veteran's Vietnam service. Although generally the Board would refer this issue to the RO, here the adjudication of that claim may directly impact the Board's consideration of his perfected hypertension appeal. As such, the Board finds that the RO should adjudicate this claim on remand. Thereafter, the Board finds that an opinion as to the relationship between each of these disabilities, to include the aggregate impact of the conditions, is necessary to adjudicate the Veteran's appeal. The Board also observes that the Veteran receives ongoing VA treatment. However, the most recent VA treatment records are current only as of January 2010. A review of the Veteran's Virtual VA eFolder revealed no recent VA treatment records have been associated with the Veteran's file. As there potentially are outstanding VA medical records relevant to the appeal, there is a duty to obtain such records. See 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992). 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) (2012). Expedited handling is requested.) 1. Associate, with the claims folder, physically or electronically, VA medical records pertaining to the Veteran that are dated since January 2010. Any additional records identified by the Veteran should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. Notify the Veteran that he may submit additional lay and medical statements regarding the onset of his hypertension and the relationship, if any, between his hypertension and his diabetes mellitus, PTSD and/or heart disease. He should be provided an appropriate amount of time to submit this evidence. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and likely etiology of his claimed hypertension and heart disease. The claims folder should be made available and reviewed by the examiner and all necessary tests should be conducted. As to his hypertension, the examiner must opine as to whether it is at least as likely as not had its onset in service, to include his combat service in Vietnam, or within one year of his discharge. The examiner must also opine as to whether it is at least as likely as not that the Veteran's hypertension was caused by his diabetes mellitus, PTSD and/or heart disease, to include the cumulative impact of the three conditions. The examiner must also opine as to whether it is at least as likely as not that the Veteran's hypertension was aggravated by his diabetes mellitus, PTSD and/or heart disease, to include the cumulative impact of the three conditions. All findings and conclusions, accompanied by a rationale, must be set forth in a legible report. 4. Then adjudicate the Veteran's claim of service connection for heart disease, to include on a presumptive basis. Thereafter, readjudicate the appeal. If the benefit sought on appeal is not granted in full, issue the Veteran and his representative a supplemental statement of the case and provide the Veteran an opportunity to respond. The Veteran 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. 2012). _________________________________________________ STEVEN D. REISS 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).