Citation Nr: 1321667 Decision Date: 07/08/13 Archive Date: 07/18/13 DOCKET NO. 09-44 403 ) DATE ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for hypertension, claimed as secondary to service-connected posttraumatic stress disorder (PTSD). 2. Entitlement to a rating in excess of 30 percent for PTSD. REPRESENTATION Veteran represented by: Illinois Department of Veterans Affairs WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Megan C. Kral, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from September 1977 to September 1980. This matter is before the Board of Veterans' Appeals (Board) on appeal from rating decisions of the Chicago, Illinois Department of Veterans Affairs (VA) Regional Office (RO). In March 2013, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. The appeal is being REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action on his part is required. REMAND The Veteran alleges that symptoms of his PTSD continue to worsen, and include suicidal thoughts, hallucinations, and violent outbursts. He alleges that his PTSD has an adverse effect on his cardiovascular system. The record includes an April 2009 opinion by Dr. Duetsch, a VA psychiatrist, to that effect (but without adequate explanation of rationale). The record shows the Veteran began receiving treatment at the Westside Chicago VA medical center (VAMC) in 2004. At the March 2013 hearing, the Veteran testified that he continues to be seen at the [now] Jesse Brown VAMC at least twice a week. There are only scattered VA treatment records associated with the claims file (or in Virtual VA), and the most recent VA treatment record is from November 2006. VA treatment records for the disabilities at issue are likely to contain pertinent information, are constructively of record, and must be secured. Regarding the Veteran's claim for an increased rating for PTSD, he was last afforded a VA examination in October 2009. At the March 2013 hearing he testified that his symptoms were worse and included suicidal thoughts, violent hallucinations, and violent outbursts. Such symptoms were not noted on October 2009 examination. In light of the length of the intervening period since the October 2009 examination and the allegation of worsening, a contemporaneous examination is necessary. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Finally, after the record is complete, a VA examination to determine the etiology of the Veteran's hypertension (to specifically include whether it was caused or aggravated by the service-connected PTSD will be necessary). Accordingly, the case is REMANDED for the following: 1. The RO should ask the Veteran to identify the providers of all evaluations and/or treatment he has received for his PTSD and hypertension, and to provide the authorizations necessary for VA to obtain all outstanding records of any such private evaluations or treatment he has received. The RO should secure for the record copies of the complete clinical records of all evaluations and treatment from the sources identified. The RO must specifically obtain for the record complete copies of all pertinent VA treatment records that are now outstanding. If any records sought are unavailable, the reason for their unavailability must be noted in the record. If a private provider does not respond to a VA request for identified records sought, the Veteran must be so notified, and reminded that ultimately it is his responsibility to ensure that private treatment records are received. 2. The RO should then arrange for a psychiatric evaluation of the Veteran to determine the current severity of his PTSD. The entire record must be reviewed by the examiner in conjunction with the examination. The examiner should describe the nature, frequency and severity of the psychiatric symptoms found. In that regard, the examiner should have available for review a copy of the criteria for rating psychiatric disabilities, and should comment regarding the presence or absence of each listed symptom in the criteria for ratings above 30 percent (and if a symptom is noted present, its severity and frequency); the examiner should also note any symptoms found that are not listed in the rating criteria, and the related impairment.. The examiner should specifically comment on the impact of the Veteran's psychiatric symptoms on his occupational and social functioning. 3. The RO should then arrange for the Veteran to be examined by an internist to determine the etiology of his hypertension. The Veteran's claims file must be reviewed by the examiner in conjunction with the examination. Any tests of studies indicated must be completed. Based on review of the record and examination of the Veteran, the examiner should provide an opinion that responds to the following: What is the most likely etiology for the Veteran's hypertension? Specifically, is it at least as likely as not (a 50 percent or better probability) that such disease was either caused or aggravated by the Veteran's service connected PTSD? The examiner must explain the rationale for all opinions, with citation to supporting factual data and/or medical literature as deemed appropriate. The explanation should include comment on the July 18, 2007 and April 13, 2009 dated opinions by Dr. Deutsch (a VA psychiatrist) (i.e., the examiner should express agreement or disagreement, and explain the reasoning for such). 4. The RO should then review the record and readjudicate the claims. If either remains denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran and his representative the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The Veteran has the right to submit additional evidence and argument on the 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 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). _________________________________________________ GEORGE R. SENYK 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).