Citation Nr: 1323084 Decision Date: 07/19/13 Archive Date: 07/24/13 DOCKET NO. 09-46 962 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to an initial compensable rating for the service-connected rectal fissure, status post (s/p) fissurectomy. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. Turner, Counsel INTRODUCTION The Veteran served on active duty from May 1980 to February 2007. This matter comes before the Board of Veterans' Appeals (Board) on an appeal from a May 2008 rating decision issued by the RO. 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 is required on his part. REMAND A care review of the claims file shows that additional development is needed prior to further appellate review. The Veteran's service treatment records show persistently increased blood pressure readings during the later years of his service; however, his diastolic rarely reached 90 or greater, and systolic blood pressure did not reach 160 or greater at any time. Thus, the Veteran did not have hypertension as that term is defined by VA while he was in the service. 38 C.F.R. § 4.104, diagnostic code 7101, note 1. However, on a Report of Medical History dated in October 2006, shortly before separation, the Veteran reported that he had a history of high or low blood pressure. The "explanation" part of the report indicated that the Veteran had high blood pressure and gave the dates of various blood pressure readings. On the actual separation examination, which is undated, there is a diagnosis of "pre-hypertension." In his Notice of Disagreement dated in October 2008 and on his VA Form 9 dated in November 2009 the Veteran reported that, within a year of his retirement from the service, he was diagnosed with hypertension and prescribed a medication, terazosin, by a VA doctor. He indicated that he was still taking this medication to treat his hypertension and believed that he would have to take this medication for life. The claims file contains records of only approximately six visits to a VA Medical Center, and none of those visits records a diagnosis of hypertension. However, on two of those visits, in December 2007 and April 2008, the Veteran's diastolic blood pressure was 90 or greater. The April 2008 treatment record noted elevated blood pressure as a problem and recorded that the Veteran was advised of normal blood pressure levels. He reported having elevated blood pressure due to recent stress related to preparing to go overseas to work as a government contractor. A December 2008 treatment record reflected normal blood pressure. The treatment show that, in 2007, the Veteran was prescribed terazosin, a drug that can be used for the treatment of hypertension. However, the medical records noted that he was prescribed this medication to treat a prostate condition. In his Notice of Disagreement and on his VA Form 9 the Veteran wrote that his VA doctor would confirm the diagnosis of hypertension and the need to take medication to treat this condition. However, he did not submit an opinion from his doctor. The Veteran is competent to report that his doctor told him that he had hypertension shortly after service and prescribed medication for hypertension. It also appears there may be additional treatment records, either VA or private, which could confirm a diagnosis of hypertension. The Veteran should be given an opportunity to identify these records so that they can be obtained by VA. The Veteran was examined by VA in April 2008 when the examiner did not indicate whether the Veteran had hypertension or provide an opinion concerning whether the elevated blood pressures in service were related to a current diagnosis of hypertension. The recorded blood pressure readings were normal at the time of the examination; however, the Veteran asserts that this was because his hypertension was well controlled on medication at that time. Therefore, the Veteran should be afforded a VA examination that fully addresses the nature and likely etiology of the claim hypertension. The Veteran was also examined in April 2008 concerning his rectal fissure. On his VA Form 9 dated in November 2009, the Veteran claimed that his symptoms had gotten worse and requested reexamination. The Board notes that the examination of the Veteran is more than five years old. Under these circumstances, the Veteran should be granted another examination. See VAOGCPREC 11-95 (where a claimant asserts to the Board that there has been a further increase in the severity of his disability subsequent to the RO decision, the duty to assist may require that the Board remand the issue for additional evidentiary development, including a new examination). Accordingly, the case is REMANDED for the following action: 1. The RO should take appropriate steps to contact the Veteran and request that he identify all health care providers who have treated him for hypertension or rectal fissure since service. All identified records should be obtained. If the Veteran provides appropriate releases and the records still cannot be obtained, the claims file should document the attempts that were made to obtain the records. The Veteran should also be notified of VA's inability to obtain the records. The Veteran should also be notified that he may submit the records himself. 2. Then, the RO should have the Veteran scheduled for a VA examination in order to ascertain the nature and likely etiology of the claimed high blood pressure. After reviewing the entire record and examining the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (at least 50 percent likely) that any disability manifested by hypertension had its clinical onset during service. The examiner should provide a complete rationale for his or her opinion. If the examiner is unable to provide the requested opinion without resort to undue speculation, he or she should explain why this is the case. 3. The RO should also have the Veteran scheduled for another VA examination to determine the current extent of the service-connected rectal fissure or any residuals. All symptoms and functional effects of the rectal fissure should be identified. The examiner should specifically report whether the Veteran has extensive, moderate, or slight leakage and whether he has involuntary bowel movements. 4. After completing all indicated development, the RO should readjudicate the claims remaining on appeal in light of all the evidence of record. If benefit sought on appeal remains denied, the Veteran should be furnished a fully responsive Supplemental Statement of the Case (SSOC) and afforded a reasonable opportunity for response. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. The Veteran 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). _________________________________________________ STEPHEN L.WILKINS 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).