Citation Nr: 1306684 Decision Date: 02/27/13 Archive Date: 03/01/13 DOCKET NO. 10-18 461A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES Entitlement to service connection for hypertension, to include as secondary to service-connected diabetes mellitus. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD F. Yankey, Counsel INTRODUCTION The Veteran served on active duty from March 1966 to March 1968. This case comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In an April 2010 rating decision, the RO granted service connection and a 30 percent evaluation for coronary artery disease. In September 2010, the Veteran filed a claim for entitlement to a total disability rating, based on unemployability, due to service-connected disability, and indicated that he was unemployable, in part, due to his service-connected coronary artery disease. In a March 2012 rating decision, the RO granted service connection for PTSD, with a 30 percent evaluation. In the same rating decision, the RO also continued the 30 percent disability rating for the Veteran's service-connected coronary artery disease. A timely notice of disagreement with the March 2011 rating decision was received in May 2011, and a statement of the case was issued in March 2012. The Veteran did not file a timely substantive appeal with regard to these issues. Accordingly, the Board does not have jurisdiction over the claims at this time. The Veteran testified before the undersigned at an October 2012 Video Conference hearing. The hearing transcript is of record. During his hearing, the Veteran testified that his service-connected coronary artery disease and PTSD had increased in severity since his last VA examinations in March 2010 and September 2010. See also September 2011 and January 2012 statements from the Veteran. The Veteran's statements during the October 2012 hearing are construed as new claims for increased ratings for his service-connected coronary artery disease, and his service-connected PTSD, and 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 Under the VCAA, VA is obliged to provide an examination in a claim for service connection when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The types of evidence that 'indicate' that a current disability 'may be associated' with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon v. Nicholson, at 83. The Veteran does not contend, and the evidence of record does not show, that his currently diagnosed hypertension is related to his active military service. Rather, he contends that his hypertension is related to his service-connected DM, type II. Service treatment records are negative for any evidence of a treatment or a diagnosis of hypertension, and blood pressure readings were within normal limits. November 2002 private treatment records from SMRC Healthcare Group show blood pressure readings of 140/80 in the left arm and 130/80 in the right arm. Further records show normal blood pressure readings. The records do not show a diagnosis of hypertension. January 2008 treatment records from the Sanger Clinic show blood pressure readings of 140/90 supine and 130/84 standing. No diagnosis of hypertension was noted. A discharge summary dated April 2008 noted a history of hypertension and medication treatment. Additional records show that the Veteran was managing his hypertension with medication. Treatment records from Fairfield Medical Associates dated in January 2008 show a blood pressure reading of 130/60,. A history of hypertension was noted and medication was prescribed. Private treatment records from Columbia Cardiology show a diagnosis and treatment for hypertension since August 2006, and treatment records from the Washington Hospital show a diagnosis and treatment for hypertension since December 2004. Outpatient treatment records from the VA Medical Center in Columbia, South Carolina (Columbia VA) show that during treatment in July 2009, the Veteran reported a history of hypertension since the mid 1990s. His blood pressure at that time was 120/80. He was diagnosed with hypertension, controlled with treatment. In a September 2009 statement, the Veteran's private family physician, R.G., M.D. opined that the Veteran's hypertension and related heart disease is at least as likely as not secondary to his diabetes. However, he failed to provide a rationale for his opinion. Furthermore, he failed to indicate that he had reviewed the medical evidence of record, including the Veteran's entire claims file, prior to rendering his opinion. Therefore, his opinion lacks probative value, and is inadequate for rating purposes. The Court has held that instead of relying on a VA examiner's conclusory statements, the Board must return the opinion as inadequate because it fails to provide any analytical support for its conclusion. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that "once the Secretary undertakes the effort to provide an examination when developing a service-connection claim, ... he must provide an adequate one"). The Veteran was afforded a VA diabetes mellitus examination in September 2010. The examiner noted that the Veteran had hypertension, which he reported was asymptomatic. He diagnosed diabetes mellitus, type 2, but he did not did not render any opinion on the etiology of the Veteran's hypertension. More specifically, the examiner did not discuss whether the Veteran's hypertension was related to his diagnosed diabetes. The evidence of record also shows that the Veteran was diagnosed with borderline diabetes mellitus in 2002 and a definitive diagnosis of diabetes mellitus, type II was made in January 2005. In a January 2010 rating decision, the RO granted service connection for diabetes mellitus, type II, associated with herbicide exposure. In light of the Veteran's contentions and the evidence of record, including the fact that he has a current diagnosis of hypertension, and the fact that he is currently service-connected for his diabetes mellitus, the Board has determined that he should be afforded a VA examination to determine the etiology of his currently diagnosed hypertension. 38 U.S.C.A. § 5103A(d) (West 2002). The Veteran is hereby notified that it is his responsibility to report for the examination and to cooperate in the development of the case and that the consequences of failure to report for a VA examination without good cause may include denial of the claim. See 38 C.F.R. §§ 3.158 and 3.655 (2012). The Board also notes that during his October 2012 hearing, the Veteran reported that he received treatment for his coronary artery disease by his family doctor, R.G., M.D. in Princeboro, South Carolina and at the Sanger Clinic in Charlotte, North Carolina. He indicated that he visited Dr. R.G. once a month, and that he had an appointment at the Sanger Clinic the following month, in November 2012. The claims folder does not contain records of treatment from Dr. R.G. since September 2009, or records of treatment from the Sanger Clinic since July 2009. The procurement of potentially pertinent medical records referenced by the Veteran is required. As it appears that there may be available medical records that are not associated with the claims folder, a remand is required. See 38 C.F.R. § 3.159(c)(2). Accordingly, the case is REMANDED for the following action: 1. Take the necessary steps to obtain any clinical records of treatment by Dr. Roger Gaddy, and records of treatment from the Sanger Clinic, reported by the Veteran during his August 2011 hearing, including any records of an appointment in November 2012 at the Sanger Clinic, in accordance with 38 C.F.R. § 3.159(e)(2). The Veteran is advised that for VA to obtain these records, it may be necessary for him complete an authorization for their release and that he may submit these records himself. The RO should also obtain any outstanding VA medical records dated from December 2010 to the present. 2. Then, the Veteran should be afforded a VA examination by a physician with appropriate expertise to determine the etiology of his hypertension. The claims folder must be made available to and reviewed by the examiner. Any indicated studies should be performed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the current hypertension was caused by or chronically worsened by his service-connected diabetes mellitus. If not, he or she should indicate whether it is at least as likely as not that the disorder is otherwise causally or etiologically related to the Veteran's military service. The examiner should provide a rationale for all opinions and conclusions expressed. If an answer cannot be provided without resort to speculation, the examiner should provide a reason why this is so, and note whether there is any additional evidence that would permit an answer to be provided. The examiner is advised that the Veteran is competent to report symptoms and injuries, as well as diagnoses provided to him by physicians. If the Veteran's reported history is discounted, the examiner should provide a reason for doing so. 3. If any 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 appellant has the right to submit additional evidence and argument on the matter or matters 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). _________________________________________________ F. JUDGE FLOWERS 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).