Citation Nr: 1318852 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 06-28 933 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for hypertension, to include as due to service-connected posttraumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Hudson, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1963 to March 1987. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2004 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In July 2007, the Veteran withdrew his prior request for a hearing before the Board in writing; consequently, the request is deemed withdrawn and there are no outstanding requests of record. 38 C.F.R. § 20.704(e). A claim of entitlement to service connection for ischemic heart disease secondary to exposure to Agent Orange was raised by the record. This issue was previously referred in December 2012 but has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Thus, the Board does not have jurisdiction over this issue, and it is 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 While further delay is regrettable, the Board observes that further development is required prior to adjudicating the Veteran's claim of entitlement to service connection for hypertension, to include as secondary to the Veteran's service-connected PTSD. Pursuant to the Board's December 2012 remand, the Veteran was afforded a VA hypertension examination in January 2013. See 38 C.F.R. § 3.159(c)(4). The examiner found the Veteran was diagnosed with hypertension in 2001 and is currently on continuous medication for this condition. The examiner opined that the Veteran's hypertension was less likely than not incurred in or caused by the claimed in-service injury. The examiner found that although the Veteran had elevated readings of blood pressure during service, he did not meet the criteria for hypertension during service. The January 2013 VA hypertension examination was inadequate, as it failed to sufficiently address the question of secondary service connection. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). Specifically, the examination failed to address whether hypertension was proximately due to, the result of, or aggravated by the Veteran's previously service-connected PTSD. In this regard, service connection may be granted on a secondary basis for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2012); see Allen v. Brown, 8 Vet. App. 374 (1995). The Veteran must be afforded an examination which addresses this matter. Accordingly, the case is REMANDED for the following action: 1. Issue the Veteran a VCAA notice letter for the claim of hypertension secondary to service connected PTSD. 2. After completion of the above, return the claims folder to the physician who examined the Veteran in January 2013, if available, for an addendum medical opinion (if that examiner is unavailable, a medical professional with appropriate expertise). The examiner should provide an opinion as to whether it is at least as likely as not (a 50 % or higher degree of probability) that the Veteran's hypertension is proximately due to or the result of his service-connected PTSD, to include whether there is any secondary aggravation (permanent worsening beyond normal progression). The examiner should address whether any aggravation of hypertension is proximately due to or the result of the service-connected PTSD and not due to the natural progress of the disease. If the Veteran is found to have hypertension aggravated by PTSD, the examiner should quantify the approximate degree of aggravation. A complete and detailed rationale should be given for all opinions and conclusions expressed. Note: if the examiner concludes that there is insufficient information to provide an etiology opinion without resorting to mere speculation, the examiner should state whether the inability to provide a definitive opinion was due to a need for further information (please identify) or because the limits of medical knowledge had been exhausted regarding the etiology of the claimed conditions. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 3. Then, readjudicate the issue on appeal. If any benefit remains denied, the Veteran and his representative should be provided a supplemental statement of the case and given an appropriate opportunity to respond. The case should then be returned to the Board for further consideration, if otherwise in order. The appellant 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). _________________________________________________ MICHAEL MARTIN 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).